Cerebrovasculature & Stroke Flashcards by Hannah Garrett

What is a blockage of a blood vessel resulting in lack of blood flow to an area of the brain called?

Ischemic Stroke

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What is bleeding into the brain caused by a ruptured blood vessel called?

Hemorrhagic Stroke

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Which type of stroke occurs more often (80% of the time)?

Ischemic

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Stroke is ____ and occurs in _____

vascular/sudden/acute/focal; seconds to minutes

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Although the brain is only 2% of the body’s weight, it is responsible for 15% of ____, 20% of ____ and 25% of ____

Cardiac Output
Oxygen Consumption
Total Body Glucose Use

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The brain has a ___ energy reserve and relies on ___ metabolism to function normally

low; aerobic

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The brain requires a continuous supply of ___ and ___. If hypoperfusion (reduced blood flow) occurs, it will rapidly lead to ____ and even ____

oxygen and glucose

neuronal injury and death

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If soidum/potassium ATPase function decreases, intracellular potassium ____ and intracellular sodium ____, which leads to increased _____ and resulting cytotoxic edema (cell swelling)

decreases
increases
water

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Cytotoxic Edema can be visualized on what type of MRI sequences?

DWI/ADC

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Cytotoxic Edema can occur within minutes of what?

an ischemic stroke

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Vasogenic Edema develops after _____ and peaks after _____

a few hours; several days

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Increased permeability of capillary and endothelial cells leads to movement of water into the interstitial space. This is called what?

Vasogenic Edema

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Vasogenic Edema is visualized on what type of MRI sequences?

T2/FLAIR

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Vasogenic Edema appears hypodense on what imaging, therefore, should be ordered if it is suspected?

Head CT

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Cytotoxic Edema is NOT visible on what imaging?

Head CT

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What needs to be ruled out first when determining if a patient has had a stroke?

Intracranial Hemorrhage

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In a stroke code, what neuro-imaging study is most appropriate and helpful?

Head CT because it is quick and sensitive to acute blood

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Does a normal head CT rule out an ischemic stroke?

NO because cytotoxic edema is NOT visible on a CT and vasogenic edema takes a few hours to develop

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Acute stroke imaging shows a normal CT scan and FLAIR scan less than ____ hours from onset, but abnormal DWI/ADC/FLAIR ______ after

hours-days

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What is irreversibly damaged brain tissue called?

Infarct Core

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What is the salvageable brain tissue in stroke called?

Pneumbra

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What is the area of dead tissue resulting from failure of blood supply called?

Infarct

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What is inadequate blood supply called?

Ischemia

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Tissue viability is maintained by what?

Collateral circulation blood flow

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Brain tissue dies rapidly without ______ due to dependence on continuous supply of what 2 things?

blood perfusion; | oxygen and glucose

Pneumbra tissue at the _____ of an infarct dies more slowly due to blood supply from collateral circulation

periphery

Acute stroke interventions to remove _____ are most successful when performed as soon as possible

blood clots

Artery occlusion results in focal brain injury to the areas supplied by ____

that artery

What are the 3 main categories of ischemic stroke?

1. Large Vessel 2. Small Vessel 3. Cardioembolic

What are the 2 mechanisms of large vessel strokes?

1. Thromboembolic | 2. In situ thrombosis

What is the result of blood clots associated with artherosclerosis?

A large blood vessel stroke

What is a thromboembolic stroke?

traveling blood clot stroke

What is a in situ thromboembolic stroke?

blood clot that forms at its origin (stays put)

The ____ arteries join to form the basilar branches into the ____

vertebral; PCAs

The anterior circulation consists of ___, ____ and ___

ICAs, MCAs, ACAs

The posterior circulation consists of ___ arteries, ___ arteries and ____

Basilar, Vertebral, PCAs

___ branches into MCA and ACA

Internal carotids (ICAs)

The _____ artery connects the anterior and posterior circulation

PCOM - posterior communicating artery

ICA = ___ + ___

ACA + MCA

The lateral brain is supplied by the ____

MCA

The anterior brain is supplied by the ____

ACA

The posterior brain is supplied by the _____

PCA

The medial motor and sensory cortex is supplied by the ____

ACA

The primary visual cortex (occipital lobe) is supplied by the ____

PCA

The lateral portion of the primary motor and sensory cortices, language centers (left hemisphere) and spatial awareness (right hemisphere) are supplied by the ____

MCA

The ____ is the primary motor cortex and the ____ is the primary somatosensory cortex

precentral gyrus; postcentral gyrus

Cerebellar lesions cause deficits on the _____ side of the body

ipsilateral

Cortical signs of a large vessel stroke include aphasia (____ hemisphere) or neglect (____ hemisphere)

left; right

An anterior circulation stroke could affect which vessels?

MCA and ACA

MCA stroke causes _____ face/arm weakness or numbness and ____ if it includes the left hemisphere or ____ if it includes the right hemisphere

contralateral aphasia neglect

ACA stroke causes ____ leg weakness or numbness

contralateral

PCA stroke causes ____ visual field deficits

contralateral

A posterior circulation stroke could affect which vessels?

PCA, Basilar/Vertebral

Basilar/Vertebral strokes include ____ symptoms on the ipsilateral side such as ataxia (incoordination) or ____ symptoms such as cranial nerve deficits

cerebellar; brainstem

Broca's is to _____ as Wernicke's is to ___ | mneumonic

"broken speech"; "warpspeed speech"

Aphasia is a disorder of ____ whereas Dysarthria is disorder of ____

``` language (production/comprehension) speech articulation (muscle movements) ```

Where does aphasia often localize?

Left Hemisphere | Left = Language

Where does dysarthria often localize?

Relatively Nonspecific

Which subcortical structure contains corticospinal motor pathways?

Internal Capsule

Broca's area is ____ whereas Wernicke's area is ____

expressive; receptive

What is it called if a patient exhibits clinical symptoms of both brocas and wernickes aphasia?

Global Aphasia

A patient exhibits non-fluent speech, but is aware of their deficits and has intact comprehension. What is this type of aphasia?

Broca's aphasia

A patient exhibits fluent speech, but it is compared to "word salad" because of its paraphrasic errors and neologisms (new use of an old word). They have impaired comprehension and are unaware of their deficits (anosognosia). What type of aphasia do they have?

Wernicke's aphasia

Neglect is localized to which lobe and subsequently affects what side of the body?

Right parietal lobe (localization); contralateral (left) side is ignored

Impaired attention to and awareness of one side of space is called what? (hint: this is often related to doing the clock test)

Hemispatial Neglect

A patient exhibits right side weakness and numbness in their face and arm, and have aphasia. What type of stroke has occurred?

LEFT MCA stroke

A patient exhibits left side weakness and numbness in their face and arm, and have neglect. What type of stroke has occurred?

RIGHT MCA stroke

A patient exhibits weakness and numbness of the contralateral leg. What type of stroke has occurred?

ACA stroke

A patient exhibits contralateral visual field deficits. What type of stroke has occurred?

PCA stroke

A patient exhibits uncoordinated movements, dizziness, vertigo and other cerebellar/brainstem symptoms. What type of stroke has occurred?

Basilar/Vertebral

What is the strongest risk factor for a Lacunar stroke and why?

HTN because it wears and tears small delicate arteries

Small vessel stroke pathophysiology occurs when chronic ____ causes intrinsic changes to the small blood vessels, causing vessel wall ____ and lumen ____, which subsequently leads to _____

HTN thickening narrowing occlusion

Specific pathologic changes in small vessel stroke include what? (3)

1. Lipohyalinosis (vessel wall thickening and a resultant reduction in luminal diameter) 2. Arteriosclerosis (thickening and hardening of the walls of the arteries, occurring typically in old age) 3. Microatheroma (plaque)

What is Lipohyalinosis?

vessel wall thickening resulting in reduced lumen diameter

Vessel wall changes (weakening) can cause an artery rupture, which may lead to what type of stroke?

hemorrhagic stroke (focal)

T/F: Atherosclerosis of a large trunk vessel occluding the origin of a small vessel is quite common

false; LESS common

In small vessel anterior circulation, the MCA supplies what?

Lenticulostriate arteries

In small vessel posterior circulation, the PCA supplies what (perforating) arteries?

Thalamoperforators

In small vessel posterior circulation, the basilar arteries supply what (perforating) arteries?

Pontine Perforators

Cerebellar arteries in posterior circulation of small vessels include ___, ____ and ____

SCA, AICA, PICA

PICA is supplied by what artery in the posterior circulation?

vertebral

AICA and SCA are supplied by what artery in the posterior circulation?

basilar

The internal capsule and basal ganglia are supplied by what anterior circulation pathway?

MCA --> Lenticulostriate arteries --> int capsule and bg

The thalamus is supplied by what posterior circulation pathway?

PCA --> Thalamoperforators --> Thalamus

The pons is supplied by what posterior circulation pathway?

Basilar Artery --> Pontine Perforators --> Pons

The cerebellum and brainstem are supplied by what posterior circulation pathway?

Basilar/Vertebral --> SCA, AICA & PICA --> Cerebellum and Brainstem

Which type of stroke is more likely to cause motor/sensory deficits in more body parts?

small vessel strokes

Which type of stroke causes the entire contralateral hemibody to be affected?

small vessel strokes

Which type of stroke exhibits NO cortical signs?

small vessel strokes

In anterior circulation strokes (face/arm/leg weakness), fill in the blanks below: 1. Weakness distribution: - Face/Arm > Leg = ___ vessel - Just Leg = ___ vessel - Face/Arm/Leg ___ vessel or ____ (if this has occurred, proceed to #2 below to narrow down the vessel) 2. Cortical Signs? (aphasia or neglect?) - If yes = ___ - If no + ____

1. MCA; ACA; ICA (mca + aca) OR lenticulostriate | 2. yes = ICA; no = lenticulostriate

What is a major risk factor for large vessel stroke?

Atherosclerosis

What type of stroke occurs when an embolus (blood clot) travels from the heart to the brain, where is lodges in a blood vessel and causes a stroke? (Commonly a result of A-Fib)

Cardioembolic Stroke