Chapter 14: Cerebrovascular diseases Flashcards
1
Q
What is cerebrovascular disease and which 2 types are there?
A
- Cerebrovascular disease = a collection of symptoms caused by interruption of the blood supply, called cerebral stroke.
- There are two types:
1. Embolic infarction.
2. Intracerebral hemmorrhage.
2
Q
What is an intracerebral hemorrhagge?
A
- Intracerebral hemorrhage = brain hemorrhage resulting from a ruptured blood vessel.
3
Q
What is an infarction?
A
- Infarction = death of tissue due to lach of oxygen.
4
Q
What is an ischemia?
A
- Ischemia = abscence of blood flow, and doesn’t have to invovle tissue death.
5
Q
What are the symptoms of a stroke?
A
- Depending on the location of the stroke, specific functions are lost laterally in the limbs, which may include a loss of:
- Sensation,
- Strength,
- Coordination,
- And control.
- Asymmetric sagging of the mouth may also occur, causing speech difficulties.
- Patients with infarction usually remain conscious.
- Patients with cerebral hemorrhage often lose consciousness.
6
Q
How are the 2 types of strokes distinguished and diagnosed and treated?
A
- In the acute phase, the diagnosis of the stroke is made by a CT or a MRI and they can distinguish between an infarction or a hemorrhage.
- Patients are usually treated by a multidisciplinary team in a stroke unit.
7
Q
What is the epidemiology of strokes?
A
- Each year, around 17 million people suffer their 1st stroke, with infarctions having a higher incidence that hemorrhages.
- It’s estimated that the number will increase with 40% between 2005 and 2025, because the population gets older and age is a risk factor of strokes.
- Strokes are the second leading death of people above 60 years old, but this varies drastically between countries.
- Thanks to better care, the death rate is falling, which means more people are living with the aftermath of strokes.
8
Q
What are the causes of infarctions?
A
- Embolisms.
- Stenosis.
- Perfusion.
9
Q
What are embolisms and which 2 causes are there?
A
- Embolisms = a cause of infarction in which an artery in the brain is blocked because of blood clots, air bubbles or fat.
- There are 2 causes of embolisms:
1. Thrombi
2. Calcification fragments in the wall of the blood vessels.
9
Q
What are Thrombi?
A
- Thrombi = blood clots that form within blood vessels. They consists of coherent mass of platelets, fibrin, and other cellular components that may obstruct blood flow.
10
Q
What does calcification fragments in the wall of blood vessels mean?
A
- Calcification fragments in the wall of blood vessels = the accumulation of calcium within the walls of blood vessels.
- Over time, calcium deposits can accumulate and harden within the vessel walls, leading to the formation of calcification fragments.
- These fragments can contribute to the narrowing and stiffening of blood vessels, potentially impairing blood flow.
11
Q
What is stenosis and how is it caused?
A
- Stenosis = refers to the narrowing or constriction of a body passage or opening.
- In the context of blood vessels, stenosis occurs when there is a narrowing of the artery or vein, reducing the flow of blood through the vessel.
- This narrowing can be caused by various factors such as plaque buildup, inflammation, or abnormal tissue growth.
12
Q
What is perfusion?
A
- Perfusion = insufficient blood supply.
13
Q
Which arteries are affected in infarctions?
A
- The middle cerebral artery is affected in 80% of the cases.
- The posterior cerebral artery is affected in 5% to 10% of the cases.
- The anterior cerebral artery is affected 0.6% to 3% of the cases.
14
Q
What is thrombolysis and when is it performed?
A
- Thromnolysis = a treatment of infarction, in which a drug is injected into the bloodstream to disperse the blood clot.
- It is performed when the infarction is detected in time.
15
Q
What are the terms when the neurological symptoms of an infarction disappear within 24 hours?
A
- The terms for when symptoms disappear within 24 hours are:
- Transient ischemic attack (TIA),
- Or transient neurological attack (TNA).
- These usually last less than 30 min and include temporary loss of function and persistent but subtle cognitive impairment(s).
16
Q
What risk factors of infarctions are there?
A
- Of people who experienced a TIA, 30% will have a stroke within the next 5 years.
- Age.
- Atherosclerosis (caused by smoking, obesity, etc.).
- Heart disease.
17
Q
What is the main goal in the treatment of brain hemorrhages?
A
- The main goal is to maintain important functions and prevent another bleed.
- Sometimes surgery helps to reduce the pressure built up in the brain.
18
Q
What is the highest risk factor of brain hemorrhage?
A
- The highest risk factor of brain hemorrhage is high blood pressure.
19
Q
What are the different types of brain hemorrhages?
A
- The different types of brain hemorrhages are:
- Intracerebral hemorrhage.
- Subarachnoid hemorrhage (SAH).
20
Q
What is an intracerebral hemorrhage?
A
- Intracerebral hemorrhage (ICH) = a type of stroke characterized by bleeding within the brain tissue itself. It occurs when a blood vessel ruptures and released blood in the surrounding brain area(‘s), causing localized damage and compression of brain structures.
21
Q
What subtypes of intracerebral hemorrhages are there and what do they mean?
A
- Subtypes of intracerebral hemorrhages are:
1. Lobar hemorrhage = bleeding that is localized in one or more of the cerebral lobes and is caused by amyloid antipathy.
- Hemorrhage infarction = blockage and leakage of an artery.
- Hematoma = the accumulation of blood caused by trauma.
22
Q
What does amyloid antipathy mean?
A
- Amyloid antipathy = a degenerative cerebrovascular disease in which is characterized by the accumulation of amyloid protein in the walls of the blood vessels in the brain.
23
Q
What are common causes of cerebral hemorrhage?
A
- Common causes are:
- High blood pressure,
- Arteriovenous malformation,
- Inflammation of the vessel wall,
- Coagulopathy,
- And brain tumor.
24
Q
What is an subarachnoid hemorrhage (SAH)?
A
- Subarachnoid hemorrhage (SAH) = a type of brain hemorrhage, in which the bleeding occurs in the arachnoid space (between the meninges), causing sudden headache, followed by stiffness of the head.
- This type of stroke occurs in 5% of the cases.
- It is usually caused by the rupture of an aneurysm.
- Surgery is usually required to close the leak.
- 2/3 of patients with SAH suffer significant loss of function and cognitive impairment.
25
Q
What are the differences between the effects of infarction and hemorrhage and when are these differences most obvious?
A
- The differences between the effects of infarction and hemorrhage are most obvious shortly after the stroke.
- Brain hemorrhages:
- Causes immediate damage due to the increasing pressure. - - Because a larger portion of the brain is affected and the increased blood pressure causes loss of consciousness.
- This results in that normal function often can be restored when the brain pressure in lowered.
- Infarction:
- Affects specific cognitive functions based on its location and can also cause (temporary) damage to remote brain regions (diaschisis) at secondary level.
- This is why patients with an infarct usually suffer from marked cognitive impairment and cannot recover as quickly as patients with a hemorrhage.
26
Q
What is the percentage of stroke patients that experience memory impairments?
A
- 13% to 15% of patients suffer from memory impairments in the first week after the stroke.
- 11% to 31% of patients suffer from memory impairments 1 year after the stroke.
27
Q
When does memory loss frequently occur after a stroke?
A
- Memory loss frequently occurs after a stroke in the middle cerebral artery when the medial temporal lobe (hippocampus) is affected.
- But it can also appear following a stroke in other areas.
28
Q
On what is the impact of a stroke on memory loss dependent on?
A
- The impact of a stroke on memory loss is dependent on the:
- Nature,
- Extent,
- And location of the stroke.
29
Q
What is the hemispheric involvement on memory loss after a stroke?
A
- Damage in the left hemisphere or bilateral damage is more apparent in memory loss.
- Memory problems especially occur when the left hemisphere is damage.
- This also applies to modality-specific problems, such as visual memory.
- Damage in the right hemisphere has less impact on memory.
- When nonverbal memory is impaired, the right medial temporal lobe, thalamus, mamillary body, or basal frontal lobe is often affected.
30
Q
What kind of amnesia is more common after a stroke?
A
- Anterograde amnesia (forgetting new things) is in most patients effected after stroke.
- Reterograde amnesia is less common, but can occur after damage to the non-medial parts of the temporal lobe.
31
Q
What happens to the declarative and procedural memory after a stroke?
A
- Especially declarative memory is affected after a stroke.
- Procedural memory often remains unaffected, but can occur after damage in the basal ganglia.
32
Q
What is the percentage of impaired attention processes in patients after a stroke?
A
- About 40% of the patients experience impaired attention processes after a stroke.
33
Q
What kind of distinction can be made in attention processes and which brain areas are involved in these processes?
A
- Basic attentional processes = related to basic functions, such as falling asleep, and to multitasking.
- Impaired basic attentional processing: difficulty in doing more things at once.
- Originates in the subcortical networks. - Complex attentional processes = related to directing, distributing and sustaining attention, which involve limited attention time and easy distraction.
- Impaired complex attentional processing: difficulty in doing things for a longer time period.
- Originates in the parietal lobe, temporal lobe and prefrontal cortex.
34
Q
When does impaired attention becomes particularly apparent and what plays a role in this?
A
- Impaired attention becomes particularly apparent under time pressure and a declaration in the speed of information processing plays an important role in this.
