Chapter 9 - Cerebrovascular Disorders Flashcards
Brain lesions
- pathologic or traumatic discontinuity of brain tissue
- entails a loss of function
- caused by trauma or disease
- recovery can occur if neurons are not killed
Anoxia
- complete absence of O2 supply to the brain that can cause neuron death
- caused by things like heart attacks, near-drowning, CO poisoning
Hypoxia
- reduced but not complete absence of O2 supply to the brain that causes altered function of neurons
- caused by acute cardiac crisis or high elevations
Hydrocephalus
- ventricles abnormally enlarged due to increased/decreased CSF production/absorption, or blockage of CSF flow
- nausea, headache, etc
Communicating hydrocephalus
presence of blood mixing w/ CSF due to hemorrhage or infection
- interferes w/ the reabsorption of CSF
Obstructive hydrocephalus
blockage of the circulation of CSF
- tumors, children can be born with this, etc
Stroke (CVA)
- brain damage as a result of reduced blood flow w/n and to the brain
- highly variable symptoms like weakness, partial paralysis, headache, double vision, etc
Transient Ischemic Attack
- temporary lack of O2 to the brain
- time-limited set of symptoms like weakness, headache, double vision, confusion, etc
- does not kill neurons, so not considered a stroke, recovery w/n 24 hours
Do infarctions cause neuronal death?
yes
Thrombosis
- type of infarction
- clot/thrombus forms in and obstructs an artery
- most commonly seen in the middle cerebral artery
What is a common cause of a thrombosis?
atherosclerosis - buildup of plaque in arteries
Embolism
- type of infarction
- clot forms in one area of the body and travels to another
- a.k.a. traveling thrombosis
Hemorrhage
- rupturing of a blood vessel, puts pressure on surrounding tissue
- usually occurs during waking hours
- very poor prognosis
What is usually the first diagnostic test given to diagnose cerebrovascular disease?
- CT scan
- can distinguish btwn hemorrhagic and non-hemorrhagic stroke
What is the most accurate diagnostic test given to diagnose cerebrovascular disease?
angiography
What factors are involved in stroke recovery?
- size of blood vessel (major artery=more damage)
- remaining intact vessels (account for level of compensation)
- premorbid factors (health and family Hx)
- location (determines symptoms and Tx)
What are some treatments for cerebrovascular disease?
- anticoagulants to dissolve blood clots
- blood pressure medications
- surgery
Tissue plasminogen activator (tPA)
- breaks down clot
- only eligible if admitted w/n 4 hours
- FDA approved
What are some preventions for cerebrovascular disease?
- lifestyle changes like exercising, healthy eating, lowering alcohol intake, no smoking, etc.
Disinhibition
- cognitive impairment seen in strokes
- lack of inhibition and insight, impulsiveness
Attentional deficits
- cognitive impairment seen in strokes
- difficulty sustaining attention, with selective attention
- easily distracted
Motor and sensory impairment
- cognitive impairment seen in strokes
- contralateral to side of stroke
- general slowing of movements, difficulty moving, potential paralysis
- deficits in senses
Memory problems
- cognitive impairment seen in strokes, especially if hippocampus is affected
- recently created memories are typically lost
- limbic system is very vulnerable
Deficits in abstract reasoning
- cognitive impairment seen in strokes
- if frontal area is affected:
- difficulty planning, problem solving, forming new concepts, etc.
What are the cognitive deficits seen in right brain strokes?
- symptoms are more subtle, making them harder to diagnose
- spatial and nonverbal processing deficits
- contralateral motor and sensory impairment
- emotional and visuospatial deficits
What are the cognitive deficits seen in left brain strokes?
- commonly caused by blockage of middle cerebral artery
- R side weakness or paralysis
- impairment in speaking or understanding speech
- impairment of written language
Depression
- common after L side stroke
- pt. mourns loss of function
- occurs 6-12 mnths after stroke
Apathy
- common after R side stroke
- pt. becomes less expressive, monotonous
Euphoria
- common after R side stroke
- pt. will act as if nothing has happened
Impulsive emotional and behavioral displays
- more likely to occur after a R side stroke, but can occur after L as well
- EX: taking more time before speaking, odd eating behaviors
What other emotional and behavioral changes can occur after a stroke?
- lack of initiation/motivation
- poor judgement (damage to frontal lobe)
- apraxias
