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Path midterm 2 > class 16 -stroke > Flashcards

class 16 -stroke Flashcards

1
Q

what is a cerebrovascular disorder?

A

Cerebrovascular disease includes a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often damaged or deformed in these disorders.

  • interruption of blood flow to the brain
  • can be temporary or long lasting
  • includes: transient ischemia attack, stroke..
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2
Q

what is a transient ischemic attack?

A

TIA: or mini stroke, is caused by a temporary interruption of blood flow to the brain. Symptoms are similar to an ischemic stroke expect they go away within a few minutes or hours. many ppl can have a TIA without even knowing it.

  • lasts no longer than an hour
  • TIA’s are a warning sign that puts ppl at risk for a full-blown stroke
  • 80% have reoccurrence
  • temporary, intermittent
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3
Q

what is a stroke?

A
  • sudden loss of brain function
  • ischemia to the brain to the extent that neurons die
  • cerebrovascular accident
  • “brain attack”
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4
Q

prevalence of stroke?

A

One person every 10 min has a stroke

  • 3rd leading cause of death in Canada
  • more women than men have strokes
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5
Q

what are the two types of strokes?

A

1) Ischemic: due to an obstruction ~ 80% of cases
2) Hemorrhagic: blood vessel burst, bleeding outside blood vessel diverts blood flow to the brain. The brain does not get blood ~ 20% of cases

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6
Q

true or false:

For every hour in which tx does not occur, the pt will lose the same amount of neurons as it would in 3.6 years of aging

A

true!!!

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7
Q

Effects of stroke?

A

-depends on where in brain injury occurs, as well as how much damage occurred. a stroke can impact any number of areas including your ability to move, see, remember, speak, reason, and read and write

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8
Q

what is an ischemic stroke?

A

THROMBIC or EMBOLIC

  • obstruction of blood flow
  • 80- 87% of strokes
  • related to atherosclerosis
  • thrombotic stroke is caused by a blood clot that forms in an artery directly leading to the brain
  • an embolic stroke is when a clot develops somewhere in the body and travels through the bloodstream to the brain
  • same process for unstable angina but different place
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9
Q

what are some risk factors of ischemic stroke?

A
  • hypertension
  • diabetes
  • smoking
  • dyslipidemia
  • males, older age, and ethnicity
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10
Q

how can atrial fibrillation lead to a stroke?

A

-can lead to an embolic stroke because the atria is quivering instead of contraction and abnormal blood flow occurs, and clots result

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11
Q

what is the pathophysiology of an ischemic stroke?

A
  • interruption of blood flow leads to cell injury, inflammation, edmea, ischemia, and infarction (death) of brain tissue.
  • leads ot necrosis because neurons are very sensitive to O2 and glucose deprivation
  • cerebral vessels are often affected by atherosclerosis
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12
Q

Diagnosis for ischemic stroke?

A
  • early diagnosis and tx are essential
  • needs a CT scan
  • possible fibrinolytics (breaks down clots)
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13
Q

What is a hemorrhagic stroke?

A

CEREBRAL HEMORRHAGE

  • spontaneous rupture of blood vessels in brain
  • this bleeding interrupts the normal blood flow in the brain and kills brain cells either by flooding at the leakage site or by shortage of blood supply beyond they leakage
  • 13-20% of strokes
  • higher fatality
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14
Q

what are hemorrhagic strokes caused by?

A

caused by:

  • uncontrolled bleeding in brain
  • hypertension
  • cerebreal aneurysms
  • Ateriovenous malformation
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15
Q

locations of hemorrhagic stroke?

A
  • subarachnoid (between the brain and skull)

- intracerebral

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16
Q

what occurs when there is a hemorrhage in the brain?

A

-displaces and compressed brain tissue, which causes edema, increased ICP, ischemia and infarction, and possible herniation

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17
Q

what are the two congential abnormalities that can lead to a stroke?

A
  • berry aneurysm (circle of willis)

- arteriovenous malformation (sudden transition from artery to vein, no capillary

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18
Q

what are some manifestations of stroke?

A
  • weakness
  • trouble speaking
  • vision problems
  • headache (hemorrhagic has been described as “the worst headache ever”)
  • dizziness
FAST accornym 
F= facial droop 
A= arm drift 
S= speech change 
T= time to call 911
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19
Q

what are the outcomes of a stroke?

A

of every 100 ppl who have a stroke:

  • 15 will die
  • 10 will recover completely
  • 25 will recover with minor impairment
  • 40 will be left with moderate to severe impairment
  • 10 will require long term care
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20
Q

what are some possible long term effects of a stoke?

A
  • brain function is site specfic so outcome will depend on location of the stroke
  • cognitive, communication, comprehension disorders
  • aphasia, dysphasia, anogisa
  • memory, attention, emotion, behaviour, personaility
  • motor function, posturem muscle tone, gait, swallowing
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21
Q

what signs and symptoms would be seen if the left side of the cerebrum was affected?

A
  • motor weakeness the the right side (paralytic)
  • pupil doesnt change size on the left side
  • language, speech, math, slow and cautious
  • trouble with learning and memory of new info
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22
Q

what signs and symptoms would be seen if the right side of the cerebrum was affected?

A
  • motor weakness of the left side (paralytic)
  • pupil doesnt change size on the right side
  • left side neglect
  • problems distinguishing distance, depth, up and down, front and back
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23
Q

what is locked in syndrome?

A

rare when the brain stem is affected by stroke

  • when cerebral cortex will works (full congnition) but have very minimal ability to interact with environment
  • can only communicate through blinking and moving eyes up and down
  • aware but cant communicate
  • body temp dysregulation
  • breathing, HR, and BP alterations
24
Q

what is the left side of the brain responsible for?

A
  • language and speech
25
Q

what is the right side of the brain responsible for?

A

-reasoning, spatial, perceptual skills

26
Q

what can occur if the cerebellum is effected by the stroke?

A

person will have problems with balance and coordination

27
Q

what is left side neglect?

A
  • when a right sided stroke pt has the inability to perceive the left side of vision
  • around 25% of right sided strokes result in some degree of neglect
  • right side neglect is uncommon
28
Q

what is included in primary prevention for strokes?

A
  • eliminating risk factors: hypertension, diabetes, dyslipidemia, smoking, management of bp (hemorrhagic) or atrical fibirllation (embolic)
29
Q

what is secondary prevention for stroke?

A 
-early recognition 
F- face droop
A- arm drift 
S -speech
T - time to call 911
30
Q

what is tertiary prevention for stroke?

A
  • early intervention
  • early CT scan (stroke ambulance)
  • ischemic stroke (clot buster)
  • hemorrhagic stroke (surgery to stop bleeding)
31
Q

what is a neoplasm?

A

-a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer

32
Q

what causes neoplasm?

A
  • no proven causative agent
  • cause is not clear but can be due to:
  • genetics
  • radiation
  • viruses
  • chemical carcinogens
  • EMG fields
33
Q

what are the two categories of neoplasms?

A

1) Primary

2) metastatic

34
Q

what is primary neoplasm?

A
  • origionate from supporting brain cells
  • are intracerebral tumors
  • can be: astrocytoma (maintains BBB), oligodendroglomia (makes myelin) or ependymoma (makes CSF)
  • neurons dont develop tumors because they dony replicate. supporting cells do replicate therefore they can produce tumors
  • can also be extarcerebral tumors: eg, meningioma
35
Q

what is the problem with intracerebral brain tumors?

A

-they are difficult to see, diffucult to differentiate from nromal tissue, and are difficult to remove

36
Q

characterists of extracerebral brain tumors?

A
  • meningoma
  • shifting, herniation
  • is a space occupying lesion
  • signs and symptoms includes ICP
37
Q

incidence of neoplasms for adults?

A
  • incidence increased up to age 70, then decreases

- most are supratentoral (above the tentorium - seperates cerebellum from cerebrum)

38
Q

what are the most common neoplams in children?

A

solid tumors

  • most are infratentorial (below tentorium)
  • 70-75% of brain tumors in children are below the roof of the cerebellum and involve the cerebeullum, midbrain, and brain stem
39
Q

most adult brain tumors are located where?

A

-above the tentorium

40
Q

most children brian tumors are located where?

A

-below the tentorium

41
Q

in both children and adults, what is the most common neoplasm?

A

astrocytoma (maintain BBB)

42
Q

why are benign and malignant tumors difficult to differentiate in the brain?

A
  • because location affects the tumors malignancy
43
Q

what can micorscopically small benign tumors cause?

A

they can cause severe debility or death depending og where they are

  • these are difficult to remove because they look similiar to normal tissue
  • some tumors cannot be accessed
44
Q

why dont some primary malignant brain tumors metastasize outside of the brain?

A

-invasion of blood vessels is rare because of teh BBB, lymph vessel spread is rare beacuse few lymph vessels are in the brain

45
Q

what are some manifestations of brain tumors?

A
  • are local most of the time (because of its location)
  • but will have systemic effects because of compression
  • can be general, most mosty in pediatric
  • signs of ICP- first change in LOC
  • because of invasion and compression of the neoplasm that causes cerebral edema leading to ICP, manifestations include: headache, vomiting, seizures, visual distrubances, unstable gait, papilledema (swelling of optic nerve) and behavioural changes
46
Q

tx for brain tumors?

A
  • chemotherapy is generally not effective because chemo molecules are big and can’t get into the brain
  • radiation and surgery are effective
47
Q

what are CNS infections?

A
  • includes:

- meningitis and encephalitis

48
Q

what is meningitis?

A

inflammation of the meninges

  • almost always due to bacteria or virus (occasionally fungal or chemical irritants- uncommon)
  • categorized by onset
49
Q

characterists of bacterial meningitis?

A
  • rapid onset
  • mortality is high
  • organisms vary
  • can be acute or chronic depending on invading organsism (treponem pallidum is the only chronic one)
50
Q

what are some risk factors of bacterial meningitis?

A
  • open head injuries
  • basal skull fractures, meninges teared
  • sinusitis
  • otitis
  • immunocompromised individuals
  • military bases
51
Q

what are some neurological signs of bacterial meningitis?

A

altered LOC
projectile vomiting
seizures

52
Q

what are some infectious signs of bacterial meningitis?

A

fever
tachycardia
chills
lumbar puncture
-if bacterial, increased # of neutrophils, pus, glucose levels are lower than blood glucose (bacteria use glucose), protein levels are higher
if viral: glucose levels are normal since viruses dont use glucose for fuel, bacterial meningitis usually produces pus, so if no pus, usually indicative of viral

53
Q

what are some meningeal signs of bacterial meningitis?

A 
throbbing headache
kernigs sign
brudzinskis sign 
nuchal rigidity 
may see petechial or purpuric rash
54
Q

what is kernigs sign?

A

Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees

55
Q

what is bridzinski’s sign?

A

-severe neck stiffness causes a patients hip and knees to flex when the neck is flexed

56
Q

manifestations of bacteria meningitis?

A
  • increased ICP
  • cerebral edema
  • seizures
  • focal neurological deficits
  • cerebrovascular abnormalities
  • hearing loss
  • amputation
  • renal failure
  • mortality rate is 25-100% (100% if untreated)
57
Q

what do most viral menintisis tend to be?

A

enterovirus (80 kinds)

  • manifestations are less severe, includes fever, ache chills, goes awat within 10 days
    tx: Antivirals, cortiocsteriods

Path midterm 2 (13 decks)

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