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Patho - Neuro > Disorders of Vasculature & Intracranial Aneurysm > Flashcards

Disorders of Vasculature & Intracranial Aneurysm Flashcards

1
Q

*2 types of stroke

A

ischemic - lack of oxygen

hemorrhagic

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2
Q

how do we classify a stroke or CVA

A

acute neurologic deficit lasting >24hrs

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3
Q

what is an ischemic stroke

A

occlusion of artery/interruption of blood flow to the brain

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4
Q

one of the most common neurologic disorders, the most common reason for long-term disability

A

stroke

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5
Q

what is an hemorrhagic stroke

A

hemorrhage/bleeding in the brain

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6
Q

which type of stroke has a poorer outcome

A

hemorrhagic

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7
Q

a stroke can also be referred to as this

A

brain attack - as serious as a heart attack

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8
Q

strokes have a very high mortality rate, many times from secondary causes t or f

A

true

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9
Q

non-modifiable risk fxr r/t stroke

A

thins we cant control (age, family hx, race, gender)

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10
Q

***modifiable risk fxrs r/t stroke

A

***HTN - single most modifiable risk factor (both types)
smoking - atherosclerosis (hardening of arteries)
heart disease (ischemic strokes) - a lot of plaque in arteries
A FIB
drug abuse (hemorrhagic stroke)

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11
Q

**most modifiable risk factor for strokes

A

HTN

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12
Q

risk fxr specific to ischemic stroke

A

heart disease

htn

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13
Q

risk fxr specific to hemorrhagic stroke

A

drug abuse

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14
Q

patho of ischemic stroke

A

blood is supplied to the brain by 2 main pairs of arteries, carotid and vertebral

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15
Q

what area of the brain do carotid arteries feed

A

frontal area

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16
Q

what area of the brain do vertebral arteries feed

A

posterior circulation

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17
Q

do anterior and posterior cerebral circulation communicate with each other

A

yes - circle of willis

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18
Q

what allows anterior and posterior cerebral circulation to communicate with each other

A

circle of willis - re-routes blood

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19
Q

why does the brain require continuous supply of blood to the neurons

A

it needs glucose and oxygen for neurons to fxn

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20
Q

what happens if blood flow to brain is interrupted

A

in 30 sec - neurologic metabolism is altered
in 2 min - metabolism stops
in 5 min - cell death occurs

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21
Q

other fxrs affecting blood flow to the brain

A

ICP
blood viscosity
Systemic BP

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22
Q

what is collateral circulation

A

Circle of Willis - an area of the brain can receive blood flow from another vessel if original blood supply is cut

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23
Q

one of the primary causes of an ischemic stroke

A

atherosclerosis in areas where vessels split in 2

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24
Q

when somebody has an ischemic event, occlusion of blood flow to the brain, we will typically see a

A

pneumbra

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25
Q

*what is a pneumbra?

A

an area around the ischemia where blood flow circles

*can last for up to 3 hrs.

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26
Q

why is pneumbra a good thing

A

its preventing further spread of infarction

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27
Q

most common type of stroke

A

ischemic

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28
Q

3 different types of ischemic strokes

A

thrombotic
embolic
lacunar

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29
Q

what happens in a thrombotic stroke

A

injury of blood vessel wall, forming clot, lumen narrows, impeding blood flow to brain mostly in areas of plaque build-up

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30
Q

what happens in a embolic stroke

A

an embolus lodges and occludes a cerebral artery

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31
Q

most common type of ischemic strokes

A

thrombotic

32
Q

**we associate thrombotic strokes with what

A

*HTN and Diabetes

33
Q

*why do we associate diabetes and htn with a thrombotic stroke

A

overtime HTN and diabetes damage the vessel walls

34
Q

how does a thrombotic stroke present

A

slow onset
after 3 days - complete occlusion of blood flow
brain tissue = edema (ldg to lgr area of damage)

35
Q

***when you think of an embolic stroke think of this

A

*A Fib - clot from heart

36
Q

how do we prevent clots so they don’t lead to embolic strokes

A

blood thinners - warfarin

37
Q

other less common causes of clots r/t embolic strokes

A

rheumatic fever
endocarditis
cardiac infection - atrial septal defect from birth
air or fat embolism (fracture in pelvis/femur - males)

38
Q

how does a embolic stroke present

A

fast onset
pt. will remain alert
severe neurologic deficits

39
Q

can collateral circulation help during an embolic stroke

A

no - happens to quickly

40
Q

prognosis for embolic strokes

A

depends on area of the brain that’s been effected

41
Q

what is going on in an embolic stroke if pt. is bad then symptoms that appear to resolve

A

a clot gets lodged, blood flow builds-up and pushes clot along

42
Q

what is a TIA (transient ischemic attack)

A

mini-stroke - temp

43
Q

is there tissue death with a TIA

A

no - not classified as a stroke

44
Q

***difference between embolic stroke and TIA

A

embolic stroke = MRI shows area of cell death

TIA = no noticeable areas of brain infarct/cell death

45
Q

what do Tia events represent

A

warning signs - an ischemic stroke is likely - usually caused by stenosis/narrowing of the carotid arteries

46
Q

what happens in hemorrhagic stroke

A

bleeding in the brain tissue/ventricles leading to ischemia = cell death

47
Q

regardless of what type of stroke you have, the end result (s/s) will remain the same, t or f

A

true - cell-death - cerebral edema

48
Q

when you think of hemorrhagic strokes think of this

A

cerebral aneurysm

49
Q

what is a cerebral aneurysm

A

weakness of cerebral blood vessel

50
Q

where do cerebral aneurysms usually occur

A

circle of willis - causing impairment of collateral circ.

51
Q

2 different types of aneurysm’s

A

saccular (berry aneurysm)

fusiform

52
Q

which type of aneurysms is most likely to rupture

A

saccular (berry) - all blood flow is pressing on 1 area

53
Q

what size aneurysm do we get concerned with

A

anything over 2-5mm is more likely to rupture

54
Q

2 types of hemorrhagic strokes

A

intracerebral hemorrhage

sub-arachnoid hemorrhage

55
Q

what happens in intra-cerebral hemorrhagic stroke

A

ruptured cerebral vessel caused by aneurysm

bleeding into brain - blood sits, clots, causing massive cell death - cerebral edema - massive IICP very quickly

56
Q

prognosis w/intra-cerebral hemorrhagic stroke

57
Q

when does intra-cerebral hemorrhagic stroke occur

A

during periods of activity

58
Q

s/s of intra-cerebral hemorrhage

A

area of bleed dictates symptoms - if your lucky
symptoms r/t IICP -come on quickly - worsen over time
neurologic deficits

59
Q

what area of the brain would an intra-cerebral hemorrhage have the worst prognosis

A

pons - pontanel

60
Q

what is the pons responsible for

A

auto-regulation - breathing

61
Q

what happens in sub-arachnoid hemorrhage

A

bleeding into the CSF space caused by trauma, cocaine, *ruptured aneurysm

62
Q

**how does a sub-arachnoid hemorrhage present

A 
***the worst headache of my life - won't go away
LOC changes although time-line varies
IICP
seizures
stiff neck
n/v
blurred vision/double-vision
63
Q

in a sub-arachnoid hemorrhage often times there is no warning, t or f

A

true - known as a silent killer

64
Q

what determines long-term (after 48 hrs) clinical manifestations of a stroke

A

size/location of infarct

65
Q

what are some long-term s/s r/t motor fxn w/stroke

A

akinesia - difficulty w/voluntary body movements
speech
gag reflex
self-care deficits
impaired resp fxn (dependent on IICP - *Pons = severely effected)

66
Q

where will hemi-plegia occur after stroke

A

opposite the side of stroke (infarct on rt hemi - paralysis on left side)

67
Q

with brocas aphasia what area of the brain is affected

A

frontal lobe

68
Q

with wernicke’s aphasia what area of the brain is affected

A

parietal/temporal

69
Q

what is broca’s aphasia

A

difficulty speaking/writing - short sentences

70
Q

what is wernicke’s aphasia

A

no-one can understand what pt is saying - long sentences

pt can understand but cannot communicate it

71
Q

what does aphasia mean

A

inability to express

72
Q

what is dysphagia

A

difficulty swallowing

73
Q

what is dysarthia

A

trouble with annunciation - slurred slow speech

74
Q

what are some long-term s/s w/stroke

A

diff. controlling emotions -depressed
memory/judgment impairment
incontinence - usually temp.
inability to recognize self in space(this is up/this is down)
blindness
agnosia - inability to recognize self/others/objects
apraxia - skilled sequential movement

75
Q

LOCATION of the brain tissue affected is

what determines the S/S, t or f

76
Q

dx studies for suspected stroke

A

CT scan
cerebral blood flow studies
cardiac studies (a fib?)

Patho - Neuro (6 decks)

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