Exam 3

Question 1

What is a stroke?

Answer 1

The abrupt onset of a focal neurological deficit such as disruption in strength, speech, vision or cognition that is consistent with a vascular distribution and lasts more than 24 hours with a positive image.

Question 2

Name the two arteries.

Answer 2

Question 3

Name the appropriate cerebrovascular territories.

Answer 3

Question 4

How many strokes are there in Canada each year?

Answer 4

50,000.

Question 5

How many Canadians die from a stroke each year?

Answer 5

14,000.

Question 6

How many Canadians live with the effects of stroke?

Answer 6

426,000.

Question 7

What is lost in every minute of delay in treating a stroke?

Answer 7

1. 9 million brain cells
2. 8 billion synapses

12km of axonal fibre

Question 8

How many children per year experience perinatal stroke?

Answer 8

200-300.

Question 9

What does the FAST acronym mean?

Answer 9

Face drooping
Arm weakness
Speech difficulty
Time to call 911

Question 10

What are the two classes of stroke and what is their incidence?

Answer 10

Hemorrhagic, 15% and ischemic, 85%.

Question 11

What are the two kinds of hemorrhagic stroke?

Answer 11

Intracerebral and subarachnoid.

Question 12

What are the two kinds of ischemic strokes?

Answer 12

Acute ischemic stroke, transient ischemic attack.

Question 13

Name the stroke.

Answer 13

Intracerebral hemorrhagic.

Question 14

Name the stroke.

Answer 14

Subarachnoid hemorrhagic.

Question 15

What are the causes of intracranial hemorrhagic stroke?

Answer 15

• Hypertension
• Blood vessel malformation
• Tumors
• Alcohol abuse

Question 16

What is cerebral arteriosclerosis?

Answer 16

Thickening and hardening of the arteries

Plaque composed of fat, cholesterol, calcium and other substances found in blood

Question 17

What are the risk factors for ischemic stroke?

Answer 17

• Age
• Hypertension
• Diabetes
• Smoking
• Obesity

Question 18

What is an infarction?

Answer 18

The area that is permanently damaged from an ischemic stroke.

Question 19

What is the ischemic penumbra?

Answer 19

The area around the infraction that is still viable. The usual target of interventions.

Question 20

What is thrombosis?

Answer 20

Formation of a clot or plug in the blood vessel.

Question 21

What is an embolism?

Answer 21

A clot of plug brought from a larger vessel to a smaller one.

Question 22

What is a thrombotic ischemic stroke?

Answer 22

The most common type of stroke. It results from a clot in a large artery due to atherosclerosis.

Question 23

What is an embolic ischemic stroke?

Answer 23

Stroke caused by an emboli, a fragment of thrombus, air, fat, bacteria or tumor cells. It happens in younger patients, usually affects the MCA.

Question 24

What are lacunar strokes?

Answer 24

Small vessel strokes that compose 15-25% of ischemic strokes. It affects the small, penetrating branches of the Circle of Willis, MCA, or vertebrobasilar artery.

Question 25

What does lacunar stroke cause in the brain?

Answer 25

Deep brain structure infarcts 3mm to 2cm in depth * Basal ganglia * Cerebral white matter * Thamalus * Pons * Cerebellum

Question 26

Describe the presentation for each syndrome: * Pure motor hemiparesis--an infarct in the internal capsule or pons * Pure motor hemiparesis with motor aphasia--an infarct of the internal capsule and corona radiata * Ataxic hemiparesis--an infarct in the pons * Dysarthria and clumsy hand syndrome--an infarct in the pons or internal capsule * Pure sensory stroke--an infarct in the thalamus

Answer 26

* Contralateral hemiparesis of face, arm leg, with dysarthria * Hemiparesis of face, arm and leg with inability to speak * Paresis of contralateral leg and side of face, ataxia of contralateral arm and leg * Dysarthria, dysphagia (hard to eat), contralateral facial and tongue weakness, paresis and clumsiness of contralateral hand and arm * Contralateral sensory loss to all modalities usually affecting the face, upper and lower extremities

Question 27

What is a transient ischemic attack?

Answer 27

AKA "mini-stroke", a sudden, focal neurologic deficit lasting less than 24 hours, confined to an area of the brain or eye perfused by a specific artery.

Question 28

Describe a transient ischemic attack.

Answer 28

* Lasts seconds to minutes; only 25% last more than one hour * Evidence of infarction: 20% on CT and 50% on MRI * Risk of full stroke within 90 days 20% higher after TIA

Question 29

What are the symptoms of a TIA?

Answer 29

* Sudden tingling or numbness on one side of the face * Confusion of time, place or person * Speech loss or impairment for understanding and/or communicating * Sudden slurring of speech * Dizziness * Visual disturbances: blurring, double vision * Difficult reading, writing or thinking * Weakness in arm or leg on one side of the body

Question 30

What are the important common effects of a left hemispheric stroke?

Answer 30

* Aphasia or dysarthria * Normal perception * Intact judgement with good insight on limitations * Slow and caution behavioural style development; require frequent instruction and feedback * Better at emotional understanding and expression

Question 31

What are the important common effects of a right hemispheric stroke?

Answer 31

* Intact language ability, but dysarthria * Denial of paralysis, left side neglect * Impaired spatial perception and judgement * Impaired ability to locate and name body parts * Impaired judgement or insight into limitations, overestimating physical ability, impulsivity, inappropriate emotional understanding and expression

Question 32

What are some neurological consequences of strokes?

Answer 32

* Cognitive deficits of attention, memory, executive function and perception * Communication problems * Post-stroke fatigue * Psychiatric illness * Behavioural issues

Question 33

How do you treat an ischemic stroke? An hemorrhagic stroke?

Answer 33

* Clot busting medication, removing plaque from carotid artery * Blood pressure stabilization, surgical removal of hematoma

Question 34

What are some treatments and therapies for stroke survivors?

Answer 34

* Physical therapy * Occupational therapy * Speech language therapy * Cognitive rehabilitation * Psychotherapy * Recreational therapy

Question 35

What are some stroke recovery facts?

Answer 35

* 10% recovery almost completely * 25% recover with minor impairments * 40% have moderate impairment requiring special care * 10% require full-time care * 15% die shortly after

Question 36

What are the diagnostic criteria for Alzheimer's disease?

Answer 36

A. Criteria met for major or minor neurocognitive deficit B. Insidious onset and gradual progression of impairment in one or more cognitive domains C. Probable or possible AD criteria: * 1. Genetics * 2. All three of the following: * Evidence of decline in memory and one other domain * Steadily progressive, gradual decline in cognition without plateaus * No evidence of mixed etiology D. Not better explained by another neurodegenerative disorder or disease

Question 37

What are the diagnostic criteria for **Major Neurocognitive Disorder**?

Answer 37

A. Evidence of significant cognitive decline from a previous level of performance in one or more areas of cognitive domains based on: 1. Concern of the individual, a knowledgeable informant, or the clinician about significant cognitive decline 2.