Exam 3 Flashcards
What is a stroke?
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.
Name the two arteries.
Name the appropriate cerebrovascular territories.
How many strokes are there in Canada each year?
50,000.
How many Canadians die from a stroke each year?
14,000.
How many Canadians live with the effects of stroke?
426,000.
What is lost in every minute of delay in treating a stroke?
- 9 million brain cells
- 8 billion synapses
12km of axonal fibre
How many children per year experience perinatal stroke?
200-300.
What does the FAST acronym mean?
Face drooping
Arm weakness
Speech difficulty
Time to call 911
What are the two classes of stroke and what is their incidence?
Hemorrhagic, 15% and ischemic, 85%.
What are the two kinds of hemorrhagic stroke?
Intracerebral and subarachnoid.
What are the two kinds of ischemic strokes?
Acute ischemic stroke, transient ischemic attack.
Name the stroke.
Intracerebral hemorrhagic.
Name the stroke.
Subarachnoid hemorrhagic.
What are the causes of intracranial hemorrhagic stroke?
- Hypertension
- Blood vessel malformation
- Tumors
- Alcohol abuse
What is cerebral arteriosclerosis?
Thickening and hardening of the arteries
Plaque composed of fat, cholesterol, calcium and other substances found in blood
What are the risk factors for ischemic stroke?
- Age
- Hypertension
- Diabetes
- Smoking
- Obesity
What is an infarction?
The area that is permanently damaged from an ischemic stroke.
What is the ischemic penumbra?
The area around the infraction that is still viable. The usual target of interventions.
What is thrombosis?
Formation of a clot or plug in the blood vessel.
What is an embolism?
A clot of plug brought from a larger vessel to a smaller one.
What is a thrombotic ischemic stroke?
The most common type of stroke. It results from a clot in a large artery due to atherosclerosis.
What is an embolic ischemic stroke?
Stroke caused by an emboli, a fragment of thrombus, air, fat, bacteria or tumor cells. It happens in younger patients, usually affects the MCA.
What are lacunar strokes?
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.
What does lacunar stroke cause in the brain?
Deep brain structure infarcts 3mm to 2cm in depth
- Basal ganglia
- Cerebral white matter
- Thamalus
- Pons
- Cerebellum
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
- 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
What is a transient ischemic attack?
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.
Describe a transient ischemic attack.
- 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
What are the symptoms of a TIA?
- 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
What are the important common effects of a left hemispheric stroke?
- 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
What are the important common effects of a right hemispheric stroke?
- 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
What are some neurological consequences of strokes?
- Cognitive deficits of attention, memory, executive function and perception
- Communication problems
- Post-stroke fatigue
- Psychiatric illness
- Behavioural issues
How do you treat an ischemic stroke? An hemorrhagic stroke?
- Clot busting medication, removing plaque from carotid artery
- Blood pressure stabilization, surgical removal of hematoma
What are some treatments and therapies for stroke survivors?
- Physical therapy
- Occupational therapy
- Speech language therapy
- Cognitive rehabilitation
- Psychotherapy
- Recreational therapy
What are some stroke recovery facts?
- 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
What are the diagnostic criteria for Alzheimer’s disease?
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:
- Genetics
- 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
- All three of the following:
D. Not better explained by another neurodegenerative disorder or disease
What are the diagnostic criteria for Major Neurocognitive Disorder?
A. Evidence of significant cognitive decline from a previous level of performance in one or more areas of cognitive domains based on:
- Concern of the individual, a knowledgeable informant, or the clinician about significant cognitive decline
2.
