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Pathology B > Ischaemic Stroke > Flashcards

Ischaemic Stroke Flashcards

1
Q

what are the 3 pathologies included in cerebrovascular disease (stroke)

A

thrombosis, embolism, haemorrhage

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2
Q

what is a stroke

A

abnormality in the brain caused by a pathological process of the blood vessels
cliincal syndrome: rapid onset of focal disturbance in cerebral function of vascular origin longer than 24 hrs

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3
Q

describe ischaemic vs haemorrhagic strokes

A

I = thrombosis/embolism
H = bleeding by ruptured artery

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4
Q

what should you ask in a pateint history for stroke diagnosis

A

time of onset, history of mini strokes (TIA), pattern of symptom progression, specifical focal symptoms, co existing diseases

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5
Q

what happens during physical exam and lab diagnostics for stroke diagnosis

A

neuro evaluation of mental status, consciousness, cranial nerves, motor + sensory function, cerebellar function, gait, deep tendon reflexes
complete blood count, chemistry panel, coagulation studies, cardiac enzymes
CT scan

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6
Q

What does cerebral infarction lead to

A

irreversible cell death

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7
Q

which factors influence the size of the infarct

A

availability of collateral circulation
duration of iscahemia
magnitude of reduction in cerebral blood flow

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8
Q

what is a pale infarct

A

non-haemorrhagic, usually thrombosis

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9
Q

what is a red infarct

A

haemorrhagic
caused by petechial haemorrhages
associate with embolic events

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10
Q

what is the penumbra

A

potentially salvageable tissue
cells vant function but they’re not dead yet
can be rescued by reperfusion

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11
Q

which secondary factors can cause neuronal death

A

inflammation, excitotoxicity, loss of ion homeostasis, oxidative stress, mitochondrial damage. disruption of blood brain barrier, cerebral oedema

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12
Q

What is reperfusion injury

A

worsening of injury upon restoration of blood flow

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13
Q

what type of damage can occur to blood vessels during iscaemia

A

disruptions to bbl’ccausing
extravasation of fluid and proteins and rbcs to the brain parenchyma

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14
Q

what do injured endothelial cells within the capillaries and arteioles cause

A

inflammation = release of inflam mediators and WBCS causing cellular damage
and generation of free radicals -> destructive enzymes

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15
Q

What is TIA

A

mini stroke, indicator of underlying thrombotic disease
same underlying pathology as stroke
brief period of inadequate cerebral perfusion. lasts mins-hours
disturbance reverses before infarction occurs
symptoms resolve

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16
Q

cuases of tia

A

atherosclerotic plaque = break off and obscure vessel + thrombus formation
increased blood viscosity and clot formation
temporary vasospasm

17
Q

TIA mimcs

A

migraine
glucose abnormalities
brain tumours
demyelinating diseases

18
Q

within which vessels is the occlusion occurring?

A

larger arteries (ICA, MCA, BA)

19
Q

describe formation of thrombotic stroke

A

caused by arterial occlusion
artieral wall damage causes blood coag and narrowing vessel
plaques form at branches and curves in circulation
eventually occludes vessel

20
Q

what is the most common cause of cerebral infarction

A

cerebral atherosclerosis

21
Q

what is an embolic stroke and describe the speed of its onset

A

thrombus fragments that have formed outside the brain, lodging in cerebral vessel
sudden onset and big sections of brain

22
Q

individuals with what pathologies are likely to have emboli formation

A

atrial fibrilation, recent myocardial infarction, bacterial endocarditis, hypercoaguable etc

23
Q

what is large vessel disease

A

big areas of stroke
ischaemic stroke
thrombosis is common cause, within carotid or vertebral artieries
can also happen from embolisms

24
Q

what is a lacunar stroke

A

small vessel disease
usually more than 1 present
located in deep, non-cortical structures like internal capsule, basal ganglia, brain stem
territory of single penetrating artery of a large cerebral artery eg mca

25
Q

what can cause lacunar strokes and what are the risk factors

A

arteriosclerosis
chronis hypertension, diabetes

26
Q

what happens when lacunar strokes heal and how can they be best detected

A

causes small cavities
pure motor + sensory hemiplegia
mri

27
Q

what are stroke complications (haemorrhagic transformation)

A
  • bleeding into an infarct eg during reperfusion
  • redelivery of blood to ischaemic tissue -> vessels damages from ischaemia -? blood moves to parenchyma = worse outcome
28
Q

treating ischaemic stroke

A

thrombolysis, surgical removal, stenting
antiplatelet and anticoagulant can prevent recurrent stroke

29
Q

what does TPA do (tissue plasminogen activator)

A

breaks down fibrin by converting plasminogen to plamin and dissolving clot

30
Q

what does tpa do and when can it be used

A

dissolve bclots and restore flow
must be administered to iscahemic stroke patients within 4.5 hours of symptom onset

31
Q

describe hte extend trial

A

extending thromboytic window to 9hrs using perfusion imaging

32
Q

what is a mechanical thrombectomy

A

mechanical removal of blood clot from inside the artery

33
Q

effects and outcome of stroke depend on…

A

severity of initial injury
response to treatment
location
complications

34
Q

what is cerebral ischaemia

A

insufficient blood supply to brain

35
Q

what is cerebral infarction

A

cell death due to ischaemia
infarct depends on availability of collateral circulation, duration, magnitute

36
Q

what are symptoms and clinical presentation for anterior cerebral artery

A

one frontal lobe => lower extremities

37
Q

what are symptoms and clinical presentation for middle cerebral artery

A

= massive infarction +> hemiplegia, sensory impairment, loss sight in half visual field, alexia, confusion

38
Q

what are symptoms and clinical presentation for posterior cerebral artery

A

occipital + temporal lobe => colour blindness, loss central vision + hallucinations

Pathology B (2 decks)

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