L2_Cerebral vascular disorder (1) 2025 _Moodle Flashcards
what is stroke?
Stroke occurs when there is ischemia to a part of the brain or hemorrhage into the brain that results in death of brain cells.
Functions such as movement, sensation,
thinking, talking, or emotions that were
controlled by the affected area of the brain are
lost or impaired.
Types of ischemic stroke
thrombolytic
- large artery thrombosis
- small penetrating artery thrombosis
embolic
-cardiogenic embolic
Functional recovery of ischemic stroke
Usually plateaus at 6 months
when will TIA last
clinical symptoms go away within 24 hours/lasting less than 1 hour
what portion of TIA patient develop strokes later
1/3
Risk factors for
Ischemic stroke
- Hypertension
- Heart disease
e.g. Atrial fibrillation, coronary heart disease, chronic heart failure - High cholesterol levels
- Obesity
- Diabetes mellitus
- Smoking
- Excessive alcohol consumption
how can AF develops cardiogenic embolic stroke?
a lot of signals at atrium
fibrillation motion in atrium delay blood emptying from atrium and facilitate formation small embolus. Embolus will stick on wall of blood vessels or group together to form a large embolus. Embolus travels in the bloodstream and lodges in a narrow portion of a cerebral artery
Behavioral
risk factors of atherosclerosis
- Tobacco use
- Physical inactivity
- Unhealthy diet (high salt, fat, sugar, calories)
- Harmful use of alcohol
Metabolic risk factors of atherosclerosis
- Hypertension
- Diabetes mellitus
- Raised body lipids
- Overweight and obesity
what is hemorrhagic stroke
Burst of the cerebral
blood vessels
arterial or venous bleeding into the brain’s white
matter
Types of hemorrhagic stroke and their relative risk factors
Intracerebral hemorrhage (ICH)
e.g. persistent high blood pressure
Subarachnoid hemorrhage (SAH)
e.g. arteriovenous malformation (AVM); aneurysm
Stroke warning signs (6)
- numbness or weakness of the face, arm or leg, especially on one side of the body
- confusion, trouble speaking or understanding
- trouble seeing in one or both eyes
- trouble walking, dizziness, loss of balance or coordination
- severe headache with no known cause
- sudden nausea and vomiting (due to increase in ICP)
what is contralateral
deficit
impairment (paralysis) of the body opposite to the side of the brain that is damaged
Hemiparesis
Weakness of the face, arm, and leg on the same side (due to a lesion in the opposite hemisphere)
Hemiplegia
Paralysis of the face, arm, and leg on the same side (due to a lesion in the opposite hemisphere)
Ataxia
- Staggering, unsteady gait
- Unable to keep feet together; needs a broad base to stand
Dysarthria
Difficulty in forming words
Expressive aphasia
Unable to form words that are understandable; may be able to speak in single word responses
Receptive aphasia
Unable to comprehend the spoken word; can speak but may not make sense
Global (mixed) aphasia
Combination of both receptive and expressive aphasia
Dysphagia
Difficulty in swallowing
Cognitive Deficits
- Short-and long-term memory loss
- Decreased attention span
- Impaired ability to concentrate
- Poor abstract reasoning
- Altered judgment
Emotional Deficits
- Loss of self self-control
- Emotional lability
- Decreased tolerance to stressful situations
- Depression
- Withdrawal
- Fear, hostility, and anger
- Feelings of isolation
what is agnosia
Agnosia is a disturbance in the perception of familiar sensory (eg , verbal, tactile, visual) information.
types of agnosia
visual object agnosia
prosopagnosia
tactile agnosia
what is the consequence of sparial orientation being affected?
Spatial orientation is affected, resulting in interference with the patient’s ability to judge position, distance, movement, and the relationship of his
or her body parts to surrounding objects.
Which side of agnosia is more common?
left
why left agnosia is more common?
- Both hemispheres process the stimuli from the right space
- The left space is processed only by the right hemisphere.
what is Homonymous hemianopia
- Loss same half of each visual field –> sees only
one -half of the normal vision - Neglect syndrome –> Neglect of the affected side
of the body - Difficulty judging distances
what is diplopia
double vision
what are the urinary complications caused by stroke
frequency
urgency
incontenience
retention
urinary tract infection
what is the bowel complications caused by stroke and the reason behind
constipation
patients may have limited movements after stroke and prone to have constipation
symptoms of right brain damage
- Paralyzed left side: hemiplegia
- Impaired judgment, impaired time concepts
- Spatial perceptual deficits
- Tends to deny or minimize
problems - Rapid performance, short attention span
- Impulsive, safety problems
- Left sided neglect
symptoms of left brain damage
- Paralyzed right side : hemiplegia
- Impaired speech/ language aphasias
- Impaired Rt /Lt discrimination
- Slow performance
- Aware of deficits: depression, anxiety
- Impaired comprehension related to language, math
neurological examinations
Vital signs
Mental status
Cranial nerves testing including pupils
GCS
Stroke scale scale-NIHSS
Motor system including coordination and gait
Sensory
Babinski’s reflex
positive Babinski’s reflex
big toe dorsiflexes, the other toe fans out in response to sensory stimulation along the lateral aspect of the sole of the foot.
Signs of upper motor neuron lesion lesion
