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Neurology Y2 > L8 - Stroke > Flashcards

L8 - Stroke Flashcards

1. Understand the abnormalities of cerebral blood supply include ischaemia and haemorrhage. 2. Learn about types of ischaemic cerebral lesions - large and small vessel occlusion. 3. Understand risk factors relevant for ischaemic stroke. 4. Understand the subdivision of intracranial haemorrhages by location. 5. Learn about lesions that may underlie intracranial haemorrhage - vascular anomalies (aneurysms - berry and Charcot-Bouchard, AVMs and tumours)

1
Q

Textbook definition of Stroke (3)

A

Neurological deficit due to acute focal injury of CNS by vascular cause:

  • cerebral infarction
  • intracerebral haemorrhage
  • subarachnoid haemorrhage
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2
Q

CNS gains energy entirely from …

A

Oxidative metabolism of glucose

NO anaerobic respiration occurs

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3
Q

What is ischaemia?

A

Restriction blood supply to tissues.
Causes shortage of oxygen that is needed for cellular metabolism.
Partly reversible if BF restored to ischaemic area.

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4
Q

What is infarction?

A

Obstruction of blood supply to an organ or region of tissue.
- typically by a thrombus or embolus , causing local death of tissue.

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5
Q

State the two routes of circulation into brain?

A

Anterior
- Carotid circulation
Posterior
- Vertebral-basilar circulation

Anterior and Posterior feed into circle of Willis
- ACA, MCA, PCA

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6
Q

What do the external carotid arteries supply?

A

Face and scalp

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7
Q

Internal carotid arteries supply?

A

Blood to anterior portion of cerebrum.

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8
Q

Vertebrobasilar arteries supply…

A
  • Posterior 2/5ths of cerebrum
  • part of cerebellum
  • brain stem.
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9
Q

Decrease in BF through one of the internal carotid arteries may cause…

A
  • frontal lobe function impairment?
  • Impairment may result in numbness, weakness,
  • paralysis on side of body opposite to obstruction of artery.
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10
Q

Give an advantage of circle of Willis

A
  • Carotid and vertebrobasilar arteries form a circle.
  • Hence if one of main arteries occluded - distal smaller arteries that it supplies can receive blood from other arteries.
  • collateral circulation
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11
Q

Posterior arteries supply….

A

Temporal and occiptal lobes of left cerebral hemisphere and right hemisphere.

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12
Q

What are the small, deep and penetrating arteries derived from the middle cerebral artery known as?

A

Lenticulostriate arteries

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13
Q

What is a lacunar stroke?

A

Occlusion in:

  1. lenticulostriate arteries
  2. vertebral
  3. basilar arteries.
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14
Q

Briefly describe the causes of ischaemic stroke?

A
  1. Narrowing of arteries caused by atherosclerosis.
  2. Arteries become too narrow, blood cells may collect and form blood clots.
    - Blood clots can block the artery where they are formed (thrombosis).
    - may dislodge and become trapped in arteries closer to brain (embolism).
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15
Q

How may atrial fibrillation lead to ischaemic stroke?

A
  1. Heart beat irregular.
  2. Blood not pumped properly out heart, may cause it to pool and form a clot.
  3. Clot may travel to brain and block flow of blood to a specific part.
    - resulting in stroke
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16
Q

Describe a paradoxical embolism?

A
  • Dislodgement of venous thrombus
  • that courses its way into systemic circulation
  • via intracardiac shunt or pulmonary arteriovenous malformation (PAVM).

aka hole in heart.

17
Q

What is a major risk factor for small vessel ischaemic stroke?

A

Hypertension

18
Q

What might a small vessel occlusion result in?

A

Lacunar infarcts affecting deep structures of brain

  • basal ganglia
  • internal capsule
19
Q

What are some rarer causes of stroke? (e.g. younger patients who lack common risk factors)

A
  1. Dissection - tearing of BV
  2. Vasculitis - inflammation
  3. Hyper-coagulable state due to deficiencies of certain protein
  4. Genetic - BV predisposed to blocking.
20
Q

Describe cervicocephalic arterial dissection as a common cause of stroke in young adults and adolescents?

A
  • Tearing of vessel wall between intima and media
  • resulting in formation of thrombus within lumen
  • may lead to critical occlusion.

Should be suspected in patients with related clinical syndrome (sudden neck pain, connective tissue disease or minor trauma)

21
Q

What is a hyperdense MCA sign?

A
  • Focal increased density
  • of the middle cerebral artery
  • on CT.
22
Q

What are the two types of Haemorrhagic stroke?

A
  1. Intracerebral haemorrhage

2. Subarachnoid haemorrhage.

23
Q

What is the Glasgow coma scale? (GCS)

scores given based on (3)

A 
Neurological scale: aiming to give reliable way of recording conscious state of patient. 
Scores: 
- Eye opening 
- Verbal response 
- Motor response

Patient with bleed in head will have very low GCS.

24
Q

State common caused of intracerebral haemorrhage?

A
  1. Hypertension
  2. Arteriovenous malformations
  3. Head trauma
    Also: blood thinners, aneurysm, amyloid angiopathy, tumour
25
Q

What is an arteriovenous malformation?

A
  • tangle of abnormal arteries and veins
  • with no capillaries in between.
  • blood delivered at high pressure, vessel protein to rupture.
26
Q

Describe intracerebral haemorrhage due to aneurysm formation?

A

Charcot-Bouchard aneurysms

  • Hypertension weakens lining of arterioles —> leading to aneurysm formation.
  • rupture of these aneurysms occurs in deep structures of the brain.
27
Q

Describe cerebral amyloid angiopathy?

A
  • Amyloid (protein) builds up in walls of arteries in brain.

- Increases risk of stroke caused by bleeding and dementia.

28
Q

What is a subarachnoid haemorrhage?

A

Bleeding into subarachnoid space between arachnoid membrane and pia matter.

  • Spontaneous: rupture of berry aneurysm
  • berry aneurysm arises at sites of arterial bifurcation.
29
Q

What is polycystic kidney disease and how does this affect stroke risk?

A

Polycystic kidney disease - causes cysts to develop in liver and elsewhere in body.

  • can cause kidney failure
  • high blood pressure (hence increased risk of stroke)
30
Q

Describe a berry aneurysm?

A

Most common type of brain aneurysm (enlarging of artery caused by weakness in artery wall)

  • tend to appear at base of brain (circle of willis)
  • where large BV bifurcate
31
Q

Majority of large vessel blockages are secondary to thromboembolism from athersclerotic disease in ….

A

Internal Carotid Artery

32
Q

Describe how a CT scan may be used to show stroke?

A

CT scan required to distinguish between ischaemic and haemorrhagic stroke.
- fresh blood is bright white on a unenhanced CT scan.

Neurology Y2 (24 decks)

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