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Neuropathology > Lecture 10: Stroke > Flashcards

Lecture 10: Stroke Flashcards

1
Q

Anterior circulation of the brain is supplied by the?

A

Carotid Artery

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2
Q

Posterior circulation of the brain is supplied by?

A

Vertebral-Basilar Artery

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3
Q

The circle of willis is comprised of? (3)

A
  1. Anterior Communicating Artery
  2. 2 Posterior communicating arteries
  3. 3 Cerebral Arteries
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4
Q

70-80% of strokes occur in which artery?

A

Middle Cerebral Artery

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5
Q

What are the deficits associated with a MVA stroke? (5)

A
  1. Contralateral Hemiparesis
  2. Sensory Loss
  3. Homonymous Hemianopsia
  4. Dominant Hemisphere (Left MCA): Aphasia
  5. Non-dominant (Right-MCA): Impaired spatial perception and contralateral neglect
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6
Q

What is the difference between a Right and Left MCA Stroke?

A

Right MCA: Impaired spatial perception and contralateral neglect

Left MCA: Aphasia

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7
Q

A stroke in the Anterior Cerebral Artery (ACA) leads to…

A

Weakness in the UE > LE

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8
Q

A stroke in the Middle Cerebral Artery (MCA) leads to…

A

More Upper Extremity Weakness

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9
Q

This artery supplies primarily the medial frontal and parietal lobes.

A

Anterior Cerebral Artery (ACA)

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10
Q

What are the deficits associated with an ACA Stroke?

A
  1. Contralateral LE Weakness

2. Contralateral LE Sensory Loss

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11
Q

This artery supplies the small penetrating arteries to midbrain and thalamus, and the occipital lobes and inferior medial temporal lobe

A

Posterior Cerebral Artery

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12
Q

What does the Posterior Cerebral artery supply? (4)

A
  1. Small penetrating arteries to midbrain
  2. Small penetrating arteries to thalamus
  3. Occipital lobes
  4. Inferior Medial temporal lobe
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13
Q

What are the deficits associated with a PCA stroke? (3)

A
  1. Homonymous Hemianopsia
  2. Alexia
  3. Sensory Loss
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14
Q

The Medulla is supplied by what arteries? (2)

A
  1. Vertebral

2. PICA

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15
Q

The Pons are supplied by what artery(s)? (3)

A
  1. Basilar
  2. AICA
  3. SCA
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16
Q

The midbrain is supplied by what artery? (1)

A

PCA

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17
Q

What are the general deficits associated with a stroke that effects the brainstem?

A
  1. LOC
  2. Nausea, vomiting
  3. Hemiparesis
  4. Cranial Nerve Involvement
  5. Can have crossed signs (Ipsilateral face/contralateral body)
  6. Can have ipsilateral cerebellar signs
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18
Q

Small Location => Big Consequences
Example: Internal Capsule
-Occlusions of single small perforating arteries
What is this called?

A

Lacunae Syndromes

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19
Q

Left sided hemiparesis and sensory loss is associated with what kind of CVA?

A

Right CVA

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20
Q

Right sided hemiparesis and sensor loss is associated with which CVA?

A

Left CVA

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21
Q

This is denial of paralysis or impairment, reduced insight, inattention to left side

A

Left Sided Neglect

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22
Q

Left sided neglect is associated with which CVA?

A

Right CVA

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23
Q

Left side visual field cut.

RIGHT or LEFT CVA?

A

Right CVA

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24
Q

Right sided visual field cut.

RIGHT or LEFT CVA?

A

Left CVA

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25
Q

Aphasia is associated with a Right or Left CVA?

A

Left CVA

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26
Q

Individuals with a CVA that experience spatial problems: depth perception have a …
Right or Left CVA?

A

Right CVA

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27
Q

Impaired ability to do math, or to organize, reason, and analyze items is associated with…
Right or Left CVA?

A

Left CVA

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28
Q

Inability to localize or recognize body parts is associated with
Right or Left CVA?

A

Right CVA

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29
Q

Behavioral changes: depression, cautious, and hesitation are associated with which sided CVA?

A

Left CVA

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30
Q

The inability to understand maps and find objects, such as clothing or toiletry items is associated with which sided CVA?

A

Right CVA

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31
Q

Patients who experience memory problems typically have a CVA on which side?

A

Right and Left CVA

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32
Q

Behavior changes, such as impulsivity, inappropriateness, and depression typically have a cVA on which side?

A

Right CVA

33
Q

Impaired ability to read, write, and learn new information is associated with chi sided CVA?

A

Left CVA

34
Q

This is the leading cause of serious long-term disability in the United States

A

Stroke

35
Q

Which has a higher mortality rate, Ischemic or Hemorrhagic?

A

Hemorrhagic Stroke

36
Q

Which stroke is more common

Ischemic or Hemorrhagic?

A

Ischemic Stroke: 80%

Hemorrhagic: 20%

37
Q

What are the two types of hemorrhagic strokes?

A 
Intraparenchymal Hemorrhagic (IPH) 10-15% 
Intracerebral Hemorrhagic (ICH) 10-15%
Subarachnoid Hemorrhage (SAH) 5%
38
Q

What are the two types of strokes

A

Ischemic: Artery Occlusion
Hemorrhagic: Artery Rupture

39
Q

What are the two causes of Ischemic Strokes?

A
  1. Thrombotic: Atherosclerosis

2. Embolic: Embolism

40
Q

What are the two sites of occlusion for a thrombotic stroke?

A
  1. Main Artery occlusion

2. Lacunar Stroke: Small Penetrating Artery Occlusion

41
Q

What are the two types of Hemorrhagic Strokes? Artery Rupture

A
  1. Intracerebral/Intraparenchymal

2. Subarachnoid

42
Q

What are the two causes of Subarachnoid Strokes?

A
  1. Aneurysm

2. Arteriovenous Malformation

43
Q

This is partial or complete loss of blood supply to an area of the brain.

A

Ischemic Stroke

44
Q

What are the causes of an Ischemic Stroke? (5)

A
  1. Embolic (15-30%): cardiac embolus occluded cerebral artery
  2. Thrombotic/Atherosclerotic (14-25%): Gradual narrowing of cerebral artery
  3. Lacunar (15-30%): Small, deep vessel occlusions
  4. Cryptogenic (20-40%): Unknown
  5. Arterial dissection 2%: More in patients <30yrs
45
Q

What causes the brain tissue to die?

Mild to moderate ischemia

A

> Insufficient Oxygen and Glucose

  • ->Inadequate energy supply
  • —>Failure of neuronal activity regional brain dysfunction
46
Q

What can cause a severe ischemia?

A

Insufficient oxygen and glucose leading to inadequate energy supply

47
Q

What are the 3 causes of sever ischemia after insufficient oxygen and glucose leading to inadequate energy supply?

A

1) Influx of Water NA+ and Cl-
- Cytotoxic Edema
2) Influx of CA++
- Irreversible Cellular Injury
3) Anaerobic Metabolism
- Accumulating Lactic Acid and H+ compromise neuronal integrity

48
Q

What are the 3 causes of an advanced ischemia?

A
  1. Influx of water NA+ CL-
  2. Influx of Ca++
  3. Anaerobic Metabolism
49
Q

What is an advanced Ischemia?

A

Loss of function causes accumulation of glutamate and aspartame which bind to NMDA receptors

50
Q

With advanced Ischemia, there is loss of function that causes accumulation of glutamate and aspartame, which bind to NMDA receptors. This leads to…

A

Influx of water, Na+ and Ca++

51
Q

What is the end result of an advanced ischemia?

A
  1. Destruction of cell components

2. formation of free radicals, eicosanioids, and leukotrienes

52
Q

What are the temporal feature of an ischemic stroke?

A

> Abrupt

  • ->Stable
  • —>Gradual Improvement
53
Q

An ischemic stroke can be related with what medication?

A

rTPA within 3 hours

54
Q

What are the signs and symptoms associated with an Ischemic Stroke?

A
  1. Sudden onset of focal neurological deficits
  2. Symptoms in minutes
  3. Headache: 25% of patients
  4. Nausea and vomiting: typical with brainstem and cerebellum
  5. Acute HTN: 70% of cases
  6. ACT FAST
55
Q

What are the risk factors associated with an Ischemic Stroke?

A
  1. Hypertension
  2. Cardiac Disease
  3. Diabetes
  4. Hyperlipidemia
  5. Smoking
  6. Carotid Artery Stenosis
  7. TIA: transient ischemic attack
    - Focal brain ischemia
    - Usually lasts 10 minutes, resolves in 24 hours
56
Q

How is an ischemic stroke diagnosed?

A
  1. Computed Tomography (CT)
  2. Magnetic Resonance Imaging (MRI)
  3. Carotid US
  4. Echo
  5. ECG
  6. Lab Tests
57
Q

With an MRI T1, the infarct looks?

The bleed looks?

A

Infarct: Dark
Bleed: Bright

58
Q

With an MRI T2: the infarct looks?

The bleed looks?

A

Infarct: Bright
Bleed: Dark

59
Q

With a CT scan, an infarct looks?

A bleed looks?

A

Infarct: Dark

Bleed Bright

60
Q

With MRI T1, T2, and CT, the bleed looks?

A

Bright

61
Q

With MRI T1, T2, and CT scan, how does the infarct look?

A

MRI T1 and CT: Dark

MRI T2: Bright

62
Q

This is a bleed within the brain. 2 types

A

IPH or ICH

63
Q

This is a vessel rupture in the subarachnoid space

A

SAH: subarachnoid hemorrhage

64
Q

What is the pathogenesis of a Hemorrhagic CVA?

A

> Hematoma Forms

  • ->Cerebral Edema (peaks at 48 hours, resolved by 5 days)
  • —>Tissue shifts
65
Q

What is the most common cause of a Hemorrhagic stroke?

A

Hypertension

66
Q

What are the common IPH sites? (6)

A
  1. Lobar
  2. Basal Ganglia
  3. Internal Capsule
  4. Thalamus
  5. Pontine
  6. Cerebellar
67
Q

What are the signs and symptoms associated with IPH? (4)

A
  1. Focal Deficit that worsens over minutes
  2. Acute HTN
  3. Headache (50%)
  4. Large Hematoma: Nausea, vomiting, early decline in level of consciousness
68
Q

What are the risk factors associated with IPH? (6)

A
  1. Hypertension
  2. <55yrs old
  3. Smokers
  4. Non-compliant with antihypertensive medications
  5. Heavy alcohol use
  6. Illicit drug use
69
Q

What are the diagnostic tests for IPH? (3)

A
  1. CT Scan
  2. MRI
  3. Lab Tests
70
Q

What is a subarachnoid hemorrhage?

A

Bleeding into subarachnoid space

71
Q

What are the causes of aSubarachnoid Hemorrhage? (2)

A
  1. Ruptured Aneurysm

2. Vascular Malformation

72
Q

What are the clinical findings for a SAH? (3)

A
  1. Sudden onset severe headache
  2. Neurologic Signs
  3. LOC, Coma
73
Q

What are the diagnostic tests for a SAH? (4)

A
  1. CT Scan
  2. Catheter Angiography
  3. MRI
  4. Lumbar Puncture
74
Q

What are the differential diagnoses for all strokes? (8)

A
  1. Seizures
  2. Psychogenic
  3. Migraine with Aura
  4. Hypertensive Encephalopathy
  5. Toxic-Metabolic Encephalopathy (Hypoglycemia)
  6. Head Trauma
  7. Tumor
  8. Drug Toxicity
75
Q

What is the acute management protocol for a Stroke?

A
  1. rTPA: Intravenous Recombinant Tissue Plasminogen Activator
  2. Ischemic: Antiplatelet-Aspirin within 48hr
  3. All: blood pressure management
  4. Surgery
76
Q

When should rTPA be administered for a stroke?

A

Within 3-4.5 hours of ischemic stroke

-1/3rd of patients have reversal of stroke

77
Q

What is the risk with administering rTPA?

A

Risk of Hemorrhage (6.4%)

78
Q

What type of surgery is administered for strokes?

A
  1. Carotid Endartectomy: for carotid stenosis (ischemic)

2. Craniotomy: surgical decompression for increased intracerebral pressure

79
Q

What are the complications for a Stroke?

A
  1. Hemorrhagic transformation for infarcts
  2. Brain edema (max after 3-5 days)
  3. Seizures
  4. Medical complications
    - Aspiration pneumonia, UTI
    - DVT
    - Hyperglycemia

Neuropathology (7 decks)

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