Lecture 4: Stroke I Flashcards
What percent of body weight is the brain
2%
what areas requires high oxygen demand
brain, cardiac output, and total body oxygen
which vessels are in the anterior 3/5 of the brain
internal carotids
which vessels join to form the basilar artery and are in the posterior 2/5 of the brain ; run through the cerebellum and brainstem
vertebral arteries
which artery is mainly assoc. with visual probs.
posterior cerebral artery
which two molecules need to be continually fed to the brain for it to function properly
glucose and oxygen
the brain has what type of neurons
aerobic
oxidative stress can cause …
excess glutamate ( neurotoxic neurotransmitter) ; excess ic Ca -> compromised ic signaling; re-perfusion injury -> forms ROS causing mitochondrial dysfunction
what is a less severe form of stroke ; brief period of inadequate cerebral perfusion
Transient Ischemic Attack (TIA)
this attack involves sudden focal loss of neurologic function; rapid onset and resolution usually followed by full recovery in 24 hours
TIA
this attack can be caused by intermittent vessel obstruction and temporary vasospasm
TIA
what % of pts will have a full on stroke if TIA not treated
35 %
These symptoms are of what disorder: hemiplegia, diplopia, transient loss of vision , vertigo, loss of speech, loss of understanding, loss of balance
TIA
this is transient loss of vision ; blood flow issue to the eye where the vision blacks out and then comes back
Amaurosis fugax
what is a differential Dx of TIA
migraines, seizures, hx of similar episodes
what are some features of non TIA events
lightheadedness, chest tightness, stomach upset, Hx of similar episodes where TIA was ruled out , SPEED OF ONSET
this is a disturbance of blood supply causing loss of brain function
stroke
this is the #4 cause of death in the US and #6 worldwide
stroke
what are people who are at high risk for stroke
older adults ( >65 usually), African americans, american indians, Alaska natives, low level education, Southeast US
what are some risk factors for Stroke
HTN ( modifiable), Age, Patent foramen ovale , etc
this describes a structure that is congenital and delivers oxygenated blood from mother into the arterial circulation of the fetus- it should close after birth and sometimes it doesn’t- when it doesn’t the venous circulation passes into the arterial circulation
patent foramen ovale
what are the two types of strokes
ischemic and hemorrhagic
which type of stroke is more common ( 80-85 %) and has mortality rate of 40%
ischemic ( blood supply has been cut off in some way)
which type of stroke is less common ( 15-20%) and has mortality rate of 80%
hemorrhagic ( when a bv burst or breaks open and blood leaks into other areas)
what is the most common cerebral artery affected by CVA
Middle Cerebral Artery
with ischemic stroke , what are the diff types of blood vessel occlusions you can have
thrombotic, embolic, lacunar, and dissection ( carotid or vertebral)
with ischemic stroke , what are the diff types of systemic hypoperfusion you can have
pump failure, and hypovolemia
these areas of ischemic stroke are most at risk areas; no redundant blood supply ; minimally perfused area ; between major arteries
watershed areas
this area of ischemic stoke has blood flow
ischemic core
this area of ischemic stroke has blood flow between 40-15 % normal ; least severe pt of CVA’ some collateral blood flow possible
ischemic penumbra
this disorder involves plaque fragments from carotids; chronic atrial fibrillation; fat particles; gas bubbles; bacterial endocarditis; IV substance abuse
embolic stroke
this type of stroke deals with intracranial artery rupture ( hypoxic and hydraulic damage)
hemorrhagic stroke
common causes of this stroke include HTN, aneurysm , AV malformation, and trauma; sudden onset and severe
hemorrhagic stroke
what are the two locations of a hemorrhagic stroke
extra-axial ( outside brain tissue) and intra- axial ( inside brain tissue)
what are the three locations of an extra-axial hemorrhagic stroke
epidural, subdural, and subarachnoid
this type of extra- axial hemorrhagic stroke is caused by head trauma and involves the middle meningeal artery
epidural
this type of extra- axial hemorrhagic stroke is usually due to acceleration/deceleration injury and is found in elderly and alcoholics
subdural
this type of extra- axial hemorrhagic stroke is congenital or traumatic and can cause severe HA -> papilledema
subarachnoid
this type of hemorrhagic stroke involves rupture and hemorrhage into the brain ( hypoxic and hydraulic injury )
intra-axial cerebral hemorrhagic stroke
these disorders are associ with what type of hemorrhagic stroke: HTN, AVM, Berry aneurysms, trauma
Intra-axial cerebral hemorrhagic stroke
what % of strokes happen in adults less than 65 YO
25 % ( majority are ischemic) , 45% are hemorrhagic
what causes strokes in adults less than 65 YO
trauma, oral contraceptives, pregnancy, post partum, HTN, DM, obesity, smoking, atherosclerosis
which two types of ischemic strokes are involved in young adults
carotid artery and vertebral artery dissection
this type of dissection can be traumatic or spontaneous; symptoms include HA or neck pain, horners syndrome, transient vision loss, ischemic stroke
carotid artery dissection
this type of dissection is similar to carotid artery dissection
vertebral artery dissection
what is it called when the intenal wall of the bv becomes compromised from a tear and the blood pushes over the inner lining and causes a fake valve to occur and cuts off blood supply
dissection
