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Neuropsychology > Lecture 5: Cerebrovascular Disease: Chapter 14 > Flashcards

Lecture 5: Cerebrovascular Disease: Chapter 14 Flashcards

1
Q

What is a cerebrovascular disease?

A

Collection of symptoms that result from an interruption in the supply of blood in the brain, known as a stroke

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2
Q

What are 2 causes of strokes? What percentage fits with each?

A
  1. Infarct: obstructed artery (80% of stroke patients)
  2. Hemorrhage: bleeding following rupture in an artery (20% of stroke patients)
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3
Q

What are 3 visible effects of a stroke which indicate you have to call emergency services?

A

FAST:
- Face dropping
- Arm weakness
- Speech difficulty
=> Time to call

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4
Q

How can you quickly see the distinction between an infarct and a hemorrhage?

A

With a CT scan: blood shows up which on a normal CT

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5
Q

What are 4 symptoms the person having the stroke experiences?

A

Sudden onset of:
1. Headache
2. Loss of mental abilities
3. Loss of strenght/paralysis
4. Confusion, disorientation, consciousness

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6
Q

What is the prevalence of strokes?

A

Worldwide a stroke every 2 seconds
About 40.000 strokes in the Netherlands yearly

Worldwide stroke is the second leading cause of death in people over 60 years of age

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7
Q

What are 2 major risk factors of a stroke?

A
  1. Age >65
  2. Hypertension leading to artherosclerosis (also caused by lifestyle factors)
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8
Q

What are some lifestyle factors that contribute to a higher risk of a stroke?

A

Obesity, smoking, sleep apnea, heavy alcohol use, high cholesterol, diabetes, lack of exercise

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9
Q

What is the difference between an ischemic and a hemorrhagic stroke?

A

Ischemic/infarct: area is deprived of blood because of obstruction of blood flow to a part of the brain

Hemorrhagic: wall of vessel ruptures causing bleeding in the brain

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10
Q

Why do young strokes occur and why are they increasing in numbers?

A

Mostly congenital factors

Increase mostly because of lifestyle factors

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11
Q

What is an infarct? And what is ischemia?

A

Obstruction of artery that leads to tissue death

Ischemia = tissue death

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12
Q

What are the 3 causes of an infarct?

A
  1. Embolism: blood clot
  2. Perfusion: inadequate blood flow
  3. Stenosis: narrowing of blood vessels
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13
Q

What leads to small lacunar infarcts?

A

Stenosis: narrowing of blood vessels

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14
Q

What is the most common location of an infarct?

A

The middle cerebral artery

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15
Q

What is TIA as an abbreviation? How long does it last and what are the 2 consequences?

A

Transient Ischemic Attack

Neurological symptoms disappear within 24 hours

Consequences:
1. Subtle cognitive deficits
2. Risk: 30% of patients suffer a stroke within the next 5 years

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16
Q

Why will the number of people living with the consequences of a stroke increase further?

A

There is an increased prevalence and decreased mortality (new treatments)

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17
Q

How does embolism work?

A

Obstruction of artery of thrombi (blood plates clot) or calcifications in the vascular wall of the blood vessels

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18
Q

What is thrombolysis and until when can you do this?

A

Injecting drug (blood thinner) in the bloodstream in order to disperse the clot in the blood vessel. The effect is limited with regard to cognitive effects

Possible until 4 hours after the onset of the stroke

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19
Q

What is thrombectomy?

A

Removing blood clot with a catheter

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20
Q

Why is it important to know if a stroke is ischemic or hemorrhagic?

A

Because of the different treatments. Ischemic strokes can be treated with blood thinners, but that would be a real bad idea when someone has a hemorrhagic stroke where you want to stop the bleeding

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21
Q

What are the 2 causes of impairment in cognitive functions after a stroke?

A
  1. Damage to area of the infarct
  2. Diaschisis: impaired functioning in areas connected to the area of the infarct
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22
Q

What are the 2 types of cerebral hemorrhage?

A
  1. Intracranial
  2. Subarachnoid
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23
Q

What is the difference in cognitive impairments between hemorrhages and ischemia?

A

Hemorrhages: more diffuse impairments
Ischemia: more clear impairments

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24
Q

What are 5 causes of intracranial bleeding?

A
  1. Stroke, hemorrhagic
  2. Tumor
  3. Degenerative conditions
  4. TBI
  5. Arteriovenous malformation
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25
Q

In what people do cerebral hemorrhages occur more often?

A

In older people with high blood pressure

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26
Q

What is a intracerebral hemorrhage? What is the most common cause?

A

Rupture in deeper arterioles

Cause: hypertension
Other causes: trauma, hemorrhagic infarct (blockage with leakage)

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27
Q

What is the subarachnoid hemorrhage (SAH)? What are the symptoms and what is the most common cause?

A

Bleeding is in the subarachnoid space between meninges.

Acute symptoms are unexpected and it’s an intense headache, followed by neck stiffness

Cause: ruptured aneurysm

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28
Q

What is the main goal of treatment of hemorrhages? What are 2 treatment options?

A

Goal = prevent brain damage that increasing pressure can do and prevent recurrence of bleeding

  1. Drugs to reduce swelling
  2. Surgery to relieve pressure (make bone flap)
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29
Q

What may be a consequence of an increase of intracranial pressure?

A

Can lead to blockage of other blood vessels, leading to ischemia

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30
Q

What is an aneurysm and what are 2 treatment options?

A

Aneurysm is a widening of a blood vessel in the subarachnoid space, which can increase pressure in the head. 85% of the cases of an aneurysm, it ruptures due to a weak wall

  1. Coiling: catheter
  2. Clipping: surgery
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31
Q

What are the 3 possible locations of an infarct and what brain regions do they affect?

A
  1. Middle cerebral artery: temporal lobe, parietal lobe part, part of frontal lobe
  2. Anterior cerebral artery: frontal lobe
  3. Posterior cerebral artery: posterior occipital and temporal lobe
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32
Q

What are 4 possible consequences of an infarct in the middle cerebral artery (MCA)?

A
  1. Memory (making new memories)
  2. Apraxia
  3. Aphasia
  4. Neglect
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33
Q

What is a good predictor of the cognitive dysfunction after a hemorrhage?

A

The extent of the bleeding, not the location

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34
Q

Who make faster recovery, ischemic or hemorrhagic patients?

A

Hemorrhagic patients

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35
Q

What is apraxia?

A

Inability to carry out meaningful movements and gestures. People are often aware of their impairment and are frustrated

E.g. wave goodbye, soup eating with fork

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36
Q

What is aphasia and where does the stroke have to be located?

A

Don’t understand language and aren’t initially aware that they talk incoherently.

Occurs especially when language dominant hemisphere (left) is hit

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37
Q

What is the relation between aphasia and depression?

A

Aphasic patients have a higher risk of depression, because of feeling of isolation

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38
Q

What is neglect? How can you see someone has visual neglect? Give 2 examples

A

It’s an intentional deficit where someone is not aware of the stimuli on the contralesional site

E.g. clock has numbers on just one side, only one side of the person is drawn

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39
Q

How can neglect improve temporarily?

A

If the patient really pays attention to the part he/she neglects, the symptoms appear to be gone. But when there are no cues for attention left, the neglect is again visible

40
Q

What are often the consequences of stroke on the right vs. stroke on the left side?

A

Right: often neglect
Left: often language problems, less neglect

41
Q

What are 2 common consequences of an infarct in the posterior cerebral artery (PCA)?

A
  1. Hemianopsia
  2. Visual agnosia
42
Q

What is hemianopsia? What is quadrant anopsia?

A

Visual field defect where half of the visual field is gone. It’s similar to neglect except this isn’t an attentional issue but it’s really blindness. People can suffer from hallucinations

Quadrant: quarter of visual field is gone

43
Q

What is visual agnosia? What are 4 types of agnosia?

A

Impaired recognition of visual information

  1. Color agnosia
  2. Prosopagnosia
  3. Apperceptive agnosia
  4. Anosognosia
44
Q

What is color agnosia?

A

Impaired recognition of color

45
Q

What is prosopagnosia?

A

Bilateral damage that leads to impaired face recognition

46
Q

What is apperceptive agnosia?

A

Bilateral damage that leads to impaired recognition due to impaired perception

47
Q

What is anosognosia?

A

Patient doesn’t perceive or believe the fact they have a perceptual condition

48
Q

Where is the damage located when it leads to problems with the perception of one’s own body?

A

Damage to parietal lobe

49
Q

How can attention and speed of processing be impacted by a stroke? (3)

A
  1. Basic attention: fall asleep when not aroused
  2. Complex attention: limited focus, distractible
  3. Slowness
50
Q

What damage corresponds with slowness of processing?

A

Damage to white matter

51
Q

What is the difference between Broca’s and Wernicke’s aphasia?

A

Broca: impaired speech production
Wernicke: impaired comprehension

52
Q

What is global aphasia?

A

A severe combination of Broca’s and Wernicke’s aphasia

53
Q

What is pure agraphia and what is the location of the damaged area?

A

Impaired writing

Damage in angular gyrus

54
Q

What are possible consequences of damage in the angular gyrus?

A
  1. Agraphia
  2. Acalculia
55
Q

What is acalculia?

A

Impaired calculations

56
Q

What is alexia and where is the damaged area located?

A

Impaired reading

Damage left posterior cerebral artery

57
Q

What is transcortical aphasia?

A

Broca’s and Wernicke’s areas are undamaged, but the connection between these areas is affected

58
Q

What is akinetic mutism and what type of damage is needed for this?

A

Complete inability to communicate verbally

Damage to bilateral posterior cerebral artery

59
Q

What are 2 possible consequences of an infarct to the anterior cerebral artery (ACA)?

A

Impaired executive functions + social cognition

60
Q

What are the consequences of small lacunar infarcts?

A

May occur in white matter and have diffuse complaints (memory/attention e.g.)

61
Q

What are the effects of subcortical strokes?

A

Cognitive and emotional problems

62
Q

Why is there a discussion about the timing of assessment after a stroke?

A

You see more impairments directly after the stroke and due to recovery in the first few months there is an always changing pattern of symptoms

63
Q

What 2 impairments have the highest prevalence in the subacute phase and after 6 months?

A

Perception impairments and impairments in executive function

64
Q

What is the timeline of the HADS (Hamilton Anxiety Depression Scale) after a stroke?

A

The scores increase from the stroke onwards. So there is an increased amount of depressivity in people who suffered from a stroke

65
Q

What is anterograde amnesia?

A

Decreased ability to either acquire or retrieve new information

66
Q

What is retrograde amnesia? What brain areas are affected?

A

No memory for events before damage

Non-medial parts of temporal lobe

67
Q

What is mostly affected by a stroke, declarative or procedural memory? What does that mean?

A

Mainly declarative, so individuals may not be able to recall past events, but do have the capacity to ride a bike

68
Q

Give an example of modality-specific memory problems

A

E.g. inability to remember faces

69
Q

What is abulia and where is the damage located?

A

Apathy and a loss of motivation to initiate taks.

Damage in frontal lobe

70
Q

What is the consequence of damage in the anterior circulation of the brain? What is an explanation of this?

A

Clear limitations in daily functioning which don’t show in neuropsychological tests.

Because impairment is in an area of behavior and not in an entire function (e.g. changes in personality, disinhibition, blunted affect)

71
Q

What is apraxia? What are the 2 forms of apraxia?

A

Inability to carry out meaningful movement and gestures

  1. Ideomotor apraxia = concept is intact and no motor or sensory limitations
  2. Buccofacial apraxia = tongue and mouth can’t voluntarily be controlled
72
Q

What is anosodiaphoria?

A

A lack of concern about the impairment

73
Q

What is the difference between disorders in body image vs. body schema? Where is damage often located for this?

A

Body image: mental representation of own body

Schema: position of parts of their body in relation to the environment

Damage in parietal lobe

74
Q

Some patients experience problems with time perception. Where is the damage often located (3)?

A

Parietal lobe, cerebellum, prefrontal parts

75
Q

What percentage of patients experience impairments of executive functions during the acute phase following a stroke?

A

50%

76
Q

What are differences in effects of damage in hemispheres concerning social cognition? How well supported is it?

A

Damage right: depression
Damage left: indifference of euphoria

Not well supported by evidence

77
Q

What may be a consequence for social cognition with damage to the cerebellum?

A

Pathological laughter

78
Q

What is the prevalence of vascular dementia?

A

Second most common type of dementia after Alzheimer

79
Q

What are the 2 possible courses of vascular dementia?

A
  1. After a single infart in a strategic location
  2. After multiple simultaneous/shortly following infarcts in combination with slow progressive damage to white matter
80
Q

What are 3 symptoms of vascular dementia?

A
  1. Slowness
  2. Executive functioning deficits
  3. Memory loss
81
Q

What is leukoaraiosis?

A

Slow progressive damage to deep white matter in the brain

82
Q

What is small vessel disease?

A

Progressive damage to the smallest cerebral blood vessels that can result in vascular dementia

83
Q

What is vascular cognitive impairment (VCI)?

A

Umbrella term for cognitive impairments caused by vascular disorders

84
Q

What predicts proper orientation in a patient?

A

Better prognosis for recovery of cognitive functioning

85
Q

What is the link between delirium and strokes?

A

Delirium is rarely a direct consequence of stroke

Usually there is an different cause for delirium

86
Q

What is delirium and what are possible causes?

A

It entails disturbed consciousness, hallucinations, restlessness and emotional instability. It often occurs suddenly

Causes: pain, metabolic dysregulation, infection, drugs or epilepsy

87
Q

What is reduplicative paramnesia? Where is damage most likely?

A

Patient doesn’t recognize their environment and maintains, even after clear indications to the opposite effect, that it is not their home

Often after a stroke in right hemisphere

88
Q

What is hypertension?

A

High blood pressure

89
Q

What is the prevalence of fatigue in stroke patients?

A

More than 50%

90
Q

What are possible treatments for fatigue after a stroke?

A

Psychoeducation + change in attitudes to fatigue + gradual increase in physical activities–> cognitive behavioral therapy

Not a lot of evidence on this

91
Q

Why do prevalence figures vary widely on the matter of depression and strokes? (2)

A
  1. Different diagnostic instruments and criteria in various studies.
  2. Depression is not always recognized because of lack of insight of the patient/inability to express their symptoms
92
Q

What is the percentage of stroke patients that meet DSM criteria for depressive disorder? When is the onset for depression often? What is the course of the depression?

A

50%

Onset: during first 6 months after loss of function with a peak at around 3 months

Depression is usually temporary, but it can persist longer

93
Q

What is reactive depression?

A

The idea that depression occurs after a stroke

94
Q

What is the vascular depression hypothesis?

A

Depression that occurs after a stroke is caused by disruption of specifc networks in the brain, resulting from vascular damage

95
Q

What seems to be the most plausible explanation for the development of a depression after a stroke? (3)

A

Combination of the location of the lesion, reactive component and vascular risk factors

96
Q

What is a catastrophic reaction? What is it’s relation with depression? And relation with recovery?

A

The reaction when the patient has had to face the reality of their limitations in the first few days after the incident

Unclear if it’s a precursor to depression

Occurence of catastrophic raction is linked to poor prognosis for recovery

Neuropsychology (16 decks)

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