Memory and Stroke

Question 1

Human memory has 3 main types

Answer 1

sensory memory
short-term memory (working memory)
long-term memory (life-time)

Question 2

two types of long term memory

Answer 2

explicit (conscious)
implicit (unconscious)

Question 3

Procedural memory

Answer 3

unconscious recall of how to perform an action or skill (remembering how to ride a bike) type of implicit memory

Question 4

episodic memory

Answer 4

involves context; must be learned all at once (remembering where you parked your car when you go into the grocery store) type of explicit/declarative memory

Question 5

semantic memory

Answer 5

involves facts without context; facts for which the context does not matter (the sun is a star) can be acquired gradually over time; type of explicit/declarative memory

Question 6

HM and the Hippocampus

Answer 6

HM had a seizure disorder; suffered from severe intractable epilepsy; had medial temporal lobectomy surgery to remove HIPPOCAMPUS AND AMYGDALA; after surgery: reduction of seizures, emotional stable and IQ increased BUT lost all memory
wrote in diary “today I woke for the first time”

Question 7

Long term memory storage

Answer 7

memory peaks around age 8
reviewing/rehearsing materials
storage is not permanent for a few hours to day

Question 8

Amnesia

Answer 8

partial or total loss of memory
2 types

Question 9

anterograde amnesia

Answer 9

failure in explicit memory
declarative
information available to consciousness
failure of relational learning
cant form new memories

Question 10

retrograde amnesia

Answer 10

failure in implicit memory
non-declarative
cant recall previous memories

Question 11

stroke

Answer 11

occurs when something blocks blood supply to part of the brain or when a blood vessel in the brain bursts
~750,000/year

Question 12

infarcts

Answer 12

tissue necrosis due to stroke

Question 13

CVA

Answer 13

cerebrovascular accident

Question 14

ischemic stroke

Answer 14

obstruct the flow of blood; can be caused by a thrombus or an embolus
~88% strokes

Question 15

thrombus

Answer 15

blood clot in blood vessels; can be the cause of a ischemic stroke

Question 16

embolus

Answer 16

a piece of material that breaks off and is carried through the bloodstream until it reaches an artery too small to pass through: can cause an ischemic stroke

Question 17

hemorrhagic strokes

Answer 17

caused by bleeding in the brain
~12% of strokes

Question 18

transient ischemic attack (TIA)

Answer 18

a stroke that lasts only a few minutes
1/3 will eventually have an actual stroke
50% within 1 year will have a stroke

Question 19

initial damage in ischemic strokes d/t glutamate ecotoxicity

Answer 19

excessive glutamate is the immediate cause of neuron death
decreased O2 leads to neural membrane depolarization = high glutamate
NMDA receptors become overstimulated
inflammation attracts microglia
microglia attracts WBC that attach to the region
= cell death

Question 20

stroke risk factors: non-modifiable

Answer 20

age
race
family history

Question 21

stroke risk factors: modifiable

Answer 21

smoking
obesity
high blood pressure
alcohol
stress

Question 22

circle of willis

Answer 22

where the internal carotid arteries branch into smaller arteries that supply oxygenated blood to over 80% of the cerebrum: on ventral part of the brain

Question 23

Middle cerebral artery (MCA) stroke

Answer 23

90% of strokes
largest of the brain arteries
supplies most of the outer surface of the frontal, parietal, temporal lobes and basal ganglia

Question 24

MCA stroke symptoms

Answer 24

contralateral weakness and sensory loss in UPPER EXTREMITIES
loss of vision
Left MCA strokes: speech deficits (Brocas and wernicke’s)
right MCA strokes: neglect and poor motivation (flat prosody)

Question 25

anterior cerebral artery (ACA) strokes

Answer 25

less common
feeds deep structures in the brain, frontal, parietal, corpus callosum, and bottom of the cerebrum

Question 26

symptoms of an ACA stroke

Answer 26

contralateral motor and sensory loss in LOWER EXTREMITIES
poor gait and coordination = clumsy
slowed initiation
flat affect
urinary incontinence

Question 27

Posterior Cerebral Artery (PCA) stroke (and symptoms)

Answer 27

5-10%
impaired consciousness, nausea/vomiting
ataxia
vision change
nystagmus

Question 28

Arteriovenous malformations (AVMs)

Answer 28

tangle of arteries and veins without connecting capillaries
acquired through inborn genetic mutation followed by a secondary mutation (1-2% of strokes)
vary in size
damage: compression of neighboring structures and “steal” blood from surrounding areas
presentation: sx onset between 10-40; intracranial hemorrhage most common presentation

Question 29

BE FAST

Answer 29

balance: does the person have loss of balance
eyes: has the person lost vision in one/both eyes
face: does the person’s face look uneven
arms: can the person raise both arms for 10 secs
speech: is the speech slurred
time: time is $$$ call 911 asap

Question 30

Tissue plasminogen (tPA)

Answer 30

can be administered within 4.5 hours of a stroke (why time is $$$) helps to restore blood regions affected by a stroke which limits the damage and functional impairment by a stroke
after time limit = increases hemorrhagic effect (bad)

Question 31

Psychiatric considerations for stroke: depression

Answer 31

post stroke depression impacts 1/3 of stroke survivors
6x increased risk of depression 2-3 years post stroke
more common in L frontal and basal ganglia strokes

Question 32

Psychiatric considerations in stroke: anxiety

Answer 32

1/4 meet GAD criteria post stroke
less common

Question 33

Psychiatric considerations for stroke: psychosis

Answer 33

more common in right-temporo-parietal-occipito area lesions, seizures and subcortical atrophy
pseudobulbar affect: 10-15% post stroke patients
hypomanic symptoms 1%

Question 34

Post-stroke depression treatment

Answer 34

early psychopharmacological treatment is KEY