Neurological disorders & stroke

Question 1

8 kinds of diseases

Answer 1

VITAMINS (vascular, infectious, traumatic, autoimmune, metabolic, idiopathic, neoplastic, seizure)

Question 2

5 things you need to know about a disease

Answer 2

epidemiology, prognosis, pathophysiology, clinical features, treatment

Question 3

Cerebrovascular supply

Answer 3

brain receives blood from the internal carotid arteries (located at the bifurcation on the neck and branches into the MCA and ACA) and vertebral arteries

Question 4

Posterior circulation

Answer 4

supplies the posterior cortex of the brain (occipital lobe, cerebellum, brain stem) and some subcortical structures

Question 5

Arteries responsible for posterior circulation

Answer 5

posterior communicating artery (PCoA), thalamoperforating arteries, medial and lateral posterior choroidal arteries

Question 6

3 cerebral arteries

Answer 6

anterior (for anteromedial region), middle (for lateral region), posterior (medial and lateral regions of posterior cerebrum) cerebral arteries

Question 7

Deficits from right ACA stroke

Answer 7

behavioral changes (e.g. apathy), left-side deficits (e.g. hemiparesis, hemiplegia)

Question 8

Deficits from left superior MCA stroke

Answer 8

Broca’s aphasia (frontal lobe), right upper extremity weakness and spasticity

Question 9

Deficits from basilar artery stroke

Answer 9

located before the split so bilateral deficits, not cerebellar like ataxia and scanning speech

Question 10

2 types of strokes

Answer 10

ischemic and hemorrhagic

Question 11

Ischemic stroke

Answer 11

clot blocking blood flow to an area of the brain (e.g. plaque buildup or atherosclerosis, embolism); most common kind

Question 12

Hemorrhagic stroke

Answer 12

bleeding inside or around brain tissue due to rupture in a blood vessel from too much pressure

Question 13

5 subtypes of hemorrhagic stroke

Answer 13

intracerebral, aneurysm, epidural, subdural, subarachnoid

Question 14

3 most common sites of an aneurysm

Answer 14

anterior communicating artery, posterior communicating artery/internal carotid artery, middle cerebral artery

Question 15

2 surgical interventions for aneurysms

Answer 15

clip and coil

Question 16

4 major causes of disability and death

Answer 16

heart disease, cancer, accidents, aneurysms

Question 17

Incidence and risk of aneurysms

Answer 17

increases with age; risk factors modifiable (e.g. hypertension, diabetes, smoking, sodium intake)

Question 18

What increases the risk for each type of stroke?

Answer 18

anticoagulant medications increase risk for hemorrhage; atrial fibrillation increase risk for ischemic stroke

Question 19

2 regions involved in pathophysiology of ischemic stroke

Answer 19

penumbra and ischemic core

Question 20

Penumbra

Answer 20

injured brain tissue around the ischemic core that is somewhat deprived of nutrients and eventually dies if not treated

Question 21

Ischemic core

Answer 21

the structural lesion or irreversibly damaged brain tissue due to cell death

Question 22

Pathophysiology of hemorrhagic stroke

Answer 22

midline shift or displacement of brain tissue across the centerline of the brain (e.g. left hemisphere moves into right)

Question 23

Clinical presentation of acute strokes

Answer 23

focal unilateral deficits

Question 24

Clinical presentation of hemorrhagic strokes

Answer 24

headache, vomiting, severe hypertension, coma

Question 25

Deficits from infarction of left MCA superior division

Answer 25

right face and arm weakness of the upper motor neuron type; nonfluent or Broca’s aphasia; possibly some right face and arm cortical-type sensory loss

Question 26

Deficits from infarction of left MCA inferior division

Answer 26

fluent or Wernicke’s aphasia; right visual field deficit; possibly some right face and arm cortical-type sensory loss, mild right-sided weakness at the onset of symptoms; initially appear confused or crazy

Question 27

Which kind of stroke has a better prognosis?

Answer 27

ischemic (most of recovery occurs in first 3 months); risk of death and disability is higher in hemorrhagic

Question 28

Factors affecting prognosis of stroke

Answer 28

age, stroke size, severity of initial deficits

Question 29

Treatments for stroke

Answer 29

thrombolytics and thrombectomy (ischemic); surgical evacuation (hematomas); secondary prevention; rehabilitation (PT, OT, SLP, other therapies)

Question 30

Thrombolytics (tPA)

Answer 30

clot-busting medication that restores blood flow; has a limited window (must be given within the first 3 hours)

Question 31

Thrombectomy

Answer 31

mechanical evacuation of clot using a tiny metal claw through the thigh

Question 32

Surgical evacuation for hematoma

Answer 32

opening up the skull to relieve pressure and suck up excess blood

Question 33

Secondary prevention of stroke

Answer 33

medication and lifestyle management of risk factors for second stroke