NP: Chapter 14 Cerebrovascular disease Flashcards
stroke =
bunch of symptoms resulting from interruption of the blood supply to the brain
verschil infarct en ischemia
beiden: obstruction of an artery causing the blood supply to be blocked
ischaemia = nog niet afgestorven
infarct = afgestorven
hoeveel mensen met stroke hebben infarct
80%
fijn, want infarct lijkt me makkelijker weg te halen
ischemic stroke =
blood deprived area door een blockage of obstruction
hemorrhagic stroke =
bleeding area, door weak spot in vascular walls, leaks blood into the brain
dus hemorrhage = bloeding
dus verschillen ischemic en hemorrhagic stroke
ischemic = obstruction
hemorrhage = ruptured blood vessel
in most cases a stroke is manifested as…
acute loss of function in arm or leg on one side of the body
drooping corner mouth
difficulty speaking
waarbij zie je consciousness in de patienten en waar zie je decline in consciousness
consciousness = infarct
decline in consciousness = hemorrhage
welke measurement in de acute phase
ct scan of mri scan
(om te bepalen of het infarct of hemorhage was)
hoeveel strokes per jaar
17 miljoen wereldwijd
leading cause of death van stroke?
second, for ppl 60+
most infarcts are caused by…
= dus ischemic stroke!
embolism -> blood clot
wat is een transient ischemic attack TIA
ischemic stroke, door embolism, waarvan de symptomen binnen 24 uur verdwijnen (meeste verdwijnen binnen 30 minuten)
wat is de loss of function van een tia
meestal temporary, maar soms subtle cognitive effects
main risk factor for infarct?
age
other risk factors for infarcts
door atherosclerosis -> smoking, hypertension, diabetes, obesity, hypercholesterolemia
hoeveel mensen met infarct hebben cardiac disease
1/6
helft van de hemorrhages komen door
high blood pressure (50%!!)
4 andere causes van hemorrhage
arteriovenous malformation
inflammation of vascular wall
coagulopathy
brain tumor
subarachnoid hemorrhage symptoms
severe headaches, neck stiffness for a few hours
how many patients with subarachnoid hemorrhage SAH do not have significant loss of function
only 1/3
dus 2/3 van de mensen met SAH hebben wel significant loss of function
doel van treatment van hemorrhage
prevent important brain areas from becoming compressed + prevention of rebleeding
ethiology of the consequences of a stroke
door de infarct zelf
damage to remote areas due to anatomical connection with remote areas is decreased -> dysfunction
differences in recovery for hemorrhage vs infarct
hemorrhage = less conscious, confused, longer recovery
infarct = gaat sneller
pattern of cognitive functions after stroke
hetzelfde at 3,6 and 15 months after stroke
8 consequences of stroke affect…
memory
language
attention and speed of information processing
perception
social cognition
praxis and motor system
executive functions
anosognosia
memory impairments in hoeveel mensen
1 week: 13-50%
1 jaar: 11-31% of those patients
memory: waar damage?
meestal linker hemisphere (of bilateral)
kan ook door language komen?
wat voor soort memory loss is het
anterograde amnesia (dus geen nieuwe herinneringen kunnen maken) tijdens de acute phase
attention problems prevalence after stroke
40%
bradyphrenia =
slowness
hoeveel mensen bradyphrenia
bijna allemaal. vooral na infarct in subcortical areas (white matter -> connections!!!)
language prevalence stroke
21-38% mensen hebben aphasia
welke deel hersenen stroke language problems
medial cerebral artery in left hemisphere
global aphasia
mix between wernicke en broca (vaak zo na stroke)
visual and color agnosia due to damage in…
posterior cerebral artery, posterior
hemianopsia =
less vision in de helft van de visual field
anopsia =
geen vision meer
prosopagnosia =
geen gezichten meer herkennen
apperceptive agnosia =
geen afbeeldingen of kleuren herkennen
neglect komt door…
cerebral infarct bij middle cerebral artery in right hemisphere
dus welke hemisphere bij neglect aangedaan
right
executive functions hoeveel patients
50%
abulia =
inability to take initiative
apathetic
slow
apraxia welke hemisphere
left
apraxia =
inability to perform learned movements on command
buccofacial apraxia =
inability to perform goal-oriented tongue and mouth movements
cerebellum is voor
motor planning
emotional functioning welke hemisphere
right hemisphere
(but left as well, in a different way)
anosognosia =
lack of understanding/insight in seriousness of the disease
anosognosia welke hemisphere
right
vascular dementia =
wanneer resultaten van een stroke zo severe zijn dat het leidt tot cognitive dysfunctions.
hoeveel mensen diagnosed met vascular dementia
25% after 3-12 months
waardoor wordt vascular dementia veroorzaakt
1 single infarct in strategic location of multiple infarcts simultaneously
disorientation prevalence
40% during the acute phase of the infarct
delirium after stroke kenmerken
gebeurt niet vaak, suddenly, may involve:
disturbed consciousness
hallucinations
restlessness
emotional instability
lethargy
fatigue
more than 50% after stroke
emotional functioning after stroke prevalence
90% report changes in emotional functioning after 3-9 months
debate about depression after stroke
is it due to the stroke, or trauma from the life changing event???
vascular depression hypothesis: door disruption of the specific networks in the brain due to damage
reactive depression: door life changing event