- ischaemic stroke/infarct - heamorrhage stroke

NP: Lecture 5 Cerebrovascular diseases Flashcards by Megan H

4 sudden onset symptoms of a stroke

headache
loss of mental abilities
loss of strenght/paralysis
confusioon, disorientation, consciousness

How well did you know this?

Not at all

Perfectly

wat voor scan bij stroke

ct scan, voor verschil tussen hemmorhage en infarct -> blood shows up white on normal ct

How well did you know this?

Not at all

Perfectly

prevalence stroke worldwide

a stroke every 2 seconds

How well did you know this?

Not at all

Perfectly

hoeveel strokes per jaar in nl

40.000

How well did you know this?

Not at all

Perfectly

hoeveel stroke survivors in nl

200.000

How well did you know this?

Not at all

Perfectly

wat hebben de survivors vaak als symptomen

chronic deficits and complaints

How well did you know this?

Not at all

Perfectly

number of survivors are increasing due to…

better treatment and increased prevalence -> higher life expectancy

How well did you know this?

Not at all

Perfectly

stroke is an age related disease but…

young strokes (between 18-50) are increasing

How well did you know this?

Not at all

Perfectly

ethiology of strokes

ischaemic stroke/infarct
heamorrhage stroke

How well did you know this?

Not at all

Perfectly

hoeveel % ischaemic stroke

80%

How well did you know this?

Not at all

Perfectly

hoeveel % haemorrhage stroke

20%

How well did you know this?

Not at all

Perfectly

ischaemic stroke =

obstruction blocks blood flow -> area is deprived of blood

How well did you know this?

Not at all

Perfectly

haemorrhage stroke =

weakened vessel wall ruptures, causing bleeding in the brain

How well did you know this?

Not at all

Perfectly

infarcten verschillende prevalentie

arteria cerebri media = 80%
arteria cerebri posterior = 10%
arteria cerebri anterior =3%
small lacunar infarcts (in white matter)

How well did you know this?

Not at all

Perfectly

infarct =

afsterven weefsel

How well did you know this?

Not at all

Perfectly

mild form of infarct

transient ischemic attack = TIA

How well did you know this?

Not at all

Perfectly

wat is kenmerkend van een tia

de symptoms dissapear within an hour

How well did you know this?

Not at all

Perfectly

infarct acute treatment

thrombolyse
thrombectomy

How well did you know this?

Not at all

Perfectly

thrombolyse =

tissue plasminogen activator geven, lost de bloodclot op

How well did you know this?

Not at all

Perfectly

within …. after onset moet thrombolyse gedaan worden

within 4 hours

How well did you know this?

Not at all

Perfectly

thrombectomy

removal of the brain clot with a catheter

How well did you know this?

Not at all

Perfectly

cerebral haemorrhages occur more in older ppl with …

high blood pressure

How well did you know this?

Not at all

Perfectly

intracranial bleeding can also occur after…

traumatic brain injury
tumour
degenerative conditions (amyloid, dementia)
arteriovenous malformation

How well did you know this?

Not at all

Perfectly

haemorrhage acute treatment

acute treatment is often conservative
medication to reduce swelling
surgery to relieve pressure on the brain

How well did you know this?

Not at all

Perfectly

subarachnoidal heamorrhage

outside brain, in cavity between arachnoids pressure on the brain may lead to damage most frequent cause: aneurysm

2 treatments subarachnoid hemorrhage

- coiling with cathether - clipping (surgery)

cognitive consequences of a stroke: medial cerebral artery

memory language motor disorders (parese, ataxia, apraxia)

consequences of stroke: frontal lobe

exectutive orders (bv anterior communicating artery)

wanneer neuropsychological assessment

subacute phase & after 6 months

left hemisphere stroke problems

aphasia (comprension + communication -> reading, speaking, writing) apraxia (inability to carry out meaningful movements and gestures) depression

neglext =

not aware of stimuli on the contra lesional side

bij welke hemisphere vaak neglect

bij right hemisphere (dus linkerkant niet zien)

cognitive consequences of stroke

* Attention and speed of information processing * Memory * Language (aphasia) * Perception * Executive functions * Praxis and motor systems * Social cognition * Reduced self awareness * Anosognosi

emotional and behavioural consequences

* Fatigue * Emotional / lability * Depressive / anxiety * Irritability /aggressive * Sexual problems * Underestimating / overestimating self * Impulsive * Reduced initiative

post stroke emotional problems in left hemisphere

depression or catastrophic reaction

post stroke emotional problems in right hemisphere

indifferent, euphoric reactions, reduced self-awareness

frontal stroke emotional problems

impulsive, disinhibited.

wat waren de bovengenoemde post stroke emotional problems?

direct effects of the lesion! direct gaat om location of the stroke

post stroke emotional problems: indirect effects of lesions

significant relationship between size, not location of the lesion. dus indirect gaat om size of the stroke

indirect lesion associations with..

dus size association with cognitive impairments

hoeveel mensen diagnosed with traumatic brain injury each year in NL

85.000

hoeveel mensen met TBI sterven uiteindelijk

4-6%

prevalence in NL chronic tbi patients

200.000

hoeveel mensen discharged home met tbi

90%, often with little rehabilitation

majority of tbi patients is...

15-24 years old

gender in tbi

men 2x zovaak als women

2 types of tbi

open skull fracture tbi closed tbi

open skull fracture tbi voorbeelden

penetrating objects bullet wounds

closed tbi voorbeelden

traffic accidents fall from height blows to the head violence industrial accidents

open skull fracture tbi kenmerken

local lesiono rotating forcees: diffuse neural damage risk of secondary microbleeds

closed tbi kenmerken

focal atrophy (coup-contrecoup) rotating forces (neuronal shearing) microbleeds

focal atrophy: 2 vormen

frontal impact = frontal + occipital sideways impact = temporal lobes

delayed effect in adults =

boxers syndrome chronic traumatic encephalopathy

hoe zie je delayed effect

rapid development of dementia and/or Parkinson-like deficits a few years after series of head trauma’s

secondary damage of tbi

subarachnoid haemmorhages: Traumatic subarachnoid hemorrhage occurs regularly following moderate and severe TBI and is associated with poorer and slower recover

classification of traumatic brain injury: duration of unconsciousness

mild = < 30 moderate = 30 min - 24 hours severe > 24 hours

classification tbi: post traumatic amnesia

mild = < 24 hours moderate = 1-7 days severe = > 7 days

prognosis depends on ...

severity

glasgow coma schale is gebaseerd op 3 dingen

opening the eyes motor reaction verbal response

prevalences mild vs moderate vs severe tbi

mild = 80-85% moderate = 10% severe = 5-10%

is iq a good measure to assess cognitive deficits after tbi

NO!!

mental abilites affected by tbi are..

* Speed of information processing * Attention * Executive functions * Memory * Language and speech * Social cognition TBI = SALEMS (STROKE = PALMPEAS)

verschillende tijdsduur van post traumatic amnesia en unconsciousness

unconsciousness = < 30, 30-24, 24 post traumatic amnesia = 24, 7 days more than 7 days

but... what could explain what symptoms?

attention problems could be explained by speed of processing dus speed of processing -> attention

dysexecutive syndrome = problems with...

* planning * flexibility * inhibition of the dominant response * monitoring, use of feedback * insight

memory 4 types

1. remote memory (retrograde maar dan alleen de day before) 2. retrograde amnesia 3. post-traumatic amnesia 4. anterograde amnesia

welke is het vaakste aangedaan bij tbi

anterograde amnesia

hoe meet je anterograde amnesia

rey auditory verbal learning test

social cognition problems

* Difficulty to perceive emotional stimuli * Problems with understanding emotions and thoughts of others * Difficulty seeing things from another perspective * Difficulty inhibiting behavior

emotional and behavioural consequences

* Emotional lability * Irritability (aggressiveness) * Apathy * Loss of initiative * Disinhibited (loss of decorum) * Egoistical behaviour

wie heeft het meeste last van emotional + behavioural consequences

not the patient but the family/partner