NP: Lecture 5 Cerebrovascular diseases Flashcards
4 sudden onset symptoms of a stroke
headache
loss of mental abilities
loss of strenght/paralysis
confusioon, disorientation, consciousness
wat voor scan bij stroke
ct scan, voor verschil tussen hemmorhage en infarct -> blood shows up white on normal ct
prevalence stroke worldwide
a stroke every 2 seconds
hoeveel strokes per jaar in nl
40.000
hoeveel stroke survivors in nl
200.000
wat hebben de survivors vaak als symptomen
chronic deficits and complaints
number of survivors are increasing due to…
better treatment and increased prevalence -> higher life expectancy
stroke is an age related disease but…
young strokes (between 18-50) are increasing
ethiology of strokes
- ischaemic stroke/infarct
- heamorrhage stroke
hoeveel % ischaemic stroke
80%
hoeveel % haemorrhage stroke
20%
ischaemic stroke =
obstruction blocks blood flow -> area is deprived of blood
haemorrhage stroke =
weakened vessel wall ruptures, causing bleeding in the brain
infarcten verschillende prevalentie
arteria cerebri media = 80%
arteria cerebri posterior = 10%
arteria cerebri anterior =3%
small lacunar infarcts (in white matter)
infarct =
afsterven weefsel
mild form of infarct
transient ischemic attack = TIA
wat is kenmerkend van een tia
de symptoms dissapear within an hour
infarct acute treatment
- thrombolyse
- thrombectomy
thrombolyse =
tissue plasminogen activator geven, lost de bloodclot op
within …. after onset moet thrombolyse gedaan worden
within 4 hours
thrombectomy
removal of the brain clot with a catheter
cerebral haemorrhages occur more in older ppl with …
high blood pressure
intracranial bleeding can also occur after…
- traumatic brain injury
- tumour
- degenerative conditions (amyloid, dementia)
- arteriovenous malformation
haemorrhage acute treatment
acute treatment is often conservative
medication to reduce swelling
surgery to relieve pressure on the brain
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
- remote memory (retrograde maar dan alleen de day before)
- retrograde amnesia
- post-traumatic amnesia
- 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
