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Scientific Foundations > Pathophysiology of Stroke > Flashcards

Pathophysiology of Stroke Flashcards

1
Q

What are the 4 main features of a stroke?

A
  1. Rapid onset of symptoms
  2. Signs of focal disturbance of cerebral function
  3. Symptoms last 24 hours or longer
  4. No apparent cause other than vascular
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2
Q

What is a stroke in evolution?

A

A stroke that is actively progressing, with symptoms worsening

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3
Q

Which type of stroke is more likely to effect a specific region, leading to stereotyped deficits?

A

Ischaemic

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4
Q

Why do haemorrhagic strokes produce less predictable symptoms?

A

Because of possible secondary mechanisms such as raised intracranial pressure, cerebral oedema, or compression

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5
Q

What might more diffuse, global cerebral dysfunction indicate?

A

Cerebrovascular disorder (not “stroke”)

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6
Q

Which brain areas are supplied by the anterior (carotid) circulation?

A

Most of the cerebral cortex, subcortical white matter, basal ganglia, internal capsule

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7
Q

Lesions in the anterior circulation are more likely to lead to what kind of dysfunction?

A

Hemispheric, such as aphasia, apraxia, agnosia

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8
Q

Which brain areas are supplied by the posterior (vertebrobasilar) circulation?

A

The brainstem, cerebellum, thalamus, and parts of the occipital and temporal lives

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9
Q

Lesions in which part of the circulation are more likely to cause signs of brainstem dysfunction?

A

The posterior (vertebrobasilar) circulation

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10
Q

Name some of the main signs of posterior lesions and brainstem dysfunction?

A

Coma, drop attacks, nausea, ataxia, sensorimotor deficits

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11
Q

What is a TIA?

A

Transient ischaemia attack - when the deficits resolve quickly, typically within an hour

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12
Q

What type of emboli causes TIAs with different presentations?

A

Cardiac emboli

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13
Q

What type of stroke causes recurrent TIAs with identical presentations?

A

Thrombosis / cerebral embolism

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14
Q

What is a minor stroke?

A

An event with deficits that last longer than TIAs but resolve completely within a few days

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15
Q

What is the most common cause of stroke?

A

Ischaemia (90% of strokes)

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16
Q

What are the two main arteries supplying blood to the brain?

A

The common carotid artery and the vertebral artery

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17
Q

What is the ring of vessels that connects the anterior and posterior circulations of the brain?

A

The circle of Willis

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18
Q

What are the 4 main arteries of the internal carotid circulation?

A
  1. Anterior choroidal
  2. Anterior cerebral
  3. Middle cerebral
  4. Lenticulostriate
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19
Q

What are the 6 main arteries of the vertebrobasilar circulation?

A
  1. Vertebral/basilar
  2. Posterior inferior cerebellar
  3. Anterior inferior cerebellar
  4. Superior cerebellar
  5. Posterior cerebral
  6. Thalamic
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20
Q

Which artery connects the anterior circulation of the right and left hemispheres?

A

The anterior communicating artery

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21
Q

What is the role of the posterior communicating arteries?

A

To provide an alternative pathway if there is a blockage in the internal carotid or vertebral arteries

22
Q

What is ischaemia?

A

The interruption of blood flow to the brain, depriving cells of glucose and oxygen

23
Q

What is an infarction?

A

Tissue death due to inadequate blood supply, typically within the ischaemic core when flow is less than 20% of its normal amount

24
Q

What is selective vulnerability?

A

In mild ischaemia, when neuronal populations are lost preferentially

25
Q

What is selective neuronal necrosis?

A

In severe ischaemia, when neurons are targeted and the glia and vascular cells are spared

26
Q

What is pannecrosis?

A

Complete, permanent ischaemia affecting all cells, ultimately producing chronic cavitary lesions

i.e. infarction

27
Q

Name some of the key non-modifiable risk factors of stroke?

A

Older age, male sex, African American ethnicity, genetics, low birth weight

28
Q

Name some of the key modifiable risk factors for stroke?

A

Hypertension, smoking, diabetes, atrial fibrillation, recent infection, physical inactivity, low SES, alcohol intake, cholesterol, sickle cell disease

29
Q

Does the size of a stroke equate to the size of the deficit?

A

No!

30
Q

What are the two main types of primary haemorrhagic stroke?

A

▪️ Intraparenchymal
▪️ Subarachnoid

31
Q

What are the main causes of ischaemic stroke?

A

▪️ Atherosclerosis (arteriogenic emboli and hypoperfusion)
▪️ Penetrating artery disease (lacunes)
▪️ Cardiogenic embolism (a-fib, valve disease, ventricular thrombi, etc)
▪️ Cryptogenic stroke
▪️ Other (e.g., dissections, drug abuse, prothrombic states)

32
Q

What is carotid stenosis?

A

Narrowing of carotid artery

(can cause haemodynamic insufficiency or be caused by emboli)

33
Q

What is a large artery stroke?

A

▪️ Occlusion or narrowing in large extra or intracranial cerebral artery
▪️ Ischaemia in arterial territory

34
Q

What is a cardioembolic stroke?

A

One of more of:
▪️ heart valve
▪️ a fib
▪️ MI
▪️ congestive heart failure
▪️ endocarditis
▪️ etc

35
Q

What is a lacunar stroke?

A

▪️ Stroke in small penetrating artery
▪️ Lacunar syndrome = pure motor, pure sensory, ataxic hemiparesis, clumsy hand dysarthria
▪️ No lesion on imaging or deep infarct
▪️ Syndrome linked to location

36
Q

What factors contribute to plaque instability?

A

▪️ Ulceration
▪️ Lipid content
▪️ Haemorrhage
▪️ Fibrous cap thickness
▪️ Inflammation
▪️ Embolisation

37
Q

What factors in atherosclerosis contribute to risk of stroke?

A

▪️ Plaque formation
▪️ Platelet aggregation and attachment at side of endothelial injury
▪️ Increased formation of clots (thromboli) - mechanical obstruction
▪️ Vasoconstriction

38
Q

How does carotid stenosis affect risk of stroke?

A

Increases risk, particularly when very severe (90-99%)

39
Q

What is the prenumbra?

A

▪️ Area surrounding ischaemic core
▪️ Functional impairments and symptoms
▪️ BUT still likely reversible if treated

40
Q

What is the oligemia?

A

Area surrounding penumbra

▪️ Hypoperfusion but not quite severe
▪️ May resolve spontaneously

41
Q

What happens as a stroke progresses?

A

Ischaemic core gets bigger

42
Q

How is severity of carotid stenosis measured?

A

▪️ Percentage area
▪️ Percentage diameter

43
Q

What might occur with chronic SVD?

A

Leukoaraoisis - white matter appears hypodense or hyperintense, predominantly around lateral ventricles

44
Q

What might occur with chronic carotid stenosis?

A

Cerebral hypoperfusion

45
Q

What are the two main forms of chronic cerebrovascular disease that contribute to risk of stroke?

A

▪️ Carotid stenosis
▪️ Small vessel disease

46
Q

What cerebral artery is predominantly implicated in haemorrhagic stroke?

A

The middle cerebral artery

47
Q

What is an aneurysm?

A

A bulge in a blood vessel caused by a weakness in the vessel wall, most commonly where it branches (i.e. where one artery meets another)

Blood pressure pushes it out, dangerous if ruptures

48
Q

How is incidence of previous subarachnoid haemorrhage associated with probability of another?

A

▪️ Increased as years pass
▪️ Larger aneurysm associated with greatest risk

49
Q

What are the main causes of haemorrhagic stroke?

A

▪️ Primary (e.g., hypertension, amyloid angiopathy)
▪️ Secondary (e.g., aneurysm, AVM, neoplasm)
▪️ Coagulopathy
▪️ Drugs or alcohol
▪️ Haemorrhagic ischaemic stroke
▪️ Dural venous sinus thrombosis
▪️ Vaculopathy
▪️ Arterial dissection
▪️ Pregnancy and eclampsia

50
Q

What is cortical superficial siderosis?

A

Distinct pattern of blood-breakdown product deposition (iron) in cortical sulci

Scientific Foundations (27 decks)

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