PSYC 492 UNIT 3 - Cerebrovascular Disease Flashcards
What is cerebrovascular disease?
blockage in blood supply or bleeding in the brain
3.28.24 ADHDpart2 and Cerebrovascular Disease
What kind of damage can cerebrovascular disease and associated impairment of blood supply cause?
- decreases oxygenation
- bleeding may lead to increased intracranial pressure
- toxins in blood might interfere with brain metabolism
List 5 examples of cerebrovascular disease.
- stroke
- carotid stenosis
- vertebral and intracranial stenosis
- aneurysms
- vascular malformations
What is a stroke?
injury to the brain caused by blockage or bleeding
Typically, strokes are ———— but multiple strokes or major stroke can ———–.
localized; affect the entire brain
The ———- of a stroke reflects damage.
clinical presentation
What are the common warning signs of stroke?
B - Balance (stumbling, coordination is awry)
E - Eyes (vision changes)
F - Face (facial droop)
A - Arms (weakness in arms)
S - Speech (slurred)
T - Time (call 911 ASAP!)
Why is the “time” in BEFAST so important?
if a person is having a stroke, the longer they go without treatment, the more damage that happens
What are some differences in stroke symptoms for women?
Women may experience additional symptoms like:
- general weakness
- disorientation/confusion/memory
- fatigue
- nausea or vomiting
How many people in the US have a stroke per year? How many of these are new cases? How many people have had a previous stroke?
over 795000
new: 619000
have had previous stroke: 1/4
Every —- , someone has a stroke.
Every ——-, someone dies of a stroke.
In our 75min class, how many people will have died from stroke?
- 40 seconds
- 3.5 minutes
- 21 people
Stroke is the —– leading cause of death in the US.
3rd
T/F
Stroke only occurs in older people.
False, strokes can occur at any age. 38% are less than 65yo
Who is at greatest risk for having a stroke (ethnicity and gender)?
Black Americans are 2x more likely to have a stroke thank White Americans.
Black Americans have the highest rate of death due to stroke.
Stroke is more common in men than women.
What physical health factors put people at a higher risk for stroke?
6
- high blood pressure
- high cholesterol
- smoking
- obesity/physical inactivity
- diabetes
- prior heart attack/stroke
While genetics play into the physical health risk factors for stroke, we also need to consider how ——————/—————— affect physical health.
socioeconomic/social determinants
What are the two primary types of stroke?
Hemorrhagic and ischemic
What are the 3 types of ischemic stroke?
- thrombotic
- embolic
- transient ischemic attack (TIA)
What is an ischemic stroke?
the death of neural tissue due to inadequate blood supply (obstruction of blood circulation)
T/F
Hemorrhagic strokes account for the majority of strokes.
False, ischemic strokes are more common
Thrombosis often affects which artery?
left middle cerebral artery, but arteries of all sizes are affected
A(n) ———- stroke is more likely to affect anterior areas.
embolic stroke
What is the main difference between a thrombotic stroke and embolic stroke?
thrombotic stroke: buildup (thrombosis) that obstructs blood circulation and blocks off the ability for red blood cells to flow freely through blood vessels
embolic stroke: an embolus breaks off from buildup in a blood vessel, then floats through the blood stream, blocking blood flow in a different place in the body
A Transient Ischemic Attack (TIA) is a(n) ——–, ———- neurological deficit, ———– loss of function (order of minutes) from ——– blockage of blood flow to the brain.
A Transient Ischemic Attack (TIA) is a(n) -acute, focal neurological deficit causing transient loss of function (order of minutes) from temporary blockage of blood flow to the brain.
How often do TIA’s occur?
varies - can occur infrequently to very frequently (several times/day)
In a TIA, if anterior circulation is blocked, it causes the following symptoms:
3
- clumsiness/weakness of limbs
- dysarthria (unclear speech)
- aphasia (impairment to expression/understanding of language)
In a TIA, if posterior circulation is blocked, it can cause the following:
4
- dizziness
- neglect
- double vision
- numbness/weakness in extremities
People who have had a TIA are at a —- to —-% greater risk of a more serious stroke.
20% - 35%
What is a hemorrhagic stroke?
rupture of blood vessel causes spilling of blood into cerebral tissue
An accumulation of blood within tissue is called ————-
a hematoma
a bleed within the brain is called a(n) —————–
intracerebral hemorrhage
When a vessel on the brain’s surface bursts and bleeds into the subarachnoid space, it is called a(n) ———————–
subarachnoid hemorrhage
What are three ways a subarachnoid hemorrhage might present?
- sudden, severe generalized headache/vomiting
- sudden, severe generalized headache with loss of consciousness
- rapid loss of consciousness with no other complaints
How might an intracerebral hemmorhage present?
generally focal, neurological deficits but also may experience headache, vomiting, and altered consciousness with expansion
A stroke’s impact on neuropsychological outcomes is dependent on what factors?
5
- size
- location
- duration of occlusion
- time since stroke
- age
What does the timeline for recovery from a stroke typically look like?
Patients experience majority of recovery in first 3-6 months; additional but less pronounced recovery in 6-12 months.
T/F
Strokes are only caused by genetic factors.
False
T/F
The majority of recovery after stroke occurs after 12 months.
False
Ischemic strokes can arise from thrombotic or embolic events.
True
The —————- in which the stroke occurs can have a significant affect on symptomology.
cerebral artery
In which arteries do strokes commonly occur?
3
- middle cerebral artery stroke
- anterior cerebral artery stroke
- posterior cerebral artery
What would a middle cerebral artery stroke look like? (also describe left v. right)
- contralateral motor and sensory deficits
- dorsolateral executive dysfunction
- visuoconstructional deficits
Left:
- aphasia
- ideomotor apraxia (difficulty pantomiming but intact knowledge)
- verbal memory
Right:
- aprosodia (receptive-inferior; expressive-superior)
- dressing apraxia (inability to dress self)
- visual memory
LOOK UP what symptoms mean
aprosodia - impaired comprehension of verbal/nonverbal speech
What would an Anterior Cerebral Artery stroke look like?
- contralateral weakness
- sensory deficit affecting legs
- motor impersistence (inability to sustain certain actions)
- abulia/apathy (abulia = no willpower)
- complex/divided attention
- memory deficits
Left:
- Executive Function including verbal reasoning, transcortical motor aphasia (non-fluent; stop/start speech), verbal fluency
Right:
- Executive function including poor social insight and judgement
What would a stroke in the Posterior Cerebral Artery look like?
- contralateral homonymous hemianopia (vision lost in opposite halves of each eye)
- contralateral hemisensory affecting hands
- constructional apraxia (inability to copy drawings)
- visuoperceptual deficits
- color anomia (inability to find the name, but knows color)
- memory loss with poor encoding
Left:
- verbal memory loss
- transcortical sensory aphasia (impaired auditory comprehension with intact repitition and fluent speech)
- visuoconstructional – loss of detail but gestalt maintained
Right:
- visual memory loss
- agnosias (cannot recognize object)
- visuoconstructional (detailed but loss of gestalt), hemi-neglect
What mood/affect and personality changes might a person with a stroke on the left side have?
- “catastrophic reaction”
- depression and affective lability (strong, variable emotions)
- often tearful and might have pseudobulbar affect
4.2.24 Stroke Part 2
What is pseudobulbar affect?
uncontrolled crying or laughing that is disproportionate/inappropriate for the social context
What do we mean by a “catastrophic reaction” and what disorder might cause it?
disruptive, emotional outburst involving anxiety, agitation, aggression
- occurs after stroke on left side (left-sided lesion to brain)
What mood/affect and personality changes might be experienced by a person with a right-sided lesion (stroke on right side)?
- affective flattening and indifference
- difficulty with nonverbal cues in social settings
- pronounced behavioral changes
- amotivation, abulia, apathy, agitation
- decreased inhibition, lack of regard
abulia = absence of willpower/decision making issues
a bulge in a blood vessel caused by weakness in the vessel wall
aneurism
What are three types of aneurysms?
- saccular (berry) aneurism
- fusiform aneurysm
- dissecting aneurysm
aneurysm resulting in congenital weakness
saccular aneurysm
aneurysm associated with enlargement of vessels from atherosclerosis
fusiform aneurysm
aneurysm characterised by a tear in the vessel wall that allows blood to seep through the laters of the blood vessel
dissecting aneurysm
Which type of aneurysm may lead to an ischemic stroke?
fusiform aneurysm
Congenital collections of abnormal vessels resulting in abnormal blood flow.
Arteriovenous Malformation (AVM)
AVM is typically seen in —— patients with ——– hemorrhage. This typically ends in ————– survival.
- younger
- smaller
- better
When an individual has an AVM, what symptoms do they typically experience beforehand?
- typically no symptoms until hemorrhage
- some may experience headache and/or seizure
