Secondary Stroke- Patho, Symptoms, Risk Factors

Question 1

Carotid artery stroke symptoms

Answer 1

Unilateral weakness, and sensory symptoms

Aphasia- difficulty understanding speech (receptive aphasia) or speaking (expressive aphasia), or both

Monocular vision loss

Transient global amnesia

Question 2

Vertebrobasilar stroke symptoms

Answer 2

Bilateral weakness, sensory, and/or visual complaints

Diplopia, vertigo, ataxia without weakness

dysphagia (difficulty swallowing)

Question 3

General signs and symptoms of a stroke

Answer 3

Unilateral weakness and sensory symptoms, dysphasia, dysarthria, vision disturbances, sudden confusion/mental status changes, facial droop, seizures (rare), asymmetric face, slurred speech, pronator drift, ataxia, loss of balance, vertigo, dizziness, dysphagia, headache, vomiting

Question 4

Etiologies that can present as stroke

Answer 4

Seizures, migraines, syncope, brain tumors, hyponatremia, hypoglycemia, Bell’s palsy, MS, conversion disorder

Question 5

Patients at the most risk of having a stroke

Answer 5

Patients who already had a stroke

Question 6

Treatable risk factors

Answer 6

HTN, HLD, heart disease (especially Afib), DM, smoking, excessive alcohol intake, physical inactivity, obesity, carotid bruit, post-menopausal hormone therapy

Question 7

Untreatable risk factors

Answer 7

Age (age >55), sex (men > women), race (AA and Hispanics are more at risk), prior stroke, hereditary

Question 8

Organ with the highest metabolic rate

Answer 8

Brain

Question 9

Blood flow to the brain

Answer 9

750ml/min

Question 10

When blood goes through the aortic arch, where is its first stop?

Answer 10

Carotid artery

Ask patient where the stroke happened; if it’s thromboembolic, ask where the thrombus came from

Question 11

Anterior arteries supply what area of the brain

Answer 11

Frontal area

Question 12

Feature about the carotid artery

Answer 12

Comes out of the neck (extra cranial) and goes back in (intracranial)

Question 13

Feature about the vertebral arteries

Answer 13

Come up the spinal column and fuse together to become the basilar artery to supply the brainstem

Question 14

Is it possible to have a completely occluded artery and be asymptomatic?

Answer 14

Yes, if the occlusion occurred over a long period of time

Question 15

The medulla is supplied by what arteries

Answer 15

anterior spinal and vertebral arteries, posterior inferior cerebellar artery

Question 16

The pons is supplied by what artery?

Answer 16

Basilar artery

Question 17

The midbrain is supplied by what arteries

Answer 17

posterior cerebral, posterior communicating

Question 18

The middle cerebral area vascularizes what area?

Answer 18

Lateral surface of the frontal, temporal, and parietal lobes

Question 19

Functional areas supplied by the middle cerebral

Answer 19

auditory cortex, language, and speech areas of the dominant hemisphere, sensory and motor areas of the homunculus

Question 20

The anterior cerebral area vascularizes what?

Answer 20

medial aspect of the frontal and parietal lobes

Question 21

Functional areas supplied by the anterior cerebral

Answer 21

sensory and motor areas of the lower extremity homunculus

Question 22

Posterior cerebral area vascularizes what?

Answer 22

medial and part of the lateral surfaces of the occipital lobe and inferior surface of the temporal lobe

Question 23

Functional areas supplied by the posterior cerebral

Answer 23

visual cortex and memory areas

Question 24

Homunculus main takeaway point

Answer 24

IT’S NOT A DEMOCRACY, more areas of the brain are dedicated to some areas over others (face has more areas vs. the leg)

Question 25

Gray matter vs. white matter

Answer 25

There’s a lot of gray matter, so if an occlusion of a vessel occurs there, it could be without consequence because there’s other areas blood can flow through that aren’t affected by an infarction. If this happens in the white matter, there may be a symptomatic infarction

Question 26

Ischemic strokes make up how much (% out of 100) of strokes?

Answer 26

71%

Question 27

Embolic stroke definition

Answer 27

Embolism from somewhere else in the body goes upstream into the brain; can start in the heart and go to the brain but can also originate in the cerebral vasculature

Question 28

Hemorrhagic strokes make up how much (% out of 100) of strokes?

Answer 28

26%

Question 29

Subtypes of hemorrhagic stroke

Answer 29

Subarachnoid, intracerebral

Question 30

Subarachnoid hemorrhage definiton

Answer 30

aneurysm in a large vessel that transverses the surface of the brain into the subarachnoid space → vessel bursts → inflammation and bleeding → pressure pushes it down onto the brain

NOT A BRAIN BLEED

Question 31

Intracerebral hemorrhage definiton

Answer 31

BLEEDING INTO THE BRAIN TISSUE → blood is neurotoxic to the brain if it’s outside the blood vessel and can expand the infarction further

Question 32

What does the CHA2DS2VASc score do?

Answer 32

Estimates stroke risk

Question 33

What score of the CHA2DS2VASc prompts anticoagulation?

Answer 33

≥2

Question 34

Risk factors in CHA2DS2VASC score and how many points they each get

Answer 34

Congestive heart failure- 1 point

HTN (>140/90)- 1 point

Age >75- 2 points

Diabetes- 1 point

Stroke history/TIA- 2 points

Vascular disease (MI, aortic plaque, etc.)- 1 point

Age 65-74- 1 point

Sex- being female gives you 1 point

Question 35

True or false: ischemic strokes are all treated the same way acutely and for prophy

Answer 35

True, the exception is if it’s AFib

Question 36

Thrombus formation patho

Answer 36

Asymptomatic atherosclerotic plaque → platelet deposition → occlusive thrombus formation → plaque fissure → red thrombus → embolism

Question 37

Platelet cascade in thrombus formation patho

Answer 37

Lipid plaque has a fissure → fissure in endovascular interarterial plaque → body recognizes it as an injury → platelets activate → platelets adhere to the fissure → platelets aggregate → fibrin and RBCs are called in → thrombus formation

Question 38

Feature of activated platelets

Answer 38

Activated platelets change biochemically and release a cascade of biochemical and calls in additional platelets to aggregate → biochemical storm and exponential increase in platelets that are activated and aggregate and have morphological changes in the platelets

Question 39

What do activated platelets do to aggregate?

Answer 39

IRREVERSIBLY INTERLOCK

Question 40

Cardiogenic embolus patho

Answer 40

blood stasis → thrombus → ejected to brain