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Neuro Block 5 > Stoke And Hemorrhage > Flashcards

Stoke And Hemorrhage Flashcards

1
Q

Normal value for protein in CSF

A

15-60

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2
Q

Protein content in CSF in presence of bacterial infection

A

Very high

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3
Q

Normal glucose numbers in CSF

A

45-100

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4
Q

Glucose presence in CSF in presence of bacterial infection

A

Low because bacteria eats it all

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5
Q

Normal white blood cell count in CSF

A

0-5

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6
Q

White blood cell count in CSF in bacterial infection

A

Very high (mostly neutrophils)

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7
Q

Protein count in CSF of viral infection

A

Increased

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8
Q

Glucose levels in CSF in viral infection

A

Normal to slightly decreased

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9
Q

Protein levels in CSF in fungal infection

A

Increased

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10
Q

WBC of CSF in viral infection

A

Increased

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11
Q

WBC of CSF in fungal infections

A

Increased

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12
Q

What does yellow CSF mean

A

Suspect brain hemorrhage

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13
Q

What will change in CSF in the case of autoimmune disease?

A

High protein (IgG)

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14
Q

Presence of blood in CSF

A

Hemorrhage

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15
Q

Worst headache of my life

A

Subarachnoid hemorrhage

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16
Q

Historically, this has been associated with all clinical manifestations of a sudden loss of neurological function

A

Stroke

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17
Q

What can cause malfunction or death of neurons?

A

Any reduction of brain perfusion

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18
Q

Reduction of the flow rate by 60% in brain

A

Causes neurons to stop generating electrical signals

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19
Q

Reduction of the flow rate to about 20% in the brain for more than a few minutes

A

Initiates processes that result in necrosis of the involved brain tissue

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20
Q

A necrotic region of tissue in brain

A

Infarct

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21
Q

An abrupt incident of vascular insufficiency is called

A

Stroke

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22
Q

What can cause stroke like consequences

A

Bleeding into or immediately adjacent to the brain

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23
Q

Loss of blood supply to an area of the brain resulting in a loss of neurological function

A

Stroke

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24
Q

Stroke and age

A

Incidence increases with age

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25
Q

Stroke and gender

A

More common in men

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26
Q

Types of stroke

A
  • occlusive (ischemic) 70-80%

- hemorrhagic (not due to trauma)

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27
Q

Thrombotic or emboli strokes

A

Occlusive (ischemic)

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28
Q

Intracerebral hemorrhage or subarachnoid hemorrhage can cause what

A

Stroke

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29
Q

What kind of stroke is from a comprised artery or blood loss?

A

Hemorrhagic

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30
Q

What kind of stroke happens from any occlusion of arteries

A

Occlusive

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31
Q

What is the most important factor of a stroke

A

The location, not necessarily the size

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32
Q

Risk factors of stroke

A
  • HTN
  • smoking
  • abdominal obesity
  • poor diet
  • lack of exercise
  • diabetes
  • excess alcohol
  • stress and depression
  • heart disorders
  • presence of blood fat molecules called apolipoproteins (LDL)
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33
Q

Preventable risk factors of stroke

A
  • smoking
  • alcohol excess
  • obesity
  • lack of exercise
  • heart disease
  • type II diabetes
  • stress and depression
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34
Q

The region surrounding the area of permanent tissue damage

A

Penumbra

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35
Q

Area that will survive if you treat rapidly and appropriately

A

Penumbra

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36
Q

Re perfection over the penumbra

A

May salvage this region and reduce the neurologic deficits suffered by the patient

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37
Q

Time to treat penumbra

A

Up to 3 hours

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38
Q

Close forms locally over an atherosclerotic lesion, often has prodromes - vasospasms and partial occlusion aka transient ischemic attack (TIA)

A

Thrombotic occlusive stroke

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39
Q

Blockage by thrombi formed elsewhere. The thrombus detaches, travels and lodges in an artery. Often without prodromes

A

Embolic occlusive (ischemic) stroke

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40
Q

hypoxia due to insufficient blood supply. Hypotension/hypovolemia. Affects vulnerable sites. Caused by systemic conditions. No occluded artery but blood supply is still insufficient

A

Watershed infarct (stroke)

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41
Q

What are the most common causes of subarachnoid hemorrhage

A

Aneurysm rupture, arteriovenous malformation

-superficial artery bursts in the subarachnoid space

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42
Q

Types of hemorrhagic stroke

A

Subarachnoid hemorrhage

Intracerebral hemorrhage

43
Q

Most common intracerebral hemorrhage causes

A

Hypertension

Arteriovenous malformation

44
Q

Why are strokes so bad for brain

A

Brain does not have collateral arteries to save compromised arteries, areas near end of blood supply gets affected first, if severe, whole brain suffers

45
Q

Classification of the U of New England cerebrovasular disease classification advantages

A
  • takes into account pathological features of stroke

- relatively less complicated

46
Q

Advantages of the may clinic stroke classification chart

A

Takes into account also the clinical feature of the stroke

Takes into account the size of the vessels involved

47
Q

How are strokes clinically classified as?

A

Focal or diffuse

48
Q

Focal stroke

A

Due to artery occlusion to relatively small hemorrhage

  • particular area of brain is affected
  • patient presents with neural deficits at multiple sites
49
Q

Diffuse stroke

A

The whole or multiple regions of the brain are affected

-patient is usually unconscious

50
Q

What type of stroke is the patient usually unconscious?

A

Diffuse

51
Q

How are strokes pathophysiologically classified as?

A
  • ischemic

- hemorrhagic

52
Q

This type of stroke leads to decreased oxygenation of brain tissue (hypoxia), which can progress to tissue necrosis (infarction)

A

Ischemic (reduced blood supply)

53
Q

This type of stroke results from a rupture of a blood vessel

A

Hemorrhagic

54
Q

Overlap of types of stroke

A

If you have a hemorrhagic stroke, you will have parts of the brain that are ischemic

55
Q

Hemorrhagic stroke in brain parenchyma

A

Rupture of a small artery. Leads to accumulation of blood within the brain and compression of adjacent tissue

56
Q

Hemorrhagic stroke in subarachnoid space

A

Rupture of a superficial artery (most often aneurysm). Again, the collected blood compresses the brain underneath

57
Q

Clinical presentation of ischemia and hemorrhage

A

Lead to virtually the same clinical presentation. The only difference is the mechanism

58
Q

What does a severe headache indicate when figuring out the type of stroke that it is

A

Hemorrhagic stroke

59
Q

Vascular event with symptoms similar to stroke

A

Transient ischemic attack

60
Q

What is the crucial difference between a TIA and stroke

A

The deficits associated with TIA persist only a few minutes to a few hours and are followed by an essentially complete recovery

61
Q

What are TIAs usually caused by

A

Minute emboli

62
Q

TIA example: amaurosis fugax

A
  • transient monocular blindness
  • caused by emboli that detach from a plaque in the internal carotid artery, enter the ophthalmic artery, and render the retina temporarily ischemic
63
Q

Why is amaurosis fugax clinically important?

A

Often precede a stroke

64
Q

Infection of the brain caused by a platelet thrombus that develops over a disrupted atherosclerotic plaque in a cerebral artery

A

Thrombotic stroke (ischemic)

65
Q

Thrombus has formed elsewhere, detaches, travels to a more distal location where it lodges and occluded the vessel

A

Embolic stroke (ischemic)

66
Q

Sources of emboli

A
  • left atrium of the heart
  • carotid arteries
  • paradoxycal embolus
67
Q

Venous embolus that passes through a patent foramen ovale and lodges in a cerebral artery

A

Paradoxycal embolus

-this type is not arterial, so it has to go to the heart and the brain

68
Q

When is an emboli in the left atrium of the heart more common

A

When someone has atrial fib

69
Q

Common locations of ischemic strokes

A
  • MCA
  • internal carotid artery near the bifurcation
  • basilar artery
70
Q

What is the most common location for an ischemic stroke

A

MCA

71
Q

Gross and microscopic findings of ischemic stroke

A
  • swelling of brain
  • loss of demarcation between gray and white
  • breakdown of myelin
  • gliosis as a reaction to injury
72
Q

What is necrosis of the brain tissue called

A

Liquefaction necrosis

73
Q

Main symptoms of a stroke involving the MCA

A
  • Contralateral hemiparesis and sensory loss predominantly in the face and upper extremity
  • aphasia (wernicke and broca)
74
Q

What are the areas that are controlled by parts of hte brain supplied by MCA?

A
  • hip, neck, trunk, head
  • upper extremities
  • eye, nose, lips, teeth, gums, jaw, tongue
  • face
  • pharynx
  • intrrabdominal
75
Q

What kind of stroke has symptoms that are pure motor or pure sensory?

A

Lacunae stroke (MCA stroke)

  • monoparesis
  • isolated sensory loss
76
Q

Main symptoms involving the anterior cerebral artery

A
  • contralateral hemiparesis predominantly in lower extremity
  • contralateral sensory loss predominantly in the lower extremity
  • urinary inontinecn
77
Q

What does the part of the brain control that is supplied by the anterior cerebral artery (ACC)?

A

Lower extremities and geneital

78
Q

Stroke involving the vertebral artery

A
  • posterior inferior cerebellar artery (PICA)

- lateral medullary syndrome (Wallenberg)

79
Q

Strokes involving the basilar artery

A
  • AICA

- SCA

80
Q

Main symptoms of strokes involving the vertebral-basilar system

A
  • vertigo (ataxia)
  • ipsilateral sensory loss in the face
  • contralateral hemiparesis and sensory loss in the trunk and limbs
  • posterior cerebral arteries
81
Q

What is the give away point for someone with a vertebral-basilar stroke

A

Vertigo, ataxia

82
Q

What does the PICA supply?

A
  • inferior surface of the cerebellar hemisphere
  • lateral medulla
  • its occlusion causes lateral medullary syndrome (Wallenberg syndrome)
83
Q

Lateral medullary syndrome (Wallenberg syndrome)

A
  • ataxia, vertigo
  • sensory deficits affecting the trunk and extremities on the opposite side of the infarction and cranial nerves on the same side with the infarct
  • loss of pain and temperature sensation on the contralateral side of the body and ipsilateral side of the face
  • swallowing difficulty (dysphagia) and slurred speech
  • hornets syndrome-miosis, ptosis, anhydrosis
84
Q

Main symptoms of strokes involving posterior cerebral artery

A 
Gaze paralysis
-paralysis of cranial nerve III
Visual fields defects
-hemianopsia-eyes deviate toward the side of the lesion to compensate 
-EYES LOOK TOWARDS THE LESION
-Contralateral sensory loss
85
Q

What is a giveaway for strokes involving posterior cerebral artery

A

Eyes look towards the lesion

86
Q

Locations of intracranial hematoma

A
  • epidural
  • subdural
  • subarachnoid
87
Q

Cause of epidural hematoma

A

Rupture of a meningeal artery

-blow to the head

88
Q

Cause of subdural hematoma

A

Rupture of a bridging vein

-accident-head hits hard surface and the brain moves abruptly in the skull

89
Q

Causes of subarachnoid hematoma

A

Most often aneurysm rupture

-worst head of my life

90
Q

Arterial bleed creates a blood filled space between the bone and the dura mater

A

Epidural hematoma

91
Q

Pathophysiology of epidural hematoma

A

Temporal or parietal skull fracture tears middle meningeal artery
-vessel lies between the dura and the inner table of the bone

92
Q

Presentation of epidural hematoma

A

Short (or no) loss of consciousness, lucid interval, neurological deterioration, death

93
Q

What causes death in epidural hematoma

A

Intracranial pressure increases, leading to herniation and death

94
Q

Diagnosis of epidural hematoma

A

Head CT scan is the imaging test of choice. Hematoma rarely crosses the suture line because the dura is firmly attached at these sites. Lens shaped mass

95
Q

Treatment for epidural hematoma

A

Creating burr holes to relieve pressure

96
Q

Subdural rupture of bridging veins between dura and arachnoid matter

A

Subdural hematoma

97
Q

Why does venous bleeding in subdural hematoma make a difference?

A

Less pressure leads to slow expansion of hematoma with a delayed onset of symptoms (days to weeks)

98
Q

Predisposing factors of subdural hematoma

A

Brain atrophy, shaking, whiplash

99
Q

Subdural hematoma often seen in

A
  • shaken baby syndrome
  • alcoholics
  • elderly
100
Q

Causes of subarachnoid hemorrhage

A
  • ruptured berry aneurysm (malformation)
  • congenital atrivenous malformation
  • trauma
101
Q

Clinical presentation of subarachnoid hemorrhage

A
  • sudden onset-worst headache of my life
  • sluctuating level of consciousness
  • CN III paralysis
102
Q

Diagnosis of subarachnoid hemorrhage

A
  • bloody or xanthochromic (yellow) spinal tap
  • crescent shaped hemorrhage in CT, crosses suture lines
  • cerebral compression and displacement of temporal lobe, tentorial herniation
103
Q

Treatment of choice for subarachnoid hemorrhage

A

Removal of hematoma by craniotomy

104
Q

What is the significance of the lack of neurologic deficit in someone with a subarachnoid hemorrhage?

A

Could progress to stroke

Neuro Block 5 (11 decks)

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