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Neuro > Stoke Pathology N29 > Flashcards

Stoke Pathology N29 Flashcards

1
Q

CVA

A

cerebrovascular accident or stroke, non-convulsive focal neurological deficit

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2
Q

Risk Factors for CVA

A

Advanced age, “stroke belt” SE US, genetic predisposition, male, black (hypertension)

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3
Q

Hypertension, high cholesterol, diabetes, smoking alter

A

vessel walls: decrease the production of NO by epithelial cells and increase local mediation of vessel tone = atherosclerosis

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4
Q

Result of alteration in blood vessel walls:

A

thombosis, embolism, inflammation, vasoconstriction, vascular remodeling

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5
Q

Ischemic Stroke (80%)

A

insufficient blood supply to meet metabolic demands

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6
Q

Types of ischemic strokes

A

Focal ischemia: occlusion of a specific vessel

Global ischemia: drastic reduction in systemic BP

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7
Q

Causes of ischemic strokes

A

Thrombosis (localized occlusion), embolism (dislodged thrombosis), Hypoperfusion (heart failure)

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8
Q

Hemorrhagic Stroke (20%, but 3x as lethal)

A

accumulation of blood due to ruptured vessels

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9
Q

Types of Hemorrhagic strokes

A

Intra-axial (within the brain) or extra-axial ( within the skull, outside the brain)

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10
Q

Types of Intra-axial hemorrhagic strokes

A

Intra-parenchymal: bleeding within the brain tissue

Intra-ventricular: bleeding within the ventricles

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11
Q

Types of Extra-axial hemorrhagic strokes

A

Epidural: bleeding between dura mater and skull
Subdural: between dura and arachnoid mater
Subarachnoid: between arachnoid and pia mater

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12
Q

Cerebral Blood Flow regulation

A

blood vessel diameter can become blocked and therefor CBF to area diminishes

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13
Q

Ischemia causes

A

decline in ATP, glucose, and pH also in apparent diffusion coefficient in ECS (tissue swelling)

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14
Q

Normal CBF

A

50-60

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15
Q

Oligemia

A

20-40

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16
Q

Ischemia

A

<20

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17
Q

During ischemia, electrical function becomes impaired

A

<20

18
Q

During ischemia, cell death occurs

A

> 10

19
Q

Core infarct occurs when

A

CBF is >10 and cell death occurs due to ischemia (localized O2 deprivation)

20
Q

Penumbra

A

Within 1 hr, an area surrounding the core infarct is under oligemia conditions

21
Q

Core Infarct is determined by levels of

A

decreased ATP

22
Q

Penumbra is determined by levels of

A

decreased pH

23
Q

Window of Opportunity

A

2-4 hours following infarct if the viable penumbra is reperfused, ischemia can be reversed

24
Q

Ischemia-induced neuronal cell death may spread

A

from the infarct and into the penumbra

25
Q

Mechanisms of ischemia-induced neuronal cell death

A

Glutamate excitotoxicity, peri-infarct or spreading depolarization, Calcium homeostasis disruption

26
Q

Glutamate excitotoxicity (primary)

A

depleted energy stores –> release of glutamate–>NMDA and AMPA–>influx of Na and Ca–> excitation/excitotoxicity

27
Q

Peri-infarct or spreading depolarization (secondary)

A

Infarct cell death –> release of glutamate and K penumbra –> repetitive depolarization/repolarization causing cell death

28
Q

Calcium Homeostasis disruption (delayed)

A

Ca influx causes activation of destructive enzymes –> inflammation

29
Q

Necrosis

A

Compaction and rupturing of cell contents causing inflammation

30
Q

Apoptosis

A

programmed cell death, membrane intact, not associated with inflammation (requires ATP)

31
Q

Edema

A

increases intra-cranial pressure (secondary damage)

32
Q

Vasogenic Edema

A

increased ECF due to BBB defect

33
Q

Cytotoxic edema

A

swelling or neurons and glia due to failure to transport Na and Ca

34
Q

Inflammation

A

tissue injury–> inflammatory mediators–> vasodilation, vasoconstriction, increased permeability, and platelet aggregation

35
Q

Histologically you may not see the demarcation between ___________ and

A

gray and white matter due to loss of structural integrity mediated by proteases
Fluid-filled cysts: result of macrophage removal

36
Q

Glutamate receptor antagonist

A

reduce spreading of depolarizations to reduce infarct size (ADVERSE effects cause neurotoxicity)

37
Q

Calcium Channel Inhibitors

A

Reduce infarct size (no benefit to stroke patient)

38
Q

Free Radical Scavengers

A

increase intracellular GLUTATHIONE levels

39
Q

Clot dissolvers

A

Tissue plasminogen activator (thrombolytic) but must be administered with 4.5 hours of stroke

40
Q

Anticoagulants

A

partially prevent stoke

41
Q

Antiplatelet agents

A

prevent platelet aggregation and clot formation (some preventative to stroke)

Neuro (23 decks)

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