Stroke Flashcards
prevalence stroke:
10/1000
Tia meaning and time lapse
transient ischemic attack
<24 h symp
CVA meaning and time lapse
cerobrovascular incident (symp >24H)
hemorrhagic stroke
blood leaks into brain
ischemic stroke
blood clot stops blood supply to area in brain
penumbra
the area surround a ischemic event such as trombotic or embolic stroke
ischemia occurs when…
blood flow is blocked, the release of free radicals causes damage to brain tissue
Etiology of Ischemic stroke (80% of cases)
trombosis –> embolism –> arterial occulsion –> brain infarction
Hemorrhagic stroke etiology (20%)
always intracranial
rupture of artery causes bleeding
two versions of hemorrhagic stroke
- intracerebral: hematoma directly in brain tissue
2. extracerebral: build up of blood anywhere within skull and meninges
Early treatment of stroke
thrombolysis, platelet aggregation inhibitors, anticoagulants
treatment within 3-4.5 hours
trombolysis with intravenous rtPA and IAT (risk = hemorrhage)
new is intra arterial thrombolysis, whats special?
it can be done in up to 6 hours.
Anterior circulation consists of (3)
internal carotid artery splits up into anterior cerebral artery and middle cerebral artery
posterior circulation consists of
vertebral arteries perforate transverse processus of cervical vertebrae via the foramen magnum. left and right fuse en form basilar artery. This one supplies the cerebellum and brain stem
circle of willis
site of large aneurysms
functional anatomy cortex.
Neocortex:
anteriorly:
posteriorly:
neocortex: mental functions
anteriorly: action related areas (frontal lobe)
posteriorly: perception areas (parietal, occipital and temporal lobes)
motor cortex
responsible for movement and arranged in anatomical order (called somatotopy)
somatotopy
arranged in anatomical order
the primary sensory area is arranged how?
topographically organized
how is the primary auditory cortex arranged?
tonotopy: all sound frequencies layed out over length of auditory gyrus
supply areas:
- anterior cerebral art:
- middle cerebral art
- posterior cerebral art
- anteromedial side
- lateral side and deep structures
- posterobasal side
Types of strokes (6)
- middle cerebral artery
- anterior cerebral artery
- carotid artery occlusion
- posterior cerebral artery stroke
- basilar artery stroke
- miscellaneous stroke
middle cerebral artery stroke symptoms:
most common
central facial palsy (opposite of where stroke occurred)
distal parts show most paresis
lower part of face dysfunctions
difference between superficial lesion and deep lesion in middle cerebral stroke
superficial leg is spared and with deep lesion arm and leg are paretic
why is the leg spared in a superficial lesion
mostly supplied by anterior artery
contralateral hemisensory loss
mixture of problems in pain/temp sense
contralateral hemianopia
loss of one of the visual field of one (most of the times both) eye(S).
homonymus hemianopia
same side both visual fields are affected
what is remarkable for the left lesions?
language (aphasia)
alexia (reading)
agraphia (writing)
apraxia (motor planning)
what is remarkable for right lesions?
spatial function and attention unilateral neglect (left side) distance judgement wrong, can't read maps or draw.
aphasia
language disorder
types of aphasia:
- broca
- wernicke
- global
- anomic
- progressive
- speech impairment (aware)
- can’t understand words (unaware)
- severe impairment in all language modalities
- difficulty word finding
- slow loss of language
apraxia
difficulty performing skilled movement
ideational appraxia
no idea or concept of what to do
location ideotional appraxia
parietal praxis center and parietotemporal cortex
ideomotor apraxia
cant perform on verbal command, inability to copy gestures, knows what to do but not how
location ideomotor apraxia
LH, left parietal lobe, frontal praxis centre
Anterior cerebral artery stroke symptoms
paresis, sensory loss of contraleteral leg
Carotid artery occlusion depends on …
circle of willis
basilar artery stroke
devestating and acute with no recovering, coma
lacunar
small infarct in deep cerebral white matter
multiple infarctions means…
vascular dementia
hemorrhagic vs ischemic
hemorrhagic has more headache, vomit and same prognosis as patients with infarctions
lethality infarctions after 30 days
15-20%
lethality hemorraghes after 30 days
60-70%
diaschisis
(sudden inhibition of function produced by acute focal disturbance in a portion of
the brain at a distance from the original site of injury, but anatomically connected with it through fiber
tracts
denervation hypersensitivity
the sharp increase of sensitivity of post‐synaptic membranes to a chemical
transmitter after denervation → a compensatory change
neurogenisis
the process in which neurvous system cells are produced by neural stem cells
sprouting/synaptogenisis
the formation of two synapses between neurons
basis for rehabilitation
body function and structure
activities
participation
FAC
functional ambulation category
TCT
trunc control test, sitting balance
ARAT
the action research arm test
primary and secondary changes
primary: cognitive, emotional, behavorial, social
secondary: withdrawal, avoidence, depression
anticipatory awareness
knowing when problems occur and being able to use compensatory strategies to prevent them
emergent awareness
recognizing problems as they occur in daily life
intellectual awareness
‘they say i’ve changed’ but unable to provide examples of problematic situations
