Stroke Flashcards
What is a stroke?
Cerebral vascular accident (CVA) that results in brain tissue death
What are the potential reasons that a stroke may occur?
Blood flow to an area of the brain is cutoff
Toxic blood comes into contact with brain tissue
There are two types of hemorrhagic strokes based on location, what are they?
Subarachnoid (in the subarachnoid space)
Intracerebral (deep in the brain tissue)
Subarachnoid hemorrhage details
Bleeding in the subarachnoid space
Most often caused by burst aneurysm
During a hemmorhagic stroke, blood can also pool …
In the ventricles which can cause hydrocephalus
Intracerebral hemmorhage features ….
Most common type
Blood vessel within the brain bursts
Often caused by hypertension and bleeding in small perforating arteries
Sometimes caused by Arteriovenous malformations (AVMs), typically a congenital jumbled mess of arteries
What are the two types of ischemic stroke?
Embolic: clot that has broken off from somewhere and travelled
Thrombotic: Clot forms in the area of atherosclerosis
Both involve clots but one is stationary while the other is not
What is a transient ischemic attack?
Blood flow to part of the brain stops for a short period of time
Appears suddenly and lasts less than 24 hours (Clot resolves on its own)
Generally no permanent damage
What are some important stats about transient ischemic attacks?
40% of people who have a TIA will have a stroke
Nearly 1/2 of all strokes occur within the first few days after a TIA
Symptoms for TIA are similar to a stroke
Which type of stroke is more common?
Ischemic
Which type of stroke causes more deaths?
Ischemic
Which type of stroke are you more likely to die from?
Hemmorhagic
What are the signs and symptoms of a stroke?
Numbness/weakness
Confusion
Trouble speaking
Vision loss
Dizziness/poor balance
Severe headache
What does the FAST acronym for strokes stand for?
Face drooping
Arm weakness
Speech difficulty
Time to call 911
What are lifestyle factors that can reduce the risk for stroke?
Healthy diet
Physical activity
Eliminate smoking
Minimize alcohol consumption
What medical factors increase the risk for stroke?
Hypertension
Afib (irregular and often fast heart movement)
Hypercholesterolemia
Diabetes
Circulation problems
Carotid artery diseases
What are some uncontrollable factors that increase the risk for stroke?
Age > or equal to 55
Gender
Race (African American)
Family history
Previous stroke
Fibromuscular dysplasia
Patent foramen ovale
What is acute stroke treatment for hemorrhagic stroke?
Stop the bleeding
What is acute stroke treatment for ischemic stroke?
Remove the clot
Dissolve the clot
What is small vessel disease?
Usually relates to ischemia in areas of the basal ganglia, thalamus, and internal capsule
What is TIA (transient ischemic attack)?
“Mini-stroke” caused by a temporary deficiency of blood supply to the brain
What is a stroke?
Disruption of blood flow to the brain that results in cell death
What is r-TPA?
Protein that breaks down blood clots
What is an intracerebral hemmorhage?
Hemorrhage in the brain, usually caused by a rupture of an artery
What is a subarachnoid hemorrhage?
Hemorrhage within the meninges
What is cerebral thrombosis?
A stationary blood clot along the wall of the blood vessel
What is cerebral embolism?
All or part of a foreign material (usually blood clot) that travels through the bloodstream to a smaller vessel and gets stuck causing obstruction
What are the three large arteries that supply the cerebral cortex?
ACA
MCA
PCA
The ACA supplies the
Medial frontal and pariteal
The MCA supplies the
Lateral cerebral hemispheres
The PCA supplies the
Medial temporal and occipital lobes
A PCA stroke typically leads to
Contralateral homonymous hemianopia
Cut in the visual field, reading deficits
What is MCA stroke?
Most common
Occlusion of main branch leads to contralateral hemiplegia, hemianesthesia of arm, face, lower extremity
Contralateral homonimous hemianopia
If damage to left, global aphasia
If damage to right, left neglect common
MCA stroke in the left superior division causes….
Non fluent aphasia, deficits in language production
MCA stroke in the left inferior division causes ….
Wernicke’s aphasia, deficits in language comprehension
MCA stroke in the deep division causes …..
Damage to the deep structures like the thalamus and basal ganglia
ACA stroke causes …
Motor and sensory issues on the contralateral side because it catches the motor strip
Flat affect: no expression (catches the limbic system)
Lack of motivation
What are watershed strokes?
Strokes that occur in borders between cerebrovascular territories that are further from arterial supply
What are the two types of watershed strokes and where do they occur?
ACA-MCA watershed stroke (between these two areas)
MCA-PCA watershed stroke (between these two areas)
What presentations do the two watershed strokes cause?
ACA-MCA: proximal arm and leg weakness, on the left > transcortical aphasia
MCA-PCA: higher order visual processing deficits
What are the 3 stages of recovery for stroke?
Acute: first hours to day or two after the stroke
Subacute: few days or 1-2 weeks after stroke (typically inpatient rehab)
Chronic: months to years after the stroke, typically 6 months after
What is seen during the acute stage of stroke recovery?
Edema: swelling of brain tissue
Excitotoxicity causing neuronal cell death (chem spill that messes up structure)
Transneuronal degeneration: healthy neurons derived of input from damaged neurons
Diaschisis: shock to areas, temporary loss of function from event
Hypoperfusion in penumbral region: not getting bloodflow to surrounding areas
What is seen during the subacute stage of stroke recovery?
Spontaneous recovery
Edema resolves which contributes to recovery
Why does spontaneous recovery occur during the subacute phase of stroke recovery?
Neuroplasticity
Synaptogenesis: new connections made
Regeneration of dendrites and axons
Increased excitation of contralesional perilesional tissue: other side of brain helps take up functions of damaged areas that they previously worked together with
What is seen during the chronic stage of stroke recovery?
Influence of intrinsic and extrinsic factors
During the chronic phase of recovery, what are intrinsic factors that impact recovery?
Age at time of the stroke (younger = better prognosis)
Lesion volume and location (larger lesion = poorer recovery)
Vascular physiology (perfusion, blood flow returns to areas of stroke)
White matter integrity (more connections = better recovery)
Personality/other cognitive abilities
During the chronic phase of recovery, what are some extrinsic factors that impact recovery?
- Use, improve, or lose it (constraint-induced therapy, forced to use impacted side)
- Specificity rebuilds targeted networks (work on what you want to see change in)
- Salience is essential (increase attention to what you are working on)
- Repetition and intensity influence learning and consolidation
- Promote generalization, avoid interference
