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pathophysiology 3801 > stroke > Flashcards

stroke Flashcards

1
Q

this is one of the connective tissues that make up the meninges of the brain. it is the outermost of the three layers that surrounds and protects the brain and spinal cord

A

dura matter

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2
Q

middle layer of the three meninges, doesn’t contain any blood vessels; has a web like structure and its function is to cushion the brain

A

arachnoid matter

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3
Q

inner layer of the three meninges and is composed of delicate connective tissue and contains many small blood vessels; clings tightly to the brain that allows for all of its convolutions

A

pia matter

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4
Q

know the order of the arteries in the brain starting with the left common carotid artery

A

left common carotid artery -> left internal carotid artery -> left middle cerebral artery -> left anterior cerebral artery

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5
Q

know the order of the arteries in the brain staring with the left vertebral artery

A

left vertebral artery -> basilar artery -> left posterior cerebral artery

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6
Q

a sudden onset of neurological dysfunction due to cerebrovascular abnormality that results in an area of brain infarction;
-local neurological deficit
-persists for more than 24 hours
-blood supply is compromised

A

stroke

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7
Q

true/false: females are affected more often than males regarding strokes

A

false! males affected more often than females

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8
Q

what risk factors are associated with stroke?

A

-hypertension
-DM
-hypercholesterolemia
-smoking
-heavy alcohol consumption
-oral contraceptive use

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9
Q

what are the two categories of stroke?

A

-ischemic stroke
-hemorrhagic stroke

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10
Q

this type of stroke is caused by a blood clot in an artery going to the brain

A

thrombotic stroke

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11
Q

this type of stroke occurs when a clot that is formed elsewhere in the body, usually in the heart or the neck, travels in the blood stream and clogs a blood vessel leading to the brain

A

embolic stroke

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12
Q

what are some signs and symptoms of stroke?

A

-numbness or weakness of the face, arm, or leg (contralateral-one side)
-confusion, trouble speaking or understanding others
-visual disturbances in one or both eyes
-dizziness, loss of balance, difficulty walking
-severe headache

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13
Q

sudden occlusion (blockage) or the cerebral artery (could be a thrombus or an emboli).

A

ischemic stroke

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14
Q

__________ are soociated with atherosclerosis and coagulopathies

A

thrombotic strokes

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15
Q

what arteries do thrombotic strokes affect

A

-internal carotid artery
-middle cerebral artery
-basilar artery

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16
Q

the symptoms of this type of stroke usually evolve over several minutes and may be preceded by transient ischemic attacks (occlusion that fluctuates between full and partial which is a warning sign)

A

thrombotic stroke

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17
Q

true/false: areas of the arteries where there are turns are more prone to atherosclerosis

A

true

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18
Q

concentric hyaline thickening of the cerebral small vessels leading to occlusion of the small penetrating arteries; this causes small vessel ischemic stroke

A

lipohyalinosis

19
Q

what are the most common affected vessels of small vessel ischemic stroke?

A

-lenticulostriate arteries
-small branches of the middle cerebral, basilar, and posterior arteries

20
Q

what areas are affected by lacunar infarctions?

A

-thalamus (pure sensory stroke)
-internal capsule or pons (pure motor stroke)
-caudate
-putame
-cerebellum

21
Q

____________ are associated with cardiac dysfunction or dysrhythmias

A

embolic stroke

22
Q

what arteries do embolic strokes affect?

A

-middle cerebral artery
-basilar artery
-posterior cerebral arteries

23
Q

signs and symptoms are less predictable than ischemic stroke. affects areas distant from the hemorrhage
-increased intracranial pressure
-edema
-compression
-rupture of blood into the ventricles and subarachnoid space

A

hemorrhagic stroke

24
Q

usually secondary to head trauma and damage to an artery; most common in the meningeal artery

A

epidural hemorrhage

25
Q

rupture of small cortical veins, caused by small trauma in the elderly

A

subdural hematoma

26
Q

result from a head trauma, extension of blood from another compartment into the subarachnoid space, rupture of an arterial aneurysm (berry aneurism)

A

subarachnoid hemorrhage

27
Q

usually occurs secondary to severe, chronic hypertension. presence of Charcot-Bouchard aneurysms; most occur in basal ganglia or thalamus and less common in the cerebellum.

A

hemorrhage within the brain parenchyma (intraparenchymal hemorrhage)

28
Q

other than hypertension, what are some other causes of intraparenchymal hemorrhage

A

-vascular malformations
-glioblastoma multiforme (aggressive type of cancer that can occur in the brain or spinal cord)
-platelet and coagulation disorders
-drugs (amphetamines and cocaine)
-alzheimers

29
Q

a phenomenon that describes the toxic actions of excitatory neurotransmitters, primarily glutamate, where the exacerbated or prolonged activation of glutamate receptors starts a cascade of neurotoxicity that ultimately leads to the loss of neuronal function

A

excitotoxicity

30
Q

know how normal glutamate is metabolized

A

-glutamate is released at excitatory synapses
-glutamate is then taken up by glial cells and is converted to glutamine by glutamine synthetase (ATP)
-glutamine is released and taken up by neurone (na+ reuptake systems)
-neurons store glutamine in vesicle for subsequent release

31
Q

what two receptors does glutamate stimulate?

A

inotropic and metabolic receptors

32
Q

know how excitotoxicity occurs (two ways)

A

-glia cell ischemia leads to low o2 glucose (ATP)
-affects transmembrane Na+ gradient leads to intracellular Na+
-decreased glutamate uptake and conversion to glutamine
-increased extracellular levels of glutamate
-overstimulation of glutamate receptors leads to cell death

-glial cell ischemia leads to low o2 glucose (ATP) which leads to decreased Na+K+ ATPase
-decreased K+ uptake by glia cell leads to increased extracellular K+ & cell depolarization
-increased glutamate release which leads to increased extracellular levels of glutamate
-increased level of intracellular Ca2+
-sustained stimulation of calcium sensitive enzymes causes “cell death” (proteases, phospholipases and endonuclease)

33
Q

what are the sequelae of stroke?

A

motor, language, cognitive and sensory deficits

34
Q

(verbal motor/expressive) consists of poor articulation and sparse vocabulary

A

broca aphasia

35
Q

(sensory, acoustic, receptive) characterized by impaired auditory comprehension and speech that is fluent but does not make sense

A

wernickle aphasia

36
Q

which artery/territory is associated with the following symptoms: paresis and sensory loss of contralateral leg and foot

A

anterior cerebral artery
territory: medial frontal and parietal cortex, anterior corpus callosum

37
Q

which artery/territory is associated with the following symptoms: aphasia (dominant hemisphere) neglect (non-dominant hemisphere), hemianopia, hemiparesis

A

middle cerebral artery
territory: medulla, lower cerebellum

38
Q

which artery/territory is associated with the following symptoms: ipsilateral cerebral ataxia, Horners syndrome, crossed sensory loss, nystagmus, vertigo, hiccup, dysarthria, dysphagia

A

vertebral artery
territory: medulla, lower cerebellum

39
Q

which artery/territory is associated with the following symptoms: nystagmus, vertigo, diplopia (seeing double), semi or cross sensory loss, ataxia and Horners syndrome, coma

A

basilar artery
territory: lower midbrain, pons, upper and mid cerebellum

40
Q

which artery/territory is associated with the following symptoms: dyslexia, hallucinations, affected memory cortical blindness

A

posterior cerebral artery
territory: distal territory

41
Q

which artery/territory is associated with the following symptoms: sensory loss ataxia, choreoathetosis, hemiballismus, affected consciousness

A

posterior cerebral artery
territory: proximal territory

42
Q

problem with sympathetic nerve supply to one side of the face:
-miosis (constricted pupils)
-ptosis (droopy eyelid)
-anhidrosis (failure to sweat)

A

Horner syndrome

43
Q

what is the treatment for the stroke?

A

-cardiovascular stabilization
-Brain CT: determines type and location of stroke

pathophysiology 3801 (8 decks)

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