Stroke

Question 1

Stroke definition

Answer 1

a sudden onset of neurological dysfunction due to cerebrovascular abnormality that results in an area of brain infarction

Question 2

What is the most common form of stoke?

Answer 2

Ischemic

Question 3

Are males or females more affected by stroke?

Answer 3

Males

Question 4

What are the risk factors of a stroke?

Answer 4

-Hypertension
-Diabetes
-Hypercholesterolemia
-Smoking
-Heavy alcohol consumption
-Oral contraceptive use

Question 5

What are the two categories of stroke?

Answer 5

-Ischemic: embolic and thrombotic
-Hemorrhagic

Question 6

What are the signs and symptoms of a stroke?

Answer 6

-Numbness or weakness of the face, arm or leg (contralateral)
-Confusion, trouble speaking or understanding others
-Visual disturbances in one or both eyes
-Dizziness, loss of balance, and difficulty with walking
-Severe headache

Question 7

What happens during an ischemic stroke?

Answer 7

-A sudden occlusion of the cerebral artery- thrombus or emboli
-Produces recognizable symptoms

Question 8

Thrombotic strokes are associated with:

Answer 8

Atherosclerosis and coagulopathies

Question 9

How long does it take for symptoms to evolve in thrombotic strokes?

Answer 9

usually several minutes and may be preceded by trans ischemic attacks

Question 10

What arteries do thrombotic strokes usually affect?

Answer 10

-Internal carotid artery
-Middle cerebral artery
-Basilar artery

Question 11

What are most ischemic strokes caused by?

Answer 11

Lipohyalinosis

Question 12

What are the most common affected vessels of ischemic stroke?

Answer 12

-Lenticulostriate arteries
-Small branches of the middle cerebral, basilar, and posterior arteries

Question 13

Occlusions of the arteries affected by ischemic stroke can cause:

Answer 13

lacunar infarctions

Question 14

What are the common affected areas of lacunar infarctions:
IMPORTANT

Answer 14

-Thalamus (pure sensory stroke)
-Internal capsule or pons ( pure motor stroke)
-Caudate
-Putame
-Cerebellum

Question 15

What are embolic strokes usually associated with:

Answer 15

cardiac dysfunction or dysrhythmias (a.fib)

Question 16

What arteries are affected by embolic strokes:

Answer 16

-Middle cerebral artery
-Basilar artery
-Posterior cerebral arteries

Question 17

Are the signs and symptoms of hemorrhagic stroke more or less predictable than in ischemic stroke?

Answer 17

LESS

Question 18

Do hemorrhagic strokes affect areas closer to or farther away from the hemorrhage?

Answer 18

Farther away

Question 19

What do hemorrhagic strokes do to the brain?

Answer 19

-Increased intracranial pressure
-Edema
-Compression
-Rupture of blood into the ventricles of the subarachnoid space

Question 20

What are the 3 types of hemorrhagic strokes?

Answer 20

-Epidural hemorrhage
-Subdural hematomas
-Subarachnoid hemorrhage

Question 21

What causes an epidural hemorrhage and where is it most common?

Answer 21

Usually secondary to head trauma and damage to an artery
Most common in the middle meningeal artery

Question 22

What causes a subdural hematoma?

Answer 22

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

Question 23

What causes subarachnoid hemorrhage?

Answer 23

Results from head trauma.
Extension of blood from another compartment into the subarachnoid space.
Rupture of an arterial aneurysm (Berry Aneurism)

Question 24

Hemorrhage within the brain parenchyma usually occurs:

Answer 24

secondary to severe chronic hypertension

Question 25

Where do hemorrhages occur within the brain parenchyma:

Answer 25

most occur in basal ganglia or thalamus and less common in the cerebellum

Question 26

Other causes of intraparenchymal hemorrhage:

Answer 26

-vascular malformations -glioblastoma multiforme -platelet and coagulation disorders -drugs (amphetamines and cocaine) -Cerebral amyloid angiopathy (Alzheimer's)

Question 27

What are the normal glutamate metabolism steps:

Answer 27

1. Glutamate is released at excitatory synapses 2. Taken up by glia cells and converted to glutamine by glutamine synthetase (ATP) 3. Glutamine release and uptake by neurons (Na+ reuptake systems) 4. Neurons store glutamine in vesicles for subsequent release

Question 28

What are the steps of cell death-excitotoxicity

Answer 28

1. Glia cell ischemia causes low O2 glucose (ATP) 2. Affects transmembrane Na+ gradient causes increased intracellular Na 3.Decreased glutamate uptake and conversion to glutamine 4. Increased extracellular levels of glutamate 5. Overstimulation of glutamate receptors leads to cell death

Question 29

Motor deficits due to stroke

Answer 29

-Initially flaccidity or paralysis then spasticity -Active/passive range of motion exercises -Intensive rehabilitation

Question 30

Sensory disturbances due to stroke

Answer 30

-Occur in the same locations as motor paralysis -Involve neglect or visual impairment -Assess fall risk -Adaptive behaviours and techniques commonly needed to prevent injury

Question 31

Two types of language deficits that can occur due to stroke

Answer 31

Broca aphasia and Wernicke aphasia

Question 32

What area of the brain is damaged causing language deficits?

Answer 32

dominant cerebral hemisphere

Question 33

Broca aphasia definition

Answer 33

verbal motor/expressive. It consists of poor articulation and sparse vocabulary

Question 34

Wernicke aphasia

Answer 34

sensory, acoustic, and receptive. Characterized by impaired auditory comprehension and speech that is fluent by does not make sense.