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Pathphysiology 2 > Stroke > Flashcards

Stroke Flashcards

1
Q

Which two major arteries supply blood to the brain?

A

internal carotid arteries
Vertebral arteries

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2
Q

Which of the two major arteries that supply the brain is anterior?

A

Internal carotid arteries

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3
Q

Which of the two major arteries that supply blood to the brain is posterior?

A

vertebral arteries

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4
Q

What supplies all of the blood to the cerebral cortex?

A

Circle of Willis

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5
Q

What do the internal coratid arteries divide to form?

A

The anterior cerebral artery and the middle cerebral artery

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6
Q

What do the anterior cerebral arteries join to form?

A

Anterior communicating artery

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7
Q

What do the vertebral arteries pass up through?

A

They pass up through foramina in transverse processes of cervical vertebrae

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8
Q

What do the vertebral arteries join to form?

A

Basilar artery

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9
Q

What does the basilar artery divide into and where does it divide?

A

It divides at the upper brainstem into 2 posterior cerebral arteries

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10
Q

What connects the posterior part of the circle of Willis to the anterior part?

A

Posterior communicating arteries

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11
Q

What does the circle of Willis do?

A

protects the brain via collateral circulation

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12
Q

What does the ACA supply?

A

the medial and superior parts of the frontal lobe and then anterior parietal lobe
This includes the frontal, pre-frontal and supplementary motor cortex as well as parts of the primary motor and primary sensory cortex

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13
Q

What does the frontal lobe control?

A

voluntary movement
attention
personality
emotion
memory
speech

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14
Q

What does the parietal lobe control?

A

perception and integration of sensory information
visuospatial processing
spatial attention

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15
Q

What does the MCA supply?

A

The greater part of the lateral cerebral surface (including the main motor and sensory areas) and supplies deep structures including the internal capsule and the basal ganglia

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16
Q

What does the basal ganglia control?

A

Involved in cognitive and emotional behaviours
Plays an important role in reward and reinforcement, addictive behaviours and habit formation

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17
Q

What does the PCA supply?

A

occipital lobe, the inferomedial surface of the temporal lobe and thalamus

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18
Q

What does the PCA supply?

A

occipital lobe, the inferomedial surface of the temporal lobe and thalamus

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19
Q

What does the temporal lobe control?

A

perception
face recognition
object recognition
memory acquisition
language understanding
emotional reactions

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20
Q

What does the occipital lobe control?

A

Primary visual area of the brain

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21
Q

What does the thalamus control?

A

It is the principle relay station for sensory input

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22
Q

What does the basilar artery supply?

A

It supplies blood to all of the brain stem and the cerebellum

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23
Q

What is the pons responsible for?

A

breathing and respiratory rhythm

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24
Q

What is the medulla responsible for?

A

cardiac, respiratory, vomiting and vasomotor centres

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25
What does the midbrain control?
vision hearing motor control sleep wakefulness alertness temperature regulation
26
What are the symptoms of a MCA infarct?
upper limb motor deficit facial droop sensory symptoms speech deficits
27
What is a stroke caused by?
Disruption of blood supply to the brain resulting in sudden and lasting neurological deficits
28
What is the medical name for a mini stroke?
Transient ischaemic attack
29
What causes a TIA?
a temporary disruption in the blood supply to part of the brain
30
How long do the effects of a TIA last?
a few minutes to a few hours and fully resolve within 24 hours
31
What are the two types of stroke?
ischaemic Haemorrhagic
32
Which type of stroke is more prevalent?
Ischaemic (85%)
33
Which type of stroke is less common?
Haemorrhagic (15%)
34
What is used to classify strokes?
Bamford/Oxford classification
35
What are strokes categorised by?
Categorisation is based on initial clinical symptoms alone and not on imaging
36
What are the 4 classifications of stroke?
total anterior circulation stroke (TACS) partial anterior circulation stroke (PACS) Lacunar stroke (LACS) Posterior circulation stroke (POCS)
37
What 3 symptoms can patients with TACS and PACS have?
unilateral weakness (and/or sensory deficit) of the face, arm and leg Homonymous hemianopia higher cerebral dysfunction (dysphasia, visuospatial disorder)
38
How many of the 3 symptoms does a TACS patient have?
3
39
How many of the 3 symptoms does a PACS patient have?
2
40
What are the symptoms that a patient with LACS will have one of?
Pure sensory stroke Pure motor stroke Sensori-motor stroke Ataxic hemiparesis There is no loss of higher cerebral functions
41
What are the symptoms that a patient with POCS will have one of?
Cranial nerve palsy and a contralateral motor/sensory deficit Bilateral motor/sensory deficit Conjugate eye movement disorder cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia) Isolated homonymous hemianopia
42
What is an ischaemic stroke due to?
occlusion of the blood vessel in the brain
43
Which blood vessels are most common to cause ischaemic strokes?
MCA>PCA>ACA
44
What are haemorrhagic strokes due to?
rupture of the blood vessels in the brain
45
What is an ICH?
intercranial or intracerebral haemorrhage (bleeding o the brain)
46
What is SAH?
Subacromial haemorrhage - bleeding on the surface of the brain in the subarachnoid space
47
In what timeframe do we aim to do brain scanning for a stroke?
within an hour
48
In what timeframe do we aim to give thrombolysis on a stroke patient?
within 4 hours for patients with acute ischaemic stroke
49
What is thrombolysis?
Clot busting drug given to patients only with ischaemic stroke
50
What is the aim of thrombolysis?
Restoring blood flow to the area thereby preventing cell death
51
What are the benefits of thrombolysis?
can significantly increase post stroke recovery available 24 hours a day, 7 days a week in england
52
What are the risks of thrombolysis?
Has risks of causing bleeding anywhere in the body
53
What is a thrombectomy?
clot removal with catheter inserted through femoral vein and guided via imaging to the site of the clot in the brain
54
What are the benefits of thrombectomy?
can significantly increase post stroke recovery
55
What are the problems/risks with thrombectomy?
there are risk associated with the procedure availability is variable
56
What is carotid endarterectomy?
treatment of carotid artery stenosis (plaque build up in carotid artery) by removing the plaque build up in the carotid artery
57
What are the risks of carotid endarterectomy?
risks of bleeding and further strokes associated
58
What should patients admitted with ICH have?
anticoagulant urgently reversed Blood pressure lowered for those who develop hydrocephalus they should be considered for surgical intervention such as insertion of a external ventricular vein
59
What does secondary prevention of strokes involve?
reviewing risk factors and providing treatment and advice to reverse these if possible establishing the cause of current stroke and treating this if possible
60
Name some motor symptoms of a stroke
lack of muscle innervation changes in muscle tone ataxia muscle weakness balance problems asymmetry loss of normal movement patterns loss of postural adjustments compensations
61
What is muscle tone?
a state of readiness in a muscle at rest
62
What do alpha motor neurons stimulate?
extrafusal muscle fibres which causes muscle contraction
63
What do gamma motor neurons stimulate?
muscle spindles
64
What neural factors produce muscle tone?
active contraction reflex contraction
65
What mechanical factors produce muscle tone?
physical inertia of limb viscoelastic properties of muscle thixotropy
66
What is thixotropy?
stickiness of the muscle and resistance to the movement the longer its at rest
67
What can hypotonicity be caused by?
CNS or PNS lesion
68
What is hypertonicity caused by?
damage to CNS
69
What is atrophy?
The partial or complete wasting away of a part of the body
70
Name some sensory impairments
impaired cutaneous sensation (light and deep touch, temperature, sharp blunt, 2 point discriminant) Impaired stereognosis impaired proprioceptive awareness visual field deficits (homonymous hemianopia, quadrantanopia)
71
What is stereognosis?
The ability to identify the shape and form of a 3D object and therefore its identity
72
Name some speech symptoms associated with stroke
dysarthria (slurred speech) expressive dysphasia receptive dysphasia
73
What is expressive dysphasia?
Difficulty in expressing words
74
Name some cognitive symptoms associated with stroke
perceptual problems dyspraxia memory retention inattention
75
Name some factors affecting the recovery of a stroke
size and location of stroke pre-morbid status patient motivation patient insight patient engagement nutrition and hydration environment therapy age
76
Does neural regeneration occur in the CNS?
NO
77
When is the greatest amount of true and spontaneous recovery seen post stroke?
in the first 1-3 month
78
What is neuroplasticity?
The adaptive capacity of the CNS and its ability to modify its own structural organisation and functioning
79
What is the name of the cerebral blood supply?
Circle of Willis
80
How would you define a stroke?
a stroke is caused by disruption of blood supply to the brain resulting in sudden and lasting neurological deficits
81
What are the two medical treatments of stroke?
thrombolysis thrombectomy
82
What is muscle tone?
a state of readiness in a muscle at rest
83
Is spasticity a CNS or PNS problem?
CNS
84
What is ataxia?
impaired coordination of voluntary muscle movement
85
What is hemiparesis?
muscle weakness on one side of the body
86
What is dyspraxia?
impaired ability to plan and process motor tasks
87
What is unilateral neglect or inattention?
Inability to recognise and/or respond to stimuli on one side of the body
88
What is receptive dysphasia?
difficulty understanding either written or spoken language
89
What is expressive dysphasia?
difficulty communicating thoughts, ideas and messages to others. This may affect speech, writing, gestures or drawing
90
What is dysarthria?
Inability to control the muscles used in speech resulting in slurred speech
91
What area of the brain is expressive dysphasia associated with?
Brocas area
92
What area of the brain is apraxia associated with?
parietal lobe
93
What area of the brain is ataxia associated with?
cerebellum
94
What area of the brain is agnosia associated with?
parietal lobe
95
What area of the brain is neglect associated with?
occipital/parietal lobe
96
What area of the brain is hemiparesis associated with?
left or right hemisphere
97
What area of the brain is spasticity associated with?
motor pathways
98
What area of the brain is low tone associated with?
motor pathways
99
What area of the brain is receptive dysphasia associated with?
wernikes area
100
Name some risk factors for stroke
age gender ethnicity previous stroke or TIA hypertension ischaemic heart disease atrial fibrillation high blood cholesterol diabetes high salt diet pregnancy contraceptive pill migraines
101
Name the 2 main principles of neuroplasticity and explain how they work
unmasking of dormant pathways -> these pathways increase in synaptic strength with continued use collateral sprouting -> adjacent neurons may sprout axons in order to strengthen neuronal pathways as part of neuroplasticity mechanisms
102
What are the 10 principles of neuroplasticity?
use it or lose it use it and improve it specificity repetition matters intensity matters time matters salience matters age matters transference interference
103
Explain the use it or lose it principle of neuroplasticity
Failure to drive specific brain functions can lead to functional degradation
104
Explain the use it and improve it principle of neuroplasticity
training that drives a specific brain function can lead to an enhancement of that function
105
Explain the specificity principle of neuroplasticity
The nature of training experience dictates the nature of plasticity
106
Explain the repetition matters principle of neuroplasticity
induction of plasticity requires sufficient repetition
107
Explain the intensity matters principle of neuroplasticity
induction of plasticity requires sufficient training intensity
108
Explain the time matters principle of neuroplasticity
different forms of plasticity occur at different times during training
109
Explain the salience matters principle of neuroplasticity
The training experience must be sufficiently salient to induce plasticity
110
Explain the age matters principle of neuroplasticity
Training induced plasticity occurs more readily in younger brains
111
Explain the transference principle of neuroplasticity
plasticity in response to one training experience can enhance the acquisition of similar behaviours
112
Explain the interference principle of neuroplasticity
plasticity in response to one experience can interfere with the acquisition of other behaviours

Pathphysiology 2 (14 decks)

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