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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
Q

What does the midbrain control?

A

vision
hearing
motor control
sleep
wakefulness
alertness
temperature regulation

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26
Q

What are the symptoms of a MCA infarct?

A

upper limb motor deficit
facial droop
sensory symptoms
speech deficits

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27
Q

What is a stroke caused by?

A

Disruption of blood supply to the brain resulting in sudden and lasting neurological deficits

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28
Q

What is the medical name for a mini stroke?

A

Transient ischaemic attack

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29
Q

What causes a TIA?

A

a temporary disruption in the blood supply to part of the brain

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30
Q

How long do the effects of a TIA last?

A

a few minutes to a few hours and fully resolve within 24 hours

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31
Q

What are the two types of stroke?

A

ischaemic
Haemorrhagic

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32
Q

Which type of stroke is more prevalent?

A

Ischaemic (85%)

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33
Q

Which type of stroke is less common?

A

Haemorrhagic (15%)

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34
Q

What is used to classify strokes?

A

Bamford/Oxford classification

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35
Q

What are strokes categorised by?

A

Categorisation is based on initial clinical symptoms alone and not on imaging

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36
Q

What are the 4 classifications of stroke?

A

total anterior circulation stroke (TACS)
partial anterior circulation stroke (PACS)
Lacunar stroke (LACS)
Posterior circulation stroke (POCS)

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37
Q

What 3 symptoms can patients with TACS and PACS have?

A

unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
higher cerebral dysfunction (dysphasia, visuospatial disorder)

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38
Q

How many of the 3 symptoms does a TACS patient have?

A

3

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39
Q

How many of the 3 symptoms does a PACS patient have?

A

2

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40
Q

What are the symptoms that a patient with LACS will have one of?

A

Pure sensory stroke
Pure motor stroke
Sensori-motor stroke
Ataxic hemiparesis

There is no loss of higher cerebral functions

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41
Q

What are the symptoms that a patient with POCS will have one of?

A

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

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42
Q

What is an ischaemic stroke due to?

A

occlusion of the blood vessel in the brain

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43
Q

Which blood vessels are most common to cause ischaemic strokes?

A

MCA>PCA>ACA

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44
Q

What are haemorrhagic strokes due to?

A

rupture of the blood vessels in the brain

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45
Q

What is an ICH?

A

intercranial or intracerebral haemorrhage (bleeding o the brain)

46
Q

What is SAH?

A

Subacromial haemorrhage - bleeding on the surface of the brain in the subarachnoid space

47
Q

In what timeframe do we aim to do brain scanning for a stroke?

A

within an hour

48
Q

In what timeframe do we aim to give thrombolysis on a stroke patient?

A

within 4 hours for patients with acute ischaemic stroke

49
Q

What is thrombolysis?

A

Clot busting drug given to patients only with ischaemic stroke

50
Q

What is the aim of thrombolysis?

A

Restoring blood flow to the area thereby preventing cell death

51
Q

What are the benefits of thrombolysis?

A

can significantly increase post stroke recovery
available 24 hours a day, 7 days a week in england

52
Q

What are the risks of thrombolysis?

A

Has risks of causing bleeding anywhere in the body

53
Q

What is a thrombectomy?

A

clot removal with catheter inserted through femoral vein and guided via imaging to the site of the clot in the brain

54
Q

What are the benefits of thrombectomy?

A

can significantly increase post stroke recovery

55
Q

What are the problems/risks with thrombectomy?

A

there are risk associated with the procedure
availability is variable

56
Q

What is carotid endarterectomy?

A

treatment of carotid artery stenosis (plaque build up in carotid artery) by removing the plaque build up in the carotid artery

57
Q

What are the risks of carotid endarterectomy?

A

risks of bleeding and further strokes associated

58
Q

What should patients admitted with ICH have?

A

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
Q

What does secondary prevention of strokes involve?

A

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
Q

Name some motor symptoms of a stroke

A

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
Q

What is muscle tone?

A

a state of readiness in a muscle at rest

62
Q

What do alpha motor neurons stimulate?

A

extrafusal muscle fibres which causes muscle contraction

63
Q

What do gamma motor neurons stimulate?

A

muscle spindles

64
Q

What neural factors produce muscle tone?

A

active contraction
reflex contraction

65
Q

What mechanical factors produce muscle tone?

A

physical inertia of limb
viscoelastic properties of muscle
thixotropy

66
Q

What is thixotropy?

A

stickiness of the muscle and resistance to the movement the longer its at rest

67
Q

What can hypotonicity be caused by?

A

CNS or PNS lesion

68
Q

What is hypertonicity caused by?

A

damage to CNS

69
Q

What is atrophy?

A

The partial or complete wasting away of a part of the body

70
Q

Name some sensory impairments

A

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
Q

What is stereognosis?

A

The ability to identify the shape and form of a 3D object and therefore its identity

72
Q

Name some speech symptoms associated with stroke

A

dysarthria (slurred speech)
expressive dysphasia
receptive dysphasia

73
Q

What is expressive dysphasia?

A

Difficulty in expressing words

74
Q

Name some cognitive symptoms associated with stroke

A

perceptual problems
dyspraxia
memory
retention
inattention

75
Q

Name some factors affecting the recovery of a stroke

A

size and location of stroke
pre-morbid status
patient motivation
patient insight
patient engagement
nutrition and hydration
environment
therapy
age

76
Q

Does neural regeneration occur in the CNS?

A

NO

77
Q

When is the greatest amount of true and spontaneous recovery seen post stroke?

A

in the first 1-3 month

78
Q

What is neuroplasticity?

A

The adaptive capacity of the CNS and its ability to modify its own structural organisation and functioning

79
Q

What is the name of the cerebral blood supply?

A

Circle of Willis

80
Q

How would you define a stroke?

A

a stroke is caused by disruption of blood supply to the brain resulting in sudden and lasting neurological deficits

81
Q

What are the two medical treatments of stroke?

A

thrombolysis
thrombectomy

82
Q

What is muscle tone?

A

a state of readiness in a muscle at rest

83
Q

Is spasticity a CNS or PNS problem?

A

CNS

84
Q

What is ataxia?

A

impaired coordination of voluntary muscle movement

85
Q

What is hemiparesis?

A

muscle weakness on one side of the body

86
Q

What is dyspraxia?

A

impaired ability to plan and process motor tasks

87
Q

What is unilateral neglect or inattention?

A

Inability to recognise and/or respond to stimuli on one side of the body

88
Q

What is receptive dysphasia?

A

difficulty understanding either written or spoken language

89
Q

What is expressive dysphasia?

A

difficulty communicating thoughts, ideas and messages to others. This may affect speech, writing, gestures or drawing

90
Q

What is dysarthria?

A

Inability to control the muscles used in speech resulting in slurred speech

91
Q

What area of the brain is expressive dysphasia associated with?

A

Brocas area

92
Q

What area of the brain is apraxia associated with?

A

parietal lobe

93
Q

What area of the brain is ataxia associated with?

A

cerebellum

94
Q

What area of the brain is agnosia associated with?

A

parietal lobe

95
Q

What area of the brain is neglect associated with?

A

occipital/parietal lobe

96
Q

What area of the brain is hemiparesis associated with?

A

left or right hemisphere

97
Q

What area of the brain is spasticity associated with?

A

motor pathways

98
Q

What area of the brain is low tone associated with?

A

motor pathways

99
Q

What area of the brain is receptive dysphasia associated with?

A

wernikes area

100
Q

Name some risk factors for stroke

A

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
Q

Name the 2 main principles of neuroplasticity and explain how they work

A

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
Q

What are the 10 principles of neuroplasticity?

A

use it or lose it
use it and improve it
specificity
repetition matters
intensity matters
time matters
salience matters
age matters
transference
interference

103
Q

Explain the use it or lose it principle of neuroplasticity

A

Failure to drive specific brain functions can lead to functional degradation

104
Q

Explain the use it and improve it principle of neuroplasticity

A

training that drives a specific brain function can lead to an enhancement of that function

105
Q

Explain the specificity principle of neuroplasticity

A

The nature of training experience dictates the nature of plasticity

106
Q

Explain the repetition matters principle of neuroplasticity

A

induction of plasticity requires sufficient repetition

107
Q

Explain the intensity matters principle of neuroplasticity

A

induction of plasticity requires sufficient training intensity

108
Q

Explain the time matters principle of neuroplasticity

A

different forms of plasticity occur at different times during training

109
Q

Explain the salience matters principle of neuroplasticity

A

The training experience must be sufficiently salient to induce plasticity

110
Q

Explain the age matters principle of neuroplasticity

A

Training induced plasticity occurs more readily in younger brains

111
Q

Explain the transference principle of neuroplasticity

A

plasticity in response to one training experience can enhance the acquisition of similar behaviours

112
Q

Explain the interference principle of neuroplasticity

A

plasticity in response to one experience can interfere with the acquisition of other behaviours

Pathphysiology 2 (14 decks)

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