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Cardiovascular > Stroke > Flashcards

Stroke Flashcards

1
Q

What are some non-modifiable risk factors for stroke?

A

age and gender
race and ethnicity
personal or family history of stroke of TIA

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2
Q

How is age a risk factor for stroke?

A

increases with age

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3
Q

How is gender and risk factor for stroke?

A

men have a greater chance than women
women who take birth control have a greater chance

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4
Q

How is race a risk factor for stroke?

A

african americans have the greatest risk

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5
Q

How is personal or family history of stroke a risk factor for stroke?

A

there is a greater risk of having a repeat stroke after a stroke

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6
Q

What are some modifiable risks associated with stroke?

A

medical conditions and behaviors

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7
Q

what are some medical conditions that are a risk for stroke?

A

hypertension
hyperlipidemia
diabetes Mellitus
carotid stenosis

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8
Q

What are some behavioral risk factors for stroke?

A

cigarette smoking
alcohol abuse
physical inactivity

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9
Q

When does a stroke occur?

A

Flow of oxygen-rich blood to a portion of the brain is blocked leading to ischemia-induced brain cells death

Sudden bleeding in the brain leading to brain cell damages

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10
Q

what are the 2 main types of strokes?

A

The two main types: ischemic (85%) and hemorrhagic (15%)

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11
Q

What are symptoms of stroke?

A

Sudden weakness

Paralysis or numbness of the face, arms, or legs

Trouble speaking or understanding speech

Trouble seeing

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12
Q

What are possible effects of having a stroke?

A

brain damage, long-term disability, or even death

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13
Q

What is ischemic stroke?

A

if an artery that supplies oxygen-rich blood to the brain becomes blocked

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14
Q

What are the two types of ischemic stroke?

A

thrombotic and embolic

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15
Q

What is thrombotic stroke?

A

a blood clot (thrombus) forms in an artery that supplies blood to the brain

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16
Q

What is embolic stroke?

A

a blood clot or other substance (such as plaque) travels through the bloodstream to an artery in the brain (embolus)

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17
Q

What are symptoms of ischemic stroke?

A

Hemiparesis, Aphasia, Dysarthria, Vision loss, Hemisensory deficits, Ataxia/vertigo
Decrease in level of consciousness

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18
Q

How does a stroke affect the neurovascular system?

A

Vascular reductions can diminish transport of energy substrates and nutrients across the Brain Blood Barrier and reduce the clearance of potential neurotoxins from the brain

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19
Q

What makes up the blood-brain barrier?

A

endothelium
pericytes
astrocytes

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20
Q

In relationship to the BBB what is the role of the endothelium?

A

provide tight cell junctions
possess abundance of mitochondria

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21
Q

In relationship to the BBB what is the role of the pericytes?

A

with smooth muscle like properties that reside adjacent to capillaries

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22
Q

In relationship to the BBB what is the role of the astrocytes?

A

envelope >95% of the abluminal vessel surface

23
Q

What is the blood-brain barrier?

A

Highly specialized brain endothelial structure of the fully differentiated neurovascular system

24
Q

What cells make up the the BBB?

A

glial cells, pericytes, neurons, and extracellular matrix

25
Q

What are significant contributors to BBB breakdown?

A

Matrix metalloproteinases (MMPs)

Integrins

Disruption of tight junction protein complexes

26
Q

How do MMPs degrade the BBB?

A

Degrade the tight junctions proteins

27
Q

How do Integrins degrade the BBB?

A

interact with constituents of the basement membrane

28
Q

How do disruptions of the tight junction protein complexes degrade the BBB?

A

VE-cadherin → the BBB disruption in mice subjected to focal cerebral ischemia
-
Occludin → BBB dysfunction in focal cerebral ischemia

29
Q

What is the timeline for ischemic stroke?

A

↑ BBB Na+/K+ cotransporters

Subsequent dysregulation of ionic homeostasis →ischemia-induced edema formation

Microglial cells → ↑ IL-1 and IL-6, intercellular adhesion molecule-1 (ICAM-1), P-selectin and E-selectin

Leukocyte adherence, accumulation and transmigration across the endothelium and mediate inflammatory cascades, further exaggerating infarction

BBB dysfunction → hemorrhagic transformation increased mortality after tissue plasminogen activator (tPA) treatment in stroke, especially following delayed tPA treatment.

30
Q

When is the highest risk of hemorrhagic transformation?

A

24-48 hrs?

31
Q

When is the therapeutic window during a stroke?

A

4.5hrs

32
Q

When is the BBQ breakdown during a stroke?

A

4-6hrs

33
Q

What is TIA?

A

Transient Ischemic Attack

34
Q

What is the difference between a stroke and TIA?

A

Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, WITHOUT acute infarction.

35
Q

What are clinical manifestations of cerebral ischemia?

A

ACA, MCA Syndrome, PCA, SCA, PICA

36
Q

ACA

A

anterior cerebral artery

37
Q

MCA syndrome

A

Contralateral hemiparesis, sensory loss (arm, face worst); Expressive aphasia (dominant) or hemineglect and spatial disorientation

38
Q

PCA

A

posterior cerebral artery

39
Q

SCA

A

Superior cerebral artery

40
Q

PICA

A

posterior inferior cerebellar artery

41
Q

Ischemic Core

A

Cells that are undergoing IRREVERSIBLE cell death

42
Q

Ischemic Penumbra

A

Cells with POTENTIALLY REVERSIBLE ischemic changes

Expansion is based on the severity of deficit in cerebral blood flow and existence of collateral blood supply

43
Q

How can atrial fibrillation affect strokes?

A

At resumption of sinus rhythm, a clot in the left atrial appendage may be pushed into the carotid arteries and to the brain.

44
Q

How can you prevent a stroke?

A

Control blood pressure
smoking cessation
adequate anticoagulation
aspirin and statin therapy
carotid endarterectomy
mediterranean diet
weight reduction
screen for sleep apnea
aspirin therapy

45
Q

what is a hemorrhaging stroke?

A

Occurs if an artery in the brain leaks blood or ruptures. The leaked blood causes swelling of the brain and increased pressure in the skull. The swelling and pressure damage cells and tissues in the brain

46
Q

what are the types of hemorrhaging strokes?

A

intracerebral and subarachnoid

47
Q

What is a intracerebral hemorrhage?

A

a blood vessel inside the brain leaks blood or ruptures

48
Q

What is a subarachnoid hemorrage?

A

a blood vessel on the surface of the brain leaks blood or ruptures. When this happens, bleeding occurs between the inner and middle layers of the membranes that cover the brain

49
Q

What are clinical presentations of a hemorrhagic stroke?

A

focal neurological deficits similar to ischemic stroke

headache

nausea and vomitting

seizures

altered mental status

crossed neurologic signs

50
Q

What are risk factors for hemorrhagic stroke?

A

hypertension
smoking
alcohol abuse
sympathomimetic drugs (cocaine)
anticoagulant therapy
thrombolytics

51
Q

What happens in subarachnoid hemorrhages?

A

Thin-walled outpouchings that protrude from the Circle of Willis

52
Q

What is Arteriovenous Malformation (AVM)?

A

Congenital lesion

Complex tangle of arteries and veins connected by one or more fistulae.

53
Q

Complications of subarachnoid hemorrhage

A

rebleeding
cerebral vasospasm
seizure
hydrocephalus

54
Q

What are complications of subarachnoid hemorrhages?

A

Cardiac – ischemia d/t increased catecholamines

Hyponatremia – most common electrolyte abnormality after SAH

Cardiovascular (5 decks)

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