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Clinical Med (Year 2) > Stroke > Flashcards

Stroke Flashcards

1
Q

What is a stroke?

A
  • Cerebral vascular accident
  • Sudden vascular event leading to disruption of blood flow to part of the brain and destruction of surrounding brain tissue
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2
Q

T/F: After a stroke there is a rapid onset of neurological deficit

A

True
- Leading cause of serious long term disability

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3
Q

What is a Transient Ischemic Attack?

A

Focal neurological symptoms, similar to stroke, but with resolution of neurological symptoms within 24 hours

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4
Q

The etiology for Transient Ischemic Attack is same as what disorder? And what may it be confused with?

A
  • Etiology is the same as stroke
  • May be confused with minor ischemic stroke
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5
Q

15% of all stroke are preceded by what?

A

Transient Ischemic Attack

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6
Q

What is the early management of Transient Ischemic Attack?

A
  • Imaging
  • Close observation
  • Blood thinners
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7
Q

What are some potentially modifiable risk factors of stroke?

A
  • HTN
  • Cardiovascular disease
  • Atrial Fibrillation
  • DM (Type II)
  • Smoking
  • Alcohol / Cocaine use
  • Medication
  • Physical inactivity
  • Obesity
  • Diet
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8
Q

What is the greatest non-modifiable risk factor for stroke?

A

-Age
- Risk double each decade after 55 yr

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9
Q

What are some non-modifiable risk factor for stroke?

A
  • Race
  • Gender
  • Family history (stroke, sickle cell disease, genetic predisposition)
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10
Q

What are the early warning signs for stroke?

A
  • BE FAST
  • Loss of BALANCE, headache, dizziness
  • EYES: blurred vision
  • one side of the FACE is drooping
  • ARM or leg weakness
  • SPEECH difficulty
  • TIME to call for ambulance immediately
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11
Q

In regards to pathogenesis of Ischemic Stroke there is a loss of blood supply so what happens as a result of:
- No blood flow?
- Reduced blood flow?

A
  • No blood flow can lead to neuronal cell death (core/infarct)
  • Reduced blood flow can lead to ischemic penumbra
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12
Q

What is an ischemic penumbra?

A

An area of damaged tissue surrounding the area of infarct

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13
Q

Inflammatory processes in the penumbra can expand what?

A

initial lesion

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14
Q

T/F: Even if blood flow is restored to ischemic area the damaged tissue can not recover

A

False
- If blood flow is restored to the ischemic area before irreversible damage occurs the tissue may recover

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15
Q

What are the inflammatory processes that occur in the penumbra?

A
  1. Change to blood brain barrier causes leukocyte infiltration
  2. Activated glial and endothelial cells cause free radicals to be released, cytokines, chemokine & enzymes
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16
Q

Inflammatory processes that occur in the penumbra lead to what?

A

Neuronal cell death within the ischemic penumbra

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17
Q

Pathogenesis: Ischemic Stroke
What is Atherosclerotic Cerebrovascular Disease?

A
  • Major Artery Occlusion
  • Plaque forms in vessel walls
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18
Q

What happens physiologically due Atherosclerotic Cerebrovascular Disease?

A
  • Carotid & Vertebrobasilar system involved
  • Decreased compliance & flow
  • May form thrombus –> occlusion or embolism
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19
Q

What is the most common source of embolism?

A

heart

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20
Q

Pathogenesis: Ischemic Stroke

Atrial fibrillation can lead to what?

A

Clot formation

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21
Q

Embolism form from what type of arteries?

A
  • Atherosclerotic
    (Carotid & Vertebrobasilar)
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22
Q

(BLANK) and (BLANK) can promote thickening of small vessel walls leading to Lacunar infarcts.

A

HTN and DM

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23
Q

Small vessel infarct can be due to what?

A
  • Ischemic necrosis
  • Cysts
  • Gliosis
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24
Q

What areas can Lacunar infarcts affect?

A
  • Basal Ganglia
  • Internal Capsule
  • Pons
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25
Q

Lacunar infarcts is also known as?

A

Small vessel disease

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26
Q

What are the two type of hemorrhagic stroke?

A
  1. Intracerebral hemorrhage
  2. Subarachnoid hemorrhage
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27
Q

What is an intracerebral hemorrhage?

A

Bleeding from artery into brain parenchyma

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28
Q

What is a subarachnoid hemorrhage?

A

Bleeding from artery into sub arachnoid space

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29
Q

In regards to Intracerebral hemorrhage how does HTN lead to microvascular disease?

A
  • Weaken arterial vessel walls
  • Forms small aneurysms (micro aneurysms)
  • Prone to leakage or rupture
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30
Q

What vessels are affected by intracerebral hemorrhage?

A
  • Distal (small) vessels
  • Arteriole branches
  • Penetrating arteries of circle of Willis
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31
Q

What event precipitates intracerebral hemorrhage?

A

Acute increase in BP or blood flow

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32
Q

What type of hemorrhage can a Berry aneurysm cause?

A

Subarachnoid hemorrhage

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33
Q

What is a Berry aneurysm? And where can they occur?

A
  • Congenital distention at bifurcation
  • Occur at Circle of Willis
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34
Q

Venous or Cavernous Malformation can cause what type of hemorrhage?

A

Subarachnoid hemorrhage

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35
Q

What is an A-V Malformation? What type of hemorrhage can this cause?

A
  • Direct artery to vein without capillary bed
  • Subarachnoid hemorrhage
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36
Q

What are three risk factors/causes of chronic subdural hemorrhage?

A
  • Elderly
  • Cerebral atrophy (increase movement between brain & skull)
  • Minor fall (trauma)
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37
Q

Tearing of (BLANK) can cause subdural hemorrhage

A

Bridging veins

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38
Q

Torn meningeal artery in periosteal layer of dura leads to what?

A

Epidural hematoma

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39
Q

What does an epidural hematoma typically occur with?

A

Traumatic skull fracture

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40
Q

In an epidural hematoma what does pooling of blood cause?

A

Compression of the brain

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41
Q

What is the onset of ischemic stroke?
What vasculature is involved?

A
  • Sudden, evolving
  • Blocked artery
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42
Q

What is the onset of intracerebral hemorrhage? What vasculature is involved?

A
  • Gradual or sudden
  • Mircorvasculature
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43
Q

What is the onset of subarachnoid hemorrhage? What vasculature is involved?

A
  • Gradual if leak precedes rupture
  • Or sudden
  • Arterial
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44
Q

What is the onset of subdural hemorrhage? What vasculature is involved?

A
  • Gradual
  • Venous (bridging)
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45
Q

What is the onset of epidural hemorrhage? What vasculature is involved?

A
  • Sudden/ trauma
  • Arterial (meningeal)
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46
Q

What are the symptoms and prognosis of ischemic stroke?

A
  • Sym: Sudden, progressive focal deficits
  • Prog: Survival better than hemorrhage
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47
Q

What are the symptoms and prognosis of intracerebral hemorrhage?

A
  • Sym: Focal deficits, headache, increased ICP
  • Prog: High mortality; good recovery among survivors
48
Q

What are the symptoms and prognosis of subarachnoid hemorrhage?

A
  • Sym: Generalized symptoms, headache, increased ICP
  • Prog: Variable with size, high mortality/ poor recovery in the elderly
49
Q

What are the symptoms and prognosis of subdural hemorrhage?

A
  • Sym: Headache, changes in mental status
  • Prog: Acute worse than chronic
50
Q

What are the symptoms and prognosis of epidural hemorrhage?

A
  • Sym: Compression of brain causes symptoms
  • Prog: Medical emergency, risk of death
51
Q

T/F: The more distal the stroke = more hypoxic tissue

A

False
- More proximal the stroke = hypoxic tissue

52
Q

Usually the more proximal the stroke = more hypoxic tissue except where?

A

Circle of Willis

53
Q

In a middle cerebral artery syndrome what are the symptoms on the contralateral side?

A
  • UE > LE
  • Hemiparesis/hemiplegia
  • Hemianesthesia
54
Q

Which hemisphere is affected with middle cerebral artery syndrome and what does this cause?

A
  • Dominant hemisphere
  • Global aphasia
55
Q

What are the symptoms of a superior division middle cerebral artery syndrome?

A
  • UE/ Face weakness
  • Broca’s aphasia
  • +/- sensory loss
56
Q

What are symptoms of an inferior division middle cerebral artery syndrome?

A
  • Wernicke’s aphasia
  • +/- sensory loss
57
Q

What are the symptoms of an anterior cerebral artery syndrome?

A
  • Contralateral (LE > UE)
  • Hemiparesis
  • Hemianesthesia
58
Q

Occlusion proximal to the anterior communicating artery leads to what?

A

Minimal dysfunction due to collateral flow

59
Q

What symptoms are seen with an internal carotid artery syndrome?

A

MCA + ACA symptoms

60
Q

Why may symptoms be minimal in an internal carotid artery syndrome?

A

Collateral flow

61
Q

In a posterior cerebral artery syndrome, injury to the thalamic branches cause?

A
  • Abnormal sensation
  • Exaggerated: light touch = pain
62
Q

In a posterior cerebral artery syndrome, injury to the occipital branches cause?

A
  • Visual changes
  • Homonymous hemianopia, visual agnosia
63
Q

In a posterior cerebral artery syndrome, injury to the temporal branches causes?

A

Memory loss

64
Q

In a posterior cerebral artery syndrome, injury to proximal occlusion before cerebral peduncle causes?

A

Contralateral hemiparesis/ hemiplegia

65
Q

In a posterior cerebral artery syndrome, injury to proximal occlusion before red nucleus causes?

A

Contralateral ataxia

66
Q

A lacunar syndrome to the internal capsule (posterior limb) cause what symptom?

A

Pure motor

67
Q

A lacunar syndrome to the internal capsule (genu) cause what symptom?

A
  • Weak face
  • Dysarthria
68
Q

A lacunar syndrome to the posterolateral thalamus causes what symptom?

A

Pure sensory

69
Q

A lacunar syndrome to the basal ganglia causes what?

A

Movement disorder

70
Q

Vertebral & Posterior Inferior Cerebellar Artery Syndrome
What are the symptoms of the Lateral medullary (Wallenberg’s) Syndrome on the whole body?

A
  • Vertigo
  • Nausea
  • Hoarseness
  • Dysphagia
71
Q

Vertebral & Posterior Inferior Cerebellar Artery Syndrome
What are the symptoms of the Lateral medullary (Wallenberg’s) Syndrome on the ipsilateral side?

A
  • Ataxia
  • Ptosis
  • Fascial sensory loss
72
Q

Vertebral & Posterior Inferior Cerebellar Artery Syndrome
What are the symptoms of the Lateral medullary (Wallenberg’s) Syndrome on the contralateral side?

A

Torso and limb sensory loss

73
Q

Vertebral & Posterior Inferior Cerebellar Artery Syndrome
What are the symptoms of Medial medullary Syndrome on the contralateral side?

A
  • Hemiparesis (arm, leg)
  • Loss of proprioception
74
Q

Vertebral & Posterior Inferior Cerebellar Artery Syndrome
What are the symptoms of Medial medullary Syndrome on the ipsilateral side?

A

Ipsilateral tongue weakness

75
Q

What are the symptoms of the anterior inferior cerebellar?

A
  • Ipsilateral hearing loss
  • Vertigo/nystagmus
  • Ipsilateral face / contralateral body pain & temp
  • Fascial weakness
  • Ataxia
76
Q

What are the symptoms of the superior cerebellar syndrome?

A
  • Ipsilateral ataxia
  • Contralateral pain / temp loss (body, limbs, face)
77
Q

Complete basilar artery syndrome causes?

A

locked in syndrome

78
Q

What are the symptoms of complete basilar artery syndrome?

A
  • Quadriplegia
  • Lower bulbar palsy
  • Mutism
79
Q

What is spared in a complete basilar artery syndrome?

A
  • Cognition
  • Sensation
  • Vertical eye movement
80
Q

What are the symptoms of a partial basilar artery syndrome?

A
  • Ataxia
  • Clumsiness
  • Weakness
81
Q

What are some ways to diagnosis strokes?

A
  • History
  • CT
  • MRI
  • PET
  • Doppler Ultrasound
82
Q

What are the pros and cons of using a CT for diagnosing stroke?

A
  • Pro: Fast & Convenient, can detect hemorrhage
  • Con: Decreased detection of acute ischemic stroke
83
Q

An MRI can detect (BLANK) within 2-6 hours

A

ischemic

84
Q

An MRI can monitor what?

A

Ischemia / Evolution of stroke

85
Q

T/F: A PET scan has higher sensitivity and earlier detection

A

True

86
Q

What areas can be seen with a PET scan?

A

Areas of hypo metabolism or decreased blood flow

87
Q

What is a doppler ultrasound used for in diagnosing stroke?

A

Carotid and vertebral arteries blood flow and identify plaque accumulation

88
Q

How is a cerebral angiography performed?

A
  • Invasive procedure
  • Inject radiopaque contrast agent or dye in a vein or artery
  • Series of x - rays are taken
89
Q

What can a cerebral angiography help to diagnosis?

A
  • Obstruction
  • Stenosis
  • Malformation
90
Q

Which type of stroke can a thrombolytic agent be used?

A

Ischemic Stroke

91
Q

When using a thrombolytic agent there is significantly more recovery if within (BLANK)

A

4.5 hours

92
Q

There is a risk of what when using a thrombolytic agent?

A

Risk of hemorrhage

93
Q

What thrombolytic agent is used in acute medical management of ischemic stroke?

A

Tissue plasminogen activator (t-PA)

94
Q

T/F: a way to manage an acute ischemic is intracranial clot retrieval

A

True

95
Q

What are some medical prophylaxis (preventive) treatment option of ischemic stroke?

A
  • Anticoagulation therapy
  • Control HTN
  • Lipid lowering agents
  • Neuroprotection
  • Surgery (manage stenotic vessels)
96
Q

When is carotid endarterectomy or stenting warranted?

A

If stenosis in carotid is > 70% (asymptomatic) or > 50% (symptomatic) in internal carotid then surgery is warranted

97
Q

T/F: Loss of consciousness is a good prognostic indicator

A

False - Poor prognostic indicator

98
Q

T/F: Once a patient has a stroke they are at risk for a recurrent stroke

A

True

99
Q

90% of recovery of stroke occurs in 1st (BLANK) months

A

3 month

100
Q

After a stroke functional recovery of movement patterns can occur for (BLANK) years

A

5 years

101
Q

What is the medical management of other hemorrhage?

A

Neurosurgery
- Evacuate
- Repair aneurysm / malformation/ rupture

102
Q

What are the medical management option of intracerebral hemorrhage?

A
  • Control HTN
  • Control ICP
  • Manage Edema
  • Surgical drainage
103
Q

When should you treat HTN and what can be used when managing intracerebral hemorrhage?

A
  • Treat sBP > 160 - 180 mmHG, dBP > 105 mmHG
  • Rapid acting antihypertensive meds
104
Q

When is surgical drainage performed when managing intracerebal hemorrhage?

A
  • Large size
  • Neurological deterioration
  • Often performed with cerebellar hemorrhage due to risk of rapid deterioration
105
Q

What are some symptoms of left (dominant) hemisphere stroke?

A
  • Right hemiparesis
  • Aphasia (receptive - Wernicke’s or Expressive - Broca’s or Global)
  • Possible dysphagia
106
Q

A patient with a left (dominant) hemisphere stroke tends to be (BLANK), (BLANK) & (BLANK) when approaching unfamiliar tasks

A

Slow, cautious & disorganized

107
Q
  • A patient with a left (dominant) hemisphere stroke may be easily (BLANK) & (BLANK) with communication difficulties
  • Also individuals aware of problems often responds with (BLANK)
A
  • Frustrated & angered
  • Anxiety
108
Q

A patient with a left (dominant) hemisphere stroke has problems with recognition of what?

A

objects, use of objects or word recall

109
Q

T/F: A patient with a left hemisphere stroke is able to process information quickly in order to respond verbally or with gestures

A
  • False
  • Needs time to process information and time to respond either verbally or with gestures
110
Q

T/F: A patient with a left hemisphere stroke can profit from gestures and non verbal instructions

A

True

111
Q

Why is repetition necessary for patients with a left hemisphere stroke?

A

They have an impaired ability to retain info

112
Q

What are some symptoms of right hemisphere stroke?

A
  • Left hemiparesis
  • Difficulty with spatial perceptual task
  • Left sided neglect
  • Thinking is disjoined
  • Safety awareness is diminished
  • Tends to move impulsively and not follow directions or cues
  • Overestimates own abilities to perform task
  • Judgment and integration of information is impaired
  • May not be aware of error
113
Q

T/F: A patient with a right hemisphere stroke profits more from gestures than verbal instruction

A

False
Profits more from verbal instructions than gestures

114
Q

T/F: For a patient with a right hemisphere stroke repetition and consistency are very important and they need cues to take things one step at at time

A

True

115
Q

Does a patient with a right hemisphere stroke have increased distractibility?

A

Yes

116
Q

When managing an acute ischemic stroke at what BP should you intervene if the patient has not taken t-PA?

A

220/120

117
Q

When managing an acute ischemic stroke, at what BP should you intervene if the patient has taken t-PA?

A

180/105

Clinical Med (Year 2) (17 decks)

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