STROKE Flashcards
Which type of stroke is this?
Ischemic (80%)
Which type of stroke is this?
Haemorrhagic (20%)
Name some of the risk factors of someone having a stroke:
Age
Medical conditions
High blood pressure, diabetes, atrial fibrillation, high cholesterol
Lifestyle
Smoking, drinking, diet, exercise
Family history and ethnicity
Likely related to incidence of other risk factors e.g. high cholesterol, diabetes
Specific for women
Pregnancy, contraceptive pill
What age is the risk of stroke highest?
At ALL stages of lifespan
Childhood stroke
Over 400 childhood strokes/year in UK
1 in 4 strokes occur in working age adults
Which condition involves an episode of neurological dysfunction without acute tissue death resulting in mini-strokes?
Transient Ischemic Attack (TIA)
SIGNIFICANT RISK FACTOR of actual strokes occuring
(within 90 days of Tia)
When focusing on stopping strokes, which area in the brain are doctors aiming to prevent the explanation of the damaged tissue at which will also prevent the symptoms of stroke?
The Penumbra
Core damage
How do patients with post-stroke depression (PSD) differ from those with primary depression?
Post-stroke depression (PSD) patients have more cognitive impairment:
memory and concentration problems
irritability
psychomotor slowing, and more mood liability.
What is the primary cause of massive cell death in stroke patients?
Due to the excessive amounts of glutamate which builds up in the blood arteries and raises blood pressure.
Glutamate is an excitatory neuron necessary for bodily function. What happens when we have an exceeded amount of this?
The glutamate becomes an excitotoxic lesion
leading to cell death and ischemic strokes
During the process of massive cell death, sodium ions become inflamed as cells absorb water and burst.
This activates the ………….. and becomes …………….
The …………… is also broken down due to influx of blood-borne immune cells.
Microglia, phagocytic (cell eating), blood-brain barrier.
Due to the disruption of ionic imbalance in our brains after a stroke what also happens?
Oedema formation
swelling due to excessive water
Which type of cell death is this?
Apoptosis
Hours/weeks
During the Penumbra area of the brain, which type of cell death occurs after days/weeks of having a stroke?
Apoptosis
Which type of cell death is this?
Necrosis
Minutes
During the core area of the brain, which type of cell death occurs in minutes of having a stroke?
Necrosis
Which type of cell death involves the contribution of the breakdown of DNA in cells?
Apoptosis
When patients are injected with a contrast agent (colour dye) what will scans show concerning their brain barrier?
Scan will show contrast agent entering the brain barrier (damage)
Showing extravasation of contrast agent
Which area of the brain involves:
Rapid necrotic cell death
Mainly due to excessive NMDA receptor stimulation
further glutamate release
Core
The initial cell death occurs due to the excessive stimulation which type of receptors via high amounts of glutamate?
NMDA receptors
Which area of the brain involves:
Slower (days) apoptotic cell death
More moderate NMDA receptor hyperactivity
Penumbra
Glutamate and aspartate are both excitatory or inhibitory NTMs?
Excitatory NTM
GABA and glycine are both excitatory or inhibitory NTMs?
Inhibitory NTM
What is the term used to describe cell death due to an excess level of an excitatory substance (glutamate) in the body?
Excitotoxicity
Excess amino acids results in prolonged depolarization of receptive neurones which in some way* leads to their eventual damage or death.
This is known as?
Excitotoxic hypothesis
How is neuroprotection achieved experimentally?
Neuroprotection is achieved with GABA agonists,
GABA modulators,
GABA transporter inhibitors
and GABA transamine inhibitors
In experimental studies, researchers try and achieve?
Neuroprotection
-prevention/ reduction of cell death
Name a treatment for Strokes:
Pharmacological
Thrombolysis
Aspirin
Modifiable risk factors
Physiotherapy
Drug serves as a precursor
Drug stimulates release of NT
Drug stimulates postsynaptic receptors
Drug increases synthesis/release of NT
This is known as an?
An agonist
Drug inhibits release of NT
Drug inactivates synthetic enzyme
Drug prevents storage of NT
Drug blocks postsynaptic receptors
Drug inhibits synthesis/release of NT
This is known as an?
An antagonist
Sites of actions of drugs
Direct = attaches to NT binding site (post-synaptic)
Indirect = drug binds to alternative binding site (pre-synaptic)
What is Non-competitive binding?
Does not compete with NTM
What drug is given to treat a stroke?
NMDA Receptor antagonist
Glutamate plays a crucial role in normal cell physiology and survivaland is disrupted by …….., ideally administered during
(or immediately after) stroke and only to damaged area?
NMDA receptor antagonists
However, this has failed in clinical trials and is unrealistic
So this excitotoxic theory of cell death no longer forms the foundations for the development of neuroprotection therapies
Name some of the pharmacological treatment drugs associated with strokes:
Which pharmacological treatment drug is the only drug limited for use in stroke in UK/USA?
Anti-coagulants
t-PA
Which pharmacological treatment drug re-establishes blood flow to remove build-up of fatty deposits within arteries when someone is having a stroke?
Thrombolysis
Only drug licensed in US for stroke
Most effective when administrated 3 hours of a stroke
but cannot administer if its a haemorrhagic stroke
Thrombolysis ( a pharmacological treatment drug administrated for people who have has strokes ) is most effective when administrated 3 hours of which type of stroke?
An Ischemic stroke
Drug cannot be administered if its a haemorrhagic stroke
Can tell which type via a CT scan
Which pharmacological treatment is given to prevent and reduce the severity of strokes?
Aspirin
Antiplatelet agents (inhibits production of thromboxane)
-Reducing thickness of plates that stick into the blood vessels
less formation of blood clots
Name 4 main stroke risk factors:
High blood pressure
Smoking
Physical inactivity
Obesity
- Physiotherapy (rehabilitation or physical activity)
