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long term conditions and rehabilitation > Stroke > Flashcards

Stroke Flashcards

1
Q

what is stroke?

A
  • syndrome characterised by rapidly developing clinical symptoms and/ or signs of focal loss of cerebral function lasting for more than 24 hours
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2
Q

what is stroke due to?

A
  • vascular origin
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3
Q

what is a stroke less than 24 hours called?

A
  • transient ischemic attack (TIA)
  • mini stroke
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4
Q

what is a mini stroke? (TIA)

A
  • temporary ischemia due to attack/ disruption of the blood supply
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5
Q

what may the mini stroke act as?

A
  • may act as a warning sign of being predisposed to a stroke
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6
Q

what many stroke deaths are there per year?

A
  • 5.45 million stroke deaths per year
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7
Q

how many stroke survivors are there?

A
  • 9 million
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8
Q

how many people with stroke die?

A
  • 20 to 50%
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9
Q

how many people are very affected from stroke?

A
  • 1 in 3 people
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10
Q

what does MCA stroke stand for?

A
  • middle cerebral artery
  • brain damage occurs due to disrupted blood flow in middle cerebral artery
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11
Q

what does PCA stroke stand for?

A
  • posterior cerebral artery
  • can restrict the blood supply of multiple brain regions
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12
Q

is MCA or PCA more common?

A
  • MCA is more common
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13
Q

what percentage of body weight is the human brain?

A
  • it is 2% of body weight
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14
Q

how much cardiac output goes to the brain?

A
  • 15% of cardiac output goes to the brain
  • 750 to 1000ml/ min
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15
Q

what is the oxygen consumption of the brain?

A
  • 20% of the whole boy
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16
Q

how long does it take for the brain to shut down?

A
  • 3 to 6 minutes
  • blood supply is cut off
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17
Q

how quick do the neurons shut down?

A
  • shut down after 30-60 secons
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18
Q

what happens to the patient when the brain shuts down?

A
  • faint towards the floor as more blood can travel to the head
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19
Q

what should you do to the patient when the blood supply is cut off?

A
  • patient should be laying
  • helps to restore blood supply
  • elevate the legs to ensure more blood pumped to upper trunk
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20
Q

where do arteries that supply the brain arise from?

A
  • arise from the arch of the aorta
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21
Q

what specific artery gives rise to different arteries?

A
  • common carotid arteries
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22
Q

what are the 9 main arteries?

A
  • common carotid artery
  • internal carotid artery
  • external carotid artery
  • anterior cerebral artery
  • middle cerebral artery
  • posterior cerebral artery
  • vertebral artery
  • subclavian artery
  • basilar artery
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23
Q

what do all the arteries form?

A
  • form a complete circle
  • called circle of willis
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24
Q

where are the vertebral artery? what do they form?

A
  • they are at the back
  • they joint to form the basilar artery
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25
Q

what artery gives rise to the PCA?

A
  • basilar artery gives rise to the posterior cerebral artery
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26
Q

what artery gives rise to the ACA and MCA?

A
  • internal carotid artery
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27
Q

what happens if one artery is blocked?

A
  • if artery is blocked on one side then the artery on opposite side is still viable
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28
Q

what do the communicating arches do?

A
  • bridges between arteries to try push blood to the other side
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29
Q

what is the communicating artery?

A
  • link between two main arteries to compensate and complete circle
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30
Q

what are the communicating arches of vertebral arteries?

A
  • ACA connected via anterior communicating artery
  • MCA and PCA linked via posterior communicating artery
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31
Q

what does the anterior cerebral artery supply?

A
  • ACA supplies top of inner aspect
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32
Q

what does the middle cerebral artery supply?

A
  • MCA supplies most of the lateral aspects
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33
Q

what does the posterior cerebral artery supply?

A
  • posterior cerebral artery supplies the bottom aspects
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34
Q

what can a CT scan of a stroke patient identify? - give an example

A
  • can use area of damage to identify which artery is blocked
    e.g., blood clot in the middle aspect = ACA blocked
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35
Q

what problems may arise from ACA being blocked?

A
  • motor problems
  • sensory problems
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36
Q

what problems may arise from MCA being blocked?

A
  • speech problems
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37
Q

what could go wrong in stroke patients?

A
  • something inside could expand if there’s a bleed and structures get crushed
38
Q

what is an acute haemorrhagic stroke?

A
  • no movement on one side
  • as swelling comes down, some of the neurons start activating and the connections reorganise to allow some activity
39
Q

what is an ischaemia stroke?

A
  • loss of blood supply due to blockage
40
Q

what can happen in the lateral stages of ischaemia strokes?

A
  • gaps filled with fibrous or fluid
  • lost action sense, just a collection of fluid
41
Q

what is necrosis?

A
  • death of brain cells
42
Q

what are the four risk factors of ischaemic strokes?

A
  • cardio- embolic
  • atherothrombo- embolic
  • small vessel disease
  • others
43
Q

what are the four aspects that cardio-embolic include?

A
  • atrial fibrillation
  • mural thrombus
  • paradoxical embolism through patent foramen ovule
  • infective endocarditis
44
Q

what is a cardioembolic stroke?

A
  • caused by blood clot or debris from the heart, blocking vessels
45
Q

what are the four aspects of atherothrombo- embolic?

A
  • carotid, vertebral, cerebral artery occlusion and carotid dissection
46
Q

what is an atherothrombosis stroke?

A
  • formation of a thrombus on an existing atherosclerotic plaque that dislodges and embolus blocks blood
47
Q

where can an atherothrombosis stroke form? (4)

A
  • carotid arteries
  • vertebral arteries
  • cerebral arteries
  • where connected artery splits
48
Q

what are the three aspects of small vessel disease?

A
  • hypertensive arterial disease
  • diabetic vasculopathy
  • vasculitis
49
Q

what is small vessel disease?

A
  • walls of small arteries/ blood vessels are damaged, which affects the blood flow to the brain
50
Q

what happens to the arteries in small vessel disease? (3)

A
  • arteries become eroded, inflame or regenerated
51
Q

what is the other risk factor of an ischemic stroke?

A
  • venous thrombosis
52
Q

what is venous thrombosis?

A
  • rare condition where person lays down for a long time so the calf muscles aren’t working and cannot pump the blood back to the heart
53
Q

what happens in deep vein thrombosis? what should you check?

A
  • blood is left stagnated and forms clots
  • check if the calf muscle is swollen due to fluid accumulation
54
Q

what is a haemorrhage?

A
  • bleed into the brain causing blood flowing to crush the brain cells
55
Q

what are the two types of haemorrhages?

A
  • sub-arachnoid
  • parenchymal
56
Q

what is the sub- arachnoid?

A
  • membrane that surrounds the brain and the spinal cord
57
Q

what are the two aspects of sub- arachnoid?

A
  • arterio venous malformation
  • aneurysm
58
Q

what is the parenchymal?

A
  • essential functioning tissue of the brain, consisting of neurons, glial cells and blood vessels
59
Q

what are the two aspects of parenchymal?

A
  • hypertensive arterial disease
  • amyloid angiopathy
60
Q

what is the atherosclerotic etio- pathology?

A
  • fatty streaks on the intimal layer of the wall
61
Q

what happens if the bleed in the brain continues?

A
  • holes will be drilled an the blood is drained out so that the brain can expand
62
Q

what happens the more the blood is pushed down? what does this control?

A
  • the more the blood is pushed down = more brainstem is pushed down
  • brainstem controls all vital functions
63
Q

what substances are present in the clinical presentation of atherosclerosis? (2)

A
  • massive extracellular lipids (fatty deposits)
  • fibrous plaques with deposits of platelets an fibrin
64
Q

what happens to the arteries in atherosclerosis? what does this decrease?

A
  • stiffness
  • kinking of artery
  • occlusion/ narrowing
  • decreases perfusion pressure
65
Q

what narrows in atherosclerosis? what does this reduce?

A
  • lumen narrows
  • reduces perfusion
66
Q

what is a major risk for injury? what else does it increase?

A
  • hypertension
  • risk for injury, stretch to the walls and burst vessel
67
Q

what people do blood clots form in?

A
  • form in people with increased cholesterol, hypertension & diabetes
68
Q

what do blood clots cause? what happens when it breaks?

A
  • causes friction on the tubes as it accumulates and builds
  • when build up breaks, it moves inside the arteries
69
Q

what is thromboembolism risk factor?

A
  • thrombus formation within the artery
70
Q

what happens when the thrombus breaks down? what does it cause?

A
  • when it breaks down, the embolus is pushed further upwards by the blood
  • it then blocks small arteries and hence blocks any blood flow
71
Q

what are the two other congenital risk factors?

A
  • berry aneurysm
  • arteriovenous malfunction
72
Q

what is a berry aneurysm? what happens to it when blood is pumping?

A
  • little pouch in the artery, which is weak
  • when blood is pumping, the pouch is at risk of cracking and bleeding
73
Q

where does berry aneurysm occur? (2)

A
  • occurs in circle of willis
  • as well as high pressure areas
74
Q

what is arteriovenous malfunction?

A
  • abnormal capillary bed as the arteries don’t dissociate the oxygen so it continues into the waste as there’s not enough capillaries
75
Q

what comes in after an advanced stroke? what does this cause?

A
  • sodium and potassium ions rush in, causing patient to use anaerobic mechanisms
  • causes necrosis so debris accumulates
76
Q

what is lost as neurons die?

A
  • neuronal integrity lost
77
Q

what does a mild- moderate stroke have inadequate supplies of?

A
  • inadequate oxygen and glucose
  • inadequate energy supply
78
Q

what fails in mild to moderate stroke?

A
  • failure of neuronal activity and regional brain dysfunction
79
Q

what is there an influx of in severe stroke?

A
  • influx of H20, Na+, Cl- and Ca+ causing anaerobic mechanisms to occur
80
Q

what does severe stroke lead to? what accumulates?

A
  • irreversible cellular injury
  • lactic acid accumulates
  • H+ compromises neuronal integrity
81
Q

what is lost in advanced stroke? what does this cause?

A
  • loss of function and accumulation of chemical influx of H20, Na+ and Ca+
  • causes destruction of cells
82
Q

what is penumbra? what does this provide a potential for?

A
  • reversibly injured brain tissue around the ischemic core
  • potential for recovery
83
Q

what is a collateral circulation?

A
  • network of blood vessels designed to preserve cerebral blood flow when primary route fails
84
Q

when can brain start reactivating? what happens when the area of penumbra is activate?

A
  • brain starts reactivating when the oedema comes down
  • when area of penumbra activated an supplied with blood and glucose then you can remove more activity
85
Q

what are the 9 risk factors of stroke?

A
  • increased age
  • males
  • african americans
  • diabetes mellitus
  • prior stroke/ transient ischemic attacks
  • family history of stroke
  • asymptomatic carotid bruit (hear a murmur as blood flows through showing friction and clumping)
  • geography/ climate
  • socio- economic factors
86
Q

what are the 5 major risk factors of stroke?

A
  • hypertension
  • high blood pressure
  • heart disease, especially atrial fibrillation, angina
  • cigarette smoking
  • transient ischemic attacks
87
Q

what are 5 secondary risk factors?

A
  • increased serum cholesterol/ lipids
  • physical inactivity
  • obesity
  • excessive alcohol intake/ drug abuse
  • acute infection
88
Q

how is stroke diagnosed?

A
  • MRI shows specific cause and area shown
89
Q

when is a CT scan not useful for stroke patients?

A
  • not useful in early hours unless it is a huge bleed
90
Q

what are the 4 factors that stroke prognosis depends on?

A
  • type
  • extent of lesion
  • access to emergency care
  • multidisciplinary input i.e., stroke physios and stroke nurses understand prognosis

long term conditions and rehabilitation (19 decks)

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