Stroke

Question 1

Stroke is development of what two neurologic deficit related to vascular event?

Answer 1

focal or global

Question 2

2 kinds of atypical strokes?

Answer 2

1. transient

2. ‘silent’

Question 3

Strokes are:
75%
20%
5%

Answer 3

75% Infarction
20% Haemorrhage
5% Subarachnoid (younger people)

Question 4

stroke risk factors: 7 bigs

Answer 4

aging
hypertension
cardiac disease
hyperlipid
DMII
hypercoagulability
smoking/obesity

Question 5

Definition of cerebral infarction?

Answer 5

necrosis due to occlusion or hypoperfusion

Question 6

what vascular structures usually cause of cerebral infarction?

Answer 6

usually arterial

arterioles, veins, heart

Question 7

3 main mechanisms of cerebral infarction

Answer 7

1. pump failure
2. narrowed lumen
3. emboli occlusion

Question 8

causes of narrowed lumen in cerebral infarction? 3 things:

Answer 8

1. atherosclerosis
2. thrombosis
3. hypertensive thickening

Question 9

what is usual cause of large artery occlusions?

Answer 9

embolic

Question 10

what is usual cause of small vessel occlusions?

Answer 10

thrombosis

Question 11

what is usual cause of venous occlusions?

Answer 11

thrombotic

Question 12

what can happen in heart valves to cause stroke? causes?

Answer 12

valve vegetations due to:

1. infectious
2. non-infectious deformities

Question 13

1/3 of population has what in their heart that will increase stroke risk?

Answer 13

1. patent interatrial septum

2. allows DVTs to pass into brain and skip lungs

Question 14

Common sites for atherosclerosis in circle of willis? 4 areas

Answer 14

vertebral artery
internal carotid
proximal MCA
basilar

Question 15

when brain tissue is injured, what happens to area around it?

Answer 15

cytotoxic oedema>increased ICP>herniations (subfalcine or uncal)

Question 16

dead neurons histologically look?

Answer 16

surrounded by anoxic-ischemic neurons

Question 17

after swelling recedes in cerebral infarct, what happens to the dead area?

Answer 17

liquidative necrosis>cystic space

Question 18

what are cerebral haemorrhagic infarcts?

Answer 18

from reperfusion damage, and can come from cardiac ventricle thrombus/emboli

Question 19

berry aneurysm cause usually?

Answer 19

hypertension causing hyaline arteriolosclerosis

Question 20

lacunar infarcts are? dangerous where?

Answer 20

small infarcts from hypertension, can be devastating if in brainstem

Question 21

people with cerebral infarcts die how? top 3:

Answer 21

Usually sequelae

1. pneumonia
2. cardiovascular disease
3. pulmonary thromboembolism (immobility)

Question 22

hypertensive small vessel disease affects which vessels?

Answer 22

deep structures

Question 23

congophilic (amyloid) angiopathy affects which vessels?

Answer 23

superficial periphery of brain

Question 24

hypertensive haemorrhage usually has what disease?

Answer 24

hyaline arteriolosclerosis

Question 25

hypertensive haemorrhage usually happens where? 4 places

Answer 25

basal ganglia/thalamus
lobar white matter
cerebellum
pons

Question 26

high pressure cerebral haemorrhage does what?

Answer 26

tear through neural tissue

Question 27

low pressure cerebral haemorrhage does what?

Answer 27

ooze and then separate cerebral tissue

Question 28

cerebral amyloid angiopathy has deposition of what? which vessels?

Answer 28

A beta-amyloid plaques in wals of superficial supratentorial blood vessels

Question 29

cerebral amyloid angiopathy has association with?

Answer 29

alzheimer’s disease

Question 30

when do you get multifocal synchronous haemorrhages?

Answer 30

coagulopathy, blood disorders (leukaemia)

Question 31

congenital ateriovenous malformation does what?

Answer 31

high pressure arteries join to low pressure veins without crossing capillaries = haemorrhage

Question 32

3 causes of subarachnoid haemorrhage?

Answer 32

1. berry aneurysm rupture
2. other aneurysm rupture (mycotic/atherosclerotic)
3. extension of intracerebral haemorrhage

Question 33

who is more at risk for devloping saccular aneurysm?

Answer 33

women

younger

Question 34

risk factors for saccular aneurysm? 5 things

Answer 34

1. polycystic kidney disease
2. coarctation of aorta
3. type III collagen deficiency
4. hypertension
5. smoking/alcohol

Question 35

saccular aneurysms occur which circulation?

Answer 35

90% anterior circulation

10% posterior

Question 36

3 places that saccular aneurysms like to form?

Answer 36

1. bi-trifurcation of MCA
2. junction of ICA/PCOM
3. ACOM

Question 37

4 complications of aneurysm rupture

Answer 37

1. subarachnoid haemorrhage
2. increase ICP/cerebral oedema
3. vasospasm/infarction
4. ventricular obstruction>hydrocephalus