Stroke

Question 0

Stroke

Answer 0

Apoplexy-struck down with violence.
1599: stroke first used to describe apopletic seizure. Greek struck by hand of God.
Hippocrates: 460-370BC
out of favour-CVA
“a neurological deficit or cerebrovascular cause that persists beyond 24 hours or is interupted by death in 24 hours”

Question 1

Prevelance

Answer 1

Every 10 minutes
#1 cause of disability
#3 cause of death
50,000 Canadians in hospital/year with stroke
16,000 die/year
3.0 billion dollars/year

Question 2

Acute Ischemic Stroke

Answer 2

Thrombo-embolism is a clot that blocks blood flow-ischemia.

Question 3

Spontaneous Intracranial Hemorrhage

Answer 3

Intracerebral Hemorrhage is 10-15% of stroke
Small artery rupture
Aneurysmal subarachnoid hemorrahge-5-10% of stroke

Question 4

Visualizing Stroke

Answer 4

1. CT Scan-ischemic infarct, intracerebral hemorrhage, subarachnoid hemorrhage.

Question 5

Signs of a Stroke

Answer 5

Hypertension, headache, left side paralysis

1. unilateral wekaness or numbing
2. Difficulty speaking/understanding
3. Loss or change in vision
4. Severe and unusual headache
5. Loss of balance/dizziness

Question 6

Language Disorders

Answer 6

1. Wernickes-word salad, no meaning
2. Brocas-no production-no syntax
   Dysarthria-do they slur?

Question 7

Neglect/Hemi-inattention

Answer 7

Right Parietal lobe lesion-usually non dominant side effected

Question 8

Sub-Cortical Anatomy (white matter)

Answer 8

Internal Capsule-absolutely paralyzed because face, arm and leg fibres travel through there.
Contralateral weakness-brain wiring

Question 9

Arterial Supply of Brain

Answer 9

Circle of Willis-Protection from stroke

Vertebral artery, internal carotid artery, aorta

Question 10

Anterior Circulations

Answer 10

Internal carotid artery-2/3 of cerebral artery. Supplied by middle cerebral artery and anterior cerebral artery.

Question 11

Middle Cerebral Artery

Answer 11

Supplies lateral surfaces of hemisphere and deep structures
Basal ganglia and subcortical white matter.
Contralateral face and arm weakness.
Dysphasia-left hemisphere. Neglect-Right hemisphere

Question 12

Anterior Cerebral Artery

Answer 12

Supplies the medial surface of hemisphere. Contralateral leg weakness and or numbness.

Question 13

Large Artery/ Cortical Stroke

Answer 13

Controlateral weakness, neglect (RH), aphasia/dysphasia (LH), contralateral visual loss

Question 14

Subcortical/ lacunar stroke

Answer 14

Deep branches of any cerebral artery. Most common symptom is contralteral weakness

Question 15

Subcortical Stroke (white matter)

Answer 15

Contralateral weakness effects face, arm and legs

Question 16

Posterior Circulation

Answer 16

Vertebral and basilar arteries supply posterior and medial regions of hemispheres brainstem, diencephalon, cerebellum. Major branches: posterior cerebral artery and cerebellar arteries

Question 17

Brainstem Stroke

Answer 17

Cranial nerves and wiring downstream from internal capsule. Lacunar syndrome. Weak and ataxic on the contralateral side.

Question 18

Posterior Cerebral Artery Stroke

Answer 18

Contralateral hemianopsia-blindness on one side of the visual space.

Question 19

Pons Stroke

Answer 19

Locked in syndrome-only stroke with bilateral symptoms. Trouble with ballistic movements

Question 20

Transient Ischemic Attack

Answer 20

Resolves by itself in 24 hours of onset (stroke and TIA are continuum).
Warning sign for major stroke
50% of all TIAs are associated with permanent damage. >1 hour symptoms usually.

Question 21

Thrombo-embolism-Imaging

Answer 21

Magnetic Resonance Angiogram

Question 22

Sources of Emboli causing a Stroke

Answer 22

1. The heart
2. Arteries in neck
3. Arteries in brain itself (large and small)
   cardio-embolsim stroke-atrial fibrillation.
   Carotid artery atherosclerosis-internal carotid artery. Atherosclerotic. Plque, CT angiogram, intracranial anthrosceloritc disease.

Question 23

Cerebral Ischemia

Answer 23

Insufficient blood supply (and therefore oxygen and glucose) to meet the metabollic demands of the brain.
Ischemic Penumbra: normal grey matter(65%), protein synthesis impaired (55%), electrical failure (20%), inactive penumbra tissue. K+ release and cell death (10%).

Target treatment: restore normal blood flow. Loss of blood and oxygen to stop making ATP. Na+/K+ pump. Keep water in cell so then water moves into the cell with sodium if they fail.
Thrombo-embolism-thrombolysis-tissue plasminogen activator (tPA)

Question 24

Hemorrhagic Shock

Answer 24

ICH is the second most common stroke type. 10-20%
more common is asian and africans
size matters
intitial level of consciousness and hematoma volume predicts death. Drawsy=worse.
Amyloid can make interacerevral arteries brittle and prone to rupture.
No treatment yet
Developmental Aneurysms:
1. Hypertension
2. Smoking
3. Family History-2 or more 1st degree relatives.

Question 25

Subarachnoid Hemorrhage

Answer 25

Bleeding into subarachnoid space

Surgical clip or endovascular coil

Question 26

Preventing Stroke

Answer 26

1. High blood pressure treament-drugs.
2. Smoking
3. Aspirin (low dose)
4. Anticoagulant-Warfarin or other newer drugs-only for patients with atrial fibrillation-cardioembolic stroke
   Low blood pressure=less stroke.
   Platelet activation-inhibited by asprin.