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syposium control and movement > stroke > Flashcards

stroke Flashcards

1
Q

how long does Stroke last?

A

Symptoms lasting more than 24 hours or leading to death

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2
Q

when is a stroke classed as a TIa?

A

Symptoms lasting less than 24 hours classified as a Transient Ischaemic Attack (TIA)

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3
Q

what characterestic a key to the diagnosis of stroke?

A

Sudden onset
Focal neurological deficit
Of presumed vascular origin
Symptoms lasting more than 24 hours or leading to death

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4
Q

what factors are excluded as causing a stroke?

A

lesions associated with trauma, infection or tumour, retinal infarction and most cases of subarachnoid heamorrhage

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5
Q

what are the two types of stroke?

A

cerebral infarction

cerebral heamorrhage

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6
Q

which is more common stroke infraction or haemorrhage?

A

infarction is more common

85% of cases?

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7
Q

are the symtpoms or infarction and heamorrhage the same?

A

yes the symptos of both is the same if they occur in the same part of the brain

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8
Q

how can stroke differ in symptoms?

A

They differ because strokes can affect on different parts of the brain. Depending where the stroke takes place depends what symptoms you get

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9
Q

what occurs in cerebral infarction?

A

there is no oxygen going to the brain

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10
Q

what occurs in cerebral heamorrhage?

A

there is a bleed in the brain

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11
Q

how often is stroke caused by a haemorrhage?

A

15% of the time

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12
Q

how can you tell the difference between cereberal infacrtion or heamorrhage?

A

either by post mortem or by MRI scans

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13
Q

what is the pathophysiology of acute ischaemic stroke?

A

Initial reduction in cerebral blood flow

Alterations in cellular chemistry caused by the ischaemia
Cellular necrosis

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14
Q

when is acte ischaemic stroke reversible?

A

when necrosis of the brain has not occured. Once necrosis occurs it is irreversible

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15
Q

what percentage of oxygen consumption goes to the brain at rest?

A

20%

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16
Q

can brain strore oxygen?

A

no

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17
Q

what is the cerebral flood flow of the brain?

A

800 mL/min (15% cardiac output)

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18
Q

what is the average weight of the brain?

A

1400 g (2% body weight

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19
Q

what is the equation to flow?

A

Flow = pressure / resistance

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20
Q

what does CPP stand for?

A

cerebral partial pressure

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21
Q

what does CVR stand for?

A

cerebralvascular resistance

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22
Q

what does CBV stand for?

A

cerebral blood volume

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23
Q

what happens to the blood vessels in the brain if PaC02 increase?

A

this causes the blood vessels to dilate –> reduction in resistance and increase in blood flow –> occurs in occlusion of blood vessels

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24
Q

what is the substrate for energy metabolism for the brain?

A

only glucose 75-100 mg/min or 125 g/day

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25
Q

how is glucose metabolised in the brain?

A

Glucose is metabolised by the glycolytic sequence and the tricarboxylic acid cycle.

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26
Q

why do neurones need a constant supply of ATP?

A

For neurones to maintain integrity –> K+ inside and Na+ and Ca2+ outside the cell.
ATP cannot be stored

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27
Q

in aerobic respiration how many moles of ATP is produced by pyruvate?

A

36

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28
Q

in anerobic respiration how many moles of ATP is produced by pyruvate?

A

2

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29
Q

how many moles of pyruvate is produced by glucose? What is the name of the process and what is the byproduct?

A

produces 2m of Pyruvate
glycolysis is the reaction
2m of ATP produced

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30
Q

what is the first thing that is affected in cerebral ischemia?

A

electrical function is impaired

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31
Q

what is the importance of electrical function impairment stage?

A

the neurones stop working but are still intact. You see symptoms but the tissue is reparable. If you identify the stroke at this point recovery is very good

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32
Q

what is the stage after electical function is impaired?

A

the release of K and movement of water intraceullarly

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33
Q

what occurs in the stage of release of K and movement of water intraceullarly?

A

the tissues of the brain start to die and change in structure –> irreversible

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34
Q

what is the threshold of cerebral infarction where normal function still takes place?

A

50-20 ml/100mg/min

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35
Q

what is the threshold of electrical function is impaired

A

20-12 ml/100mg/min

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36
Q

what is the threshold of release of K and movement of water intraceullarly?

A

12-7 ml/100mg/min

37
Q

when does cell death take place?

A

At brain function below 7 ml/100mg/min

38
Q

what is the name of the area of the brain during cerebral infarction where the tissue has completely died?

A

core

39
Q

what is occuring in the penumbra region of the brain?

A

electrical function impairment in that part of the brain has occured. There is symptoms relating to that part of the brain but you can still restore blood flow to this part of the brain and restore function

40
Q

what is occuring in the oligemia region of the brain?

A

It is below the normal brain function threshold but the brain is still functioning

41
Q

what occurs with time to the brain during cerebral infarction?

A

the core of the infarction grows –> so more dead tissue while the penumbra reduces in size

42
Q

what happens to CPP and CBF as stroke occurs and symtoms begin?

A

they keep falling until full symptoms are present

43
Q

what happens to oxygen extraction fraction as the symtpoms of stroke develops?

A

the oxygen extraction fraction rate increase

44
Q

what are the two main causes of cerebral infarction?

A

thrombosis or embolism

45
Q

what are the two type of thrombisis that causes ischaemic stroke?

A 
large arteries (mainly extra-cranial)
small arteries (mainly intra-cranial)
46
Q

what are the two types of emobilsm that cause ischaemic stroke?

A

from the heart (cardiogenic embolism)

from proximal arteries (artery to artery embolism)

47
Q

what is the most common cause of ischaemic stroke?

A

large vessel atheroscerosis

48
Q

what is the most common cardiac cause of stroke?

A

AF

49
Q

why does AF increase the likely hood of having a ischaemic stroke?

A

dilation of Left atrium –> increaes the likely hood of the formation of a clot in the left atrium and then therefore emobilsm

50
Q

when do you use aspirin?

A

you use it for ischemic stroke not for heamorrhage stroke

51
Q

what is a secondary prevent for stroke?

A

to give antcoagulants

52
Q

what is aspirin?

A

antiplatelet medicine

53
Q

what does aspirin do?

A

Reduces the risk of clots forming in your blood

54
Q

what is the acroynm used to identify someone havinga stroke?

A

F–> face
A–> arms
S–> speach
T–> time

55
Q

Will MRI scan always show a stroke?

A

it will always show a heamorrhage stroke
However not always show a ischeamic stroke because at first the brain looks normal then takes a few hours for it to develop and be seen on a scan

56
Q

what is the key secondary treatment for people with acute ischaemic stroke?

A

thromboylsis

57
Q

what is thromboylsis?

A

is a clot busting mediction –> dissolves the clot to resume blood flow to the brain

58
Q

what is the medication used in thromboylsis?

A

alteplase and it is injected

59
Q

when should thrombolysis take place?

A

ASAP –> before 4 and 1/2 hours have passed

60
Q

why should a scan of the brain be done before thrombolysis is administrated?q

A

To make sure it is a cerebral ischaemia and not heamorrhage. As it could make the haemorrhage worse

61
Q

does thrombolysis work on all occlusions?

A

Thrombolysis is less effective on large occlusions

62
Q

how offten does proximal anterior circualtion occlusion cause stroke? How often does this cause disability or death?

A

accounts for 18% - 25% of all ischaemic stroke but 60% - 70% of deaths or severe disability.

63
Q

what is the definition of a TIA?

A

Neurological Deficit lasting less than 24 hours attributable to cerebral or retinal ischaemia

64
Q

how often does TIA last for?

A

usually less than 60 minutes

65
Q

do people recover from TIA and is there any brain damage?

A

person usually recovers from a TIA on there own but it does not mean there is no brain damage. IT does leave a scar on the brain

66
Q

are the causes of stroke and TIA the same?

A

yes

67
Q

what are the causes of TIA?

A

Carotid artery Disease/Large Artery Disease
Cerebral Small Vessel Disease
Cardiac Embolism

68
Q

why do you distinguish between TIa and Stroke?

A

Distinction of research purposes
TIA indicates ischaemic pathology
TIAs represent a window of opportunity to treat

69
Q

what type of stroke does TIA indicate?

A

ischeamic stroke

70
Q

what can TIA indicate to in the future?

A

usually a stroke preceeds a TIA –> so can strart treatment to prevent this

71
Q

how common are TIAs?

A

Incidence= 50/100 000 population

72
Q

what other conditions can mimics the same symptoms of TIA?

A 
Seizures
 Syncope
 Hypoglycaemia
 Migraine
 Acute confusional states
73
Q

what occurs when there is TIa in anterior circulation?

A

Amarausis fugax

Dysphasia

Apraxia

Inattention

74
Q

what is Apraxia?

A

loosing the ability to do motor functions that involve sequence of controlled learnt movements

75
Q

what is inattention?

A

Right hemisphere –> visual/spatial awareness –> get a stroke here –> get inattention –> where they reject the left side of the hemisphere

76
Q

what is AMARAUSIS FUGAX?

A

its painless transient monocular visual loss (i.e., loss of vision in one eye that is not permanent).

77
Q

what occurs in TIa in posterior circulation?

A

Ataxia –>loss of balance
Diplopia –? double vision
Vertigo
Bilateral Symptoms

78
Q

what is more common TIa in anterior or posterior circulation?

A

anterior –> only 1/3rd happen posteriorly and less easily recognisible

79
Q

what symptoms can be present in TIA in either posterior or anterior circulation?

A

Visual field disturbance (e.g. hemianopia)
Hemiparesis
Hemisensory loss
Dysarthria

80
Q

what arteries does anterior circulation of the brain involve?

A

the interal carotid arteries

81
Q

what arteries does posteiror circulation of the brain involve?

A

vertebral arteries

82
Q

what is used to predict what the risk is of developing a stroke after a TIA?

A

ABCD2

83
Q

what does ABCD2 stand for?

A

Age 1……> 60 yrs

BP 1……> 140/90

Clinical features 2……unilateral weakness
1……speech disturbance

Duration symptoms 2…….> 60 mins
1…….10 – 59 mins
0…….

84
Q

what type of scan is done to indicate TIA and why?

A

MRI because best at identifying events that already have happened in the brain

85
Q

what preventions can take place to prevent a stroke?

A

Diet, exercise, aspirin, statins BP lowering, stop smoking, diabetic control

86
Q

what is POLYPILL?

A 
Combination of
Statin
Aspirin
Antihypertensives
Folic Acid
87
Q

how effective is poylpill?

A

Reduce risk vascular events by 80%

88
Q

if a TIA has occured and there is a fully occluded artery should Carotid Endarterectomy take place? Explain

A

No it shouldnt be –> the risk is much greater than resolving the occlusion. As the person has recovered clearly the circle of willis is adapted and strong enough to compensate for the occlusion and recover function in the brain

89
Q

why is carotid occlusion not always bad in TIa?

A

the clot cannot move and means the patient has good collateral –> circle of willis that can keep blood flow going –> still need other secondary interventions

syposium control and movement (11 decks)

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