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Neuro Pathology > Stroke > Flashcards

Stroke Flashcards

1
Q

CNS vs PNS

A 
CNS
-UMN: cortical, brainstem, spinal cord
-other: basal ganglia, cerebellum, other 
PNS
-LMN: CN motor nuclei
-other: CN sensory and special
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2
Q

neuroanatomy: MCA

A 
face mainly
contralateral hemiparesis
sensory loss
homonymous hemianopsia
dominant hemisphere (L MCA): Aphsia
non-dominant (R MCA): impaired spatial perception and contralateral neglect
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3
Q

neuroanatomy: ACA

A

supplies primarily medial frontal and parietal lobes

deficits: contralateral LE weakness, and sensory loss

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4
Q

neuroanatomy: PCA

A

supplies
-small penetrating arteries to midbrain and thalalmus
-occipital lobes and inferior medial temporal lobe
deficits
-homonymous hemianopsia, alexia, sensory loss

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5
Q

neuroanatomy: brainstem

A

medulla: vertebral and PICA
pons: basilar, ACIA, SCA
midbrain: PCA
general deficits
-LOC, nausea, vomiting, hemiparesis, CN involvement, can have crossed signs (ipsilateral face, contralateral body), can have ipsilateral cerebellar signs

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6
Q

neuroanatomy: lacunar syndromes

A

small location-big consequences (internal capsule)

occlusions of single small perforating arteries

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7
Q

definition

A

rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting for more than 24 hours or leading to death, with no apparent cause other than of vascular origin

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8
Q

prevalence/incidence

A

prevalence: older adults, blacks, lower levels of education, living in the southeastern US
incidence: every 40 sec someone in the US has a stroke

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9
Q

mortality/morbidity

A

every 4 min., someone dies of a stroke
the leading cause of serious long-term disability in the US
hemorrhagic stroke has higher mortality than ischemic

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10
Q

etiology

A

ischemic: 70-80%
hemorrhagic: 20%
- intraparenchymal or intracerebral hemorragic: 10-15%
- subarachnoid hemorrhage: 5%

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11
Q

pathogenesis: ischemic

A

partial or complete loss of blood suply to an area of the brain
causes: embolic, thrombotic/atherosclerotic, lacunar, cryptogenic, arterial dissection

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12
Q

disease course

A

focal neurologic deficits in minutes
seen by MD in 10-15 min
CT scan and interpret 25-45 min
if ischemic need treatment by rTPA within 3 hours
stable in hospital and then IP rehab or SNF
most rapid recovery in first 3-6 months
chronic lifetime recovery

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13
Q

ischemic: s/s

A

sudden onset of focal neurological deficits
symptoms in minutes
headache
nausea and vomiting (brainstem and cerebellum)
acute HTN
act FAST

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14
Q

ischemic: risk factors

A 
hypertension
cardiac disease
 diabetes
hyperlipidemia
smoking
carotid artery stenosis
TIA
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15
Q

diagnosis

A

from history, neuro exam, and imaging

CT, MRI, carotid US, echo, ECG

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16
Q

ischemic CVA prognosis

A 
30 day mortality rate
reoccurrance
-3-10% in first 30 days
-2-20% per year
3-6 months post (85%) walk independently
17
Q

hemorrhagic CVA general considerations

A

IPH or ICH: bleeding within the brain

SAH: vessel rupture in subarachnoid space

18
Q

hemorrhagic CVA pathogensis

A

hematoma forms, edema (peaks at 48 hrs, resolves by 5 days), tissue shifts

19
Q

hemorrhagic CVA causes

A 
HTN
cerebral amyloid angiopathy
vascular malformations
drug use
neoplasm
anticoagulaiton therapy
20
Q

common IPH sites

A 
lobar
basal ganglia/internal capsule
thalamic
pontine
cerebellar
21
Q

IPH s/s

A

focal deficit that worsens over minutes
acute HTN
headache
large hematomas: nausea, vomiting, early decline in level of consciousness

22
Q

IPH risk factors

A

HTN

23
Q

IPH diagnostic tests

A

CT scan
MRI
lab tests

24
Q

SAH general considertions

A 
bleeding into subarachnoid space
5-10
5 of all CVAs
mortality is high: 25-50%
causes: ruptured aneurysm, vascular malformation
25
Q

SAH clinical findings

A

sudden onset severe headache
neurologic signs
LOC, coma

26
Q

SAH diagnostic tests

A

CT scan
catheter angiographyy
MRI (cranial and possibly cervical and thoracic)
lumbar puncture

27
Q

stroke: acute medical management

A

ischemic: rTPA (given within 3-4.5 hrs of stroke)
ischemic: antiplatelet (apsirin) within 48 hrs
blood pressure measurement
surgery

28
Q

stroke: complications

A

hemorrhagic transformation for infarcts
brain edema
seizures
medical complications (aspiration pneumonia, UTI, DVT, hyperglycemia)

29
Q

better prognostic factors

A

ischemic
hemorrhagic for recovering function
younger age

30
Q

worse prognostic factors

A 
age (>75)
high blood glucose
history of prior CVA
more severe CVA
urinary incontinence
31
Q

implications for PT management

A

recovery
-flaccidity initially, then spasticity
-spontaneous recovery in first 3-6 months, but continued recovery possible in chronic stages
neuroplasticity

Neuro Pathology (7 decks)

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