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Clinical Medicine (Fall 2016) > Stroke > Flashcards

Stroke Flashcards

1
Q

what is the scientific term for a stroke

A

cerebral vascular accident

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2
Q

what is a stroke/CVA

A

sudden vascular event leading to disruption of blood flow to part of the brain and destruction of surrounding brain tissue

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3
Q

when are neurological deficits present in a stroke patient

A

rapid onset

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4
Q

what is the leading cause of serious long-term disability

A

stroke

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5
Q

how many stroke per year

A

700,000

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6
Q

what percentage of people (out of the stroke population) have their first stroke each year

A

75%

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7
Q

what percentage of people (in the stroke population) have recurrent strokes

A

25%

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8
Q

what is the leading cause of death

A

heart disease

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9
Q

what is the second leading cause of death

A

cancer

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10
Q

what is the third leading cause of death

A

chronic lover respiratory disease

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11
Q

what is the fourth leading cause of death

A

stroke

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12
Q

what are early warning signs of strokes (5)

A
  • sudden weakness or numbness
  • sudden vision change (in one eye)
  • sudden difficulty speaking or understanding speech
  • sudden severe headache
  • unexplained dizziness, unsteadiness, falls
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13
Q

what is the most common presentation for strokes

A

hemiplegic

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14
Q

what does TIA stand for

A

transient ischemic attack

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15
Q

what is a TIA

A

similar to a stroke, but with resolution of neurological symptoms within 24 hours

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16
Q

is the etiology for a TIA the same as a stroke

A

yes

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17
Q

___% of all strokes are preceded by a TIA

A

15%

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18
Q

what are two methods of early managements for TIAs

A

imaging

blood thinners

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19
Q

what are potentially modifiable risk factors for strokes

A 
HTN (greater than 140/90)
CV disease
DM (Type 2)
High cholesterol
smoking
alcohol/cocaine use
physical inactivity
obesity
diet
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20
Q

what are non-modifiable risk factors for stroke

A

age
race
gender
family history

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21
Q

what is the greatest risk of stroke

A

age

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22
Q

when is the significance of age 55 regarding strokes

A

risk doubles each decade after 55

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23
Q

what races are more prone to strokes

A

Mexican and African American

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24
Q

what gender is more prone to strokes

A

males

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25
Q

what family history should be noted for someone with a stroke

A

stroke
sickle cell disease
genetic predisposition

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26
Q

Two main types of stroke

A

ischemic and hemmoragic

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27
Q

the most common type of stroke is…

A

ischemic (85%)

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28
Q

what does an ischemic stroke involve

A

loss of blood supply

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29
Q

in ischemic strokes, what does loss of blood supply lead to

A
  • no or reduced blood flow

- secondary vascular changes (swelling)

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30
Q

what does no blood flow in an ischemic stroke result in

A

neuronal cell death

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31
Q

what does reduced blood flow in an ischemic stroke result in

A

ischmic penumbra

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32
Q

what happens to the content of the cells in cell death

A

content of cells spills out

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33
Q

what happens to neurotransmitter release in cell death

A

increased NT release

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34
Q

what results from increased NT release in cell death

A

excitotoxicity and free radicals

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35
Q

what does cell death as a whole lead to

A

damage beyond area of vascular supply

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36
Q

what are the two pathogenesis of an ischemic stroke

A

major artery occlusion

penetrating artery disease

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37
Q

what is the disease associated with ischemic strokes

A

Atherosclerotic Cerebrovascular Disease and Penetrating Artery Disease

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38
Q

what kind of disease is Atherosclerotic Cerebrovascular Disease

A

large vessel disease

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39
Q

what is the cause of Atherosclerotic Cerebrovascular Disease (Major artery occlusion)

A

plaque forms in vessel walls

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40
Q

what systems are affected in an atherosclerotic cerebrovascular disease when plaque forms in vessel walls

A

carotid and vertebrobasilar systems

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41
Q

what ultimately results when plaque forms in vessel walls

A

decreased compliance and flow

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42
Q

what are other two results of Major Artery Occlusion

A

Thrombosis and embolism

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43
Q

what is the most common source of an embolism

A

heart

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44
Q

what is atrial fibrilation in a embolism of the heart

A

clot formation

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45
Q

where are the primary locations for embolisms

A

heart and atherosclerotic arteries

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46
Q

where are embolims for atherosclerotic arteries

A

carotid and vertebrobasilar

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47
Q

what type of disease is Penetrating Artery Disease

A

small vessel disease

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48
Q

in Penetrating Artery Disease, HTN and DM can promote

A

lipohyalinosis

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49
Q

what is lipohyalinosis

A

thickening of small vessel walls and narrowing of lumen

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50
Q

what areas of the brain are affected by Penetrating Artery Disease

A

basal ganglia, internal capsule, pons

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51
Q

for Penetrating Artery Disease, what is involved with a small vessel infarct

A

ischemic necrosis, cysts, gilosis

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52
Q

what type of stroke is worse: ischemic or hemmorhagic

A

hemmorhagic

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53
Q

what are the main types of hemmorhagic strokes

A

intracerebral, subarachnoid, subdural

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54
Q

for intracerebral hemorrhage, what does HTN lead to

A

microvascular disease

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55
Q

what does HTN –> microvascular disease lead to (3)

A
  1. ) weaken vessel walls
  2. ) prone to leakage or rupture
  3. ) Charcot-Bouchard aneurysms
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56
Q

what is another term for microaneurysms

A

Charcot-Bouchard

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57
Q

what vessels are effected in intracerebral hemorrhages (3)

A
  1. ) Distal (small vessels)
  2. ) arteriole branches
  3. ) penetrating arteries of Circle of Willis
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58
Q

what is noted in blood pressure or blood flow with intracerebral hemorrhages

A

acute increase in BP or blood flow precipitate event

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59
Q

does a hemorrhage spread in a hemorrhagic stroke?

A

hemorrhage spreads into surrounding brain structures

60
Q

what are the two types of subarachnoid hemorrhage

A
  1. ) Berry aneurysm

2. ) A-V Malformation

61
Q

what is a Berry aneurysm

A

congenital distention at bifurcation

62
Q

what vessels are effected in a Berry aneurysm

A

Circle of Willis

63
Q

what is effected in AV Malformations

A

direct artery to vein without capillary bed

64
Q

what occurs with a subdural hemorrhage

A

tearing of bridging veins

65
Q

who is most effected by chronic subdural hemorrhages

66
Q

what can occur with chronic subdural hemorrhages

A

cerebral atrophy

67
Q

what happens with cerebral atrophy

A

increase movement between brain and skull

68
Q

what can cause a chronic subdural hemmorhage

A

minor trauma (falls)

69
Q

two types of stroke syndromes (general)

A

partial or complete

70
Q

what kind of tissue is effected by more proximal strokes

A

more hypoxic tissue

71
Q

what is the exception to more hypoxic tissue being affected by more proximal strokes

A

Circle of Willis

72
Q

is middle cerebral artery syndrome ipsilateral or contralateral

A

contralateral

73
Q

are UEs or LEs more effected in middle cerebral artery syndrome

74
Q

what comes with contralateral middle cerebral artery syndrome

A

hemiplegia and hemianesthesia

75
Q

what happens if a middle cerebral artery type stroke occurs in a dominant hemisphere

A

global aphasia

76
Q

for Brachial Syndrome (of partial syndromes of middle cerebral artery syndrome), what is weak

A

UE weakness

77
Q

for Frontal Opercular Syndrome, (of partial syndromes of middle cerebral artery syndrome), what occurs

A

facial weakness and Broca’s apashia

78
Q

for inferior division, (of partial syndromes of middle cerebral artery syndrome), what occurs

A

Wernicke’s apashia

79
Q

what is Broca’s apashia

A

can’t produce speech

80
Q

what is Wernircke’s apashia

A

can’t understand speech

81
Q

is Anterior Cerebral Artery Syndrome ipisilateral or contralateral

A

contralateral

82
Q

are UEs or LEs more affected in Anterior Cerebral Artery Syndrome

83
Q

what is experiencing with Anterior Cerebral Artery Syndrome

A

Hemiplegia and Hemianesthesia

84
Q

in anterior cerebral artery syndrome, what does occlusion proximal to the anterior communicating artery lead to

A

minimal dysfunction due to contralateral flow

85
Q

what symptoms are experienced with Internal Carotid Artery Syndrome

A

MCA and ACA symptoms

86
Q

what does ACA stand for

A

Anterior Cerebral Artery Syndrome

87
Q

what does MCA stand for

A

Middle Cerebral Artery Syndrome

88
Q

in internal carotid artery syndrome, what symptoms may be minimal, and why

A

ACA minimal due to contralateral flow

89
Q

in a Posterior Cerebral Artery occlusion, what is experienced with thalamic branches

A

abnormal sensation (exaggerated light touch = pain)

90
Q

in a Posterior Cerebral Artery occlusion, what is experienced with occipital branches

A

visual changes (homonymous hemianopsia, visual agnosia)

91
Q

in a Posterior Cerebral Artery occlusion, what is experienced with temporal branches

A

memory loss

92
Q

for posterior cerebral artery issues, when might contralateral hemiplegia result

A

if the cerebral peduncle is involved

93
Q

What structure is involved with Lacunar Syndrome

A

Internal Capsule

94
Q

for Lacunar Syndrome, what happens if the posterior limb of the internal capsule is affected

A

pure motor effects

95
Q

for Lacunar Syndrome, what happens if the anterior limb of the internal capsule is affected

A

weak face and dysarthria

96
Q

in Lacunar Syndrome, what happens if the posterolateral thalamus is affected

A

pure sensory problems

97
Q

What are the two Vertebral and Posterior inferior Cerebellar Artery Syndromes

A

lateral medullary syndrome and medial medullary syndrome

98
Q

what symptoms are experienced with lateral medullary syndrome

A

vertigo, hoarseness, dysphagia

99
Q

what ipsilateral symptoms are experienced with lateral medullary syndrome

A

ataxia, ptosis, facial sensory loss

100
Q

what contralateral symptoms are experienced with lateral medullary syndrome

A

torso and limb sensory loss

101
Q

what contralateral symptoms are experienced with medial medullary syndrome

A

hemiparesis (arm and leg), loss of proprioception

102
Q

what ipsilateral symptoms are experienced medial medullary syndrome

A

tongue weakness

103
Q

what is another phrase for basilar artery syndrome

A

locked in syndrome

104
Q

what symptoms are experienced in basilar artery syndrome

A

quadriplegia, lower bulbar palsy, mutism

105
Q

what is spared in basilar artery syndrome

A

cognition, sensation, vertical eye movement

106
Q

what are the three cerebellar sydromes

A
  1. ) posterior inferior cerebellar
  2. ) superior cerebellar
  3. ) anterior inferior cerebellar
107
Q

what side is a “dominant” hemisphere stroke

108
Q

what type of hemisphere stroke is right hemiparesis experienced in

A

left (dominant)

109
Q

what type of hemisphere stroke is “easily frustrated and angered with communication difficulties” experienced in

A

left (dominant)

110
Q

what type of hemisphere stroke involves “problems with recognition of objects, use of objects, or word recall”

A

left (dominant)

111
Q

what type of hemisphere stroke involves “may not be aware of errors”

A

right (non-dom)

112
Q

what type of hemisphere stroke involves possible dysphagia

A

left (dom)

113
Q

what type of hemisphere stroke involves repetition and consistency being very important

A

right (non-dom)

114
Q

what type of hemisphere stroke is thinking disjointed

A

right (non-dom)

115
Q

what type of hemisphere stroke is safety awareness diminished

A

right (non-dom)

116
Q

what type of hemisphere stroke profits from gestures and non-verbal instructions

A

left (dom)

117
Q

what type of hemisphere stroke involves needing cues to take things one step at a time

A

right (non-dom)

118
Q

what type of hemisphere stroke involves left hemiparessis

A

right (non-dom)

119
Q

what type of hemisphere stroke involves difficulty with spatial perceptual tasks

A

right (non-dom)

120
Q

what type of hemisphere stroke involves the individual being aware of problems often responds with anxiety

A

left (dom)

121
Q

what type of hemisphere stroke involves dysphagia

A

left (dom)

122
Q

what part of the brain is receptive aphasia

A

Wernicke’s

123
Q

what part of the brain is expressive aphasia

124
Q

what part of the brain is global apashia

A

wernicke’s and broca’s

125
Q

4 ways to diagnose a stroke

A
  1. ) CT
  2. ) MRI
  3. ) PET
  4. ) Doppler Ultrasound
126
Q

what type of stroke has decreased detection in a CT

A

acute ischemic stroke

127
Q

why will an acute ischemic stroke be less detectable on a CT

A

hemorrhage will be seen

128
Q

what type of a stroke can an MRI detect

129
Q

when can an MRI detect an ischemic stroke

130
Q

benefits of a PET for detecting stroke

A

higher sensitivity, earlier detection

131
Q

what is an alternative diagnostic test for stroke

A

cerebral angiography

132
Q

is cerebral angiography invasive

133
Q

how does cerebral angiography work

A

inject radiopaque contrast agent or dye in a vein or artery

134
Q

what can cerebral angiography help diagnose

A

obstruction or stenosis in vessels

135
Q

what fruit does an epidural stroke resemble

136
Q

what fruit does a subdural stroke resemble

137
Q

what does cerebral perfusion do for people with ischemic strokes

A

decrease BP if dangerously high (greater than 230/120)

138
Q

what can cerebral perfusion do to BP if it is too low in the acute stage

A

increase it

139
Q

what agent is involved in “Thrombolytic agent”

A

Tissue Plasminogen Activator (TPA)

140
Q

for thrombolytic agents (TPA), when is the optimum adminsitration

A

30% more recovery if they get it within 3 hours

141
Q

what are 5 methods of treating ischemic stroke

A
  1. anticoagulation therapy
  2. control HTN
  3. lipid lowering agents
  4. neuroprotection
  5. surgery (manage stenotic vessels)
142
Q

when is carotid enarterectomy warranted

A

if stenosis in carotid is 70% in internal carotid

143
Q

for stroke patients, what is a poor prognostic indicator

A

loss of consciousness

144
Q

when does 90% of the recovery after a stroke take plave

A

first three months

145
Q

how long can functional recovery of movement patterns occur for

Clinical Medicine (Fall 2016) (7 decks)

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