Stroke Flashcards
what are the major risk factors for stroke include
high blood pressure diabetes heart disease smoking age gender race ethnicity personal history of strokes family history of strokes TIA brain aneurysms arteriovenous malformations
what are other risk factors for stroke include
alcohol use illegal drug use certain medical conditions lack of physical activity overweight obesity stress depression unhealthy cholesterol levels unhealthy diet use of NSAIDS
what else can lower the risk of stroke
following a heart healthy lifestyle and taking medication
what is the main risk factor for strokes
high blood pressure
state 4 acute treatments for stoke
stroke unit
thrombolysis
aspirin
hemicraniectomy
state a treatment for ischaemic stroke
tissue plasminoegn activator given intravenously in the arm
what is the primary prevention of stroke
it is a reference to the treatment of individuals with no history of stroke
what is the secondary prevention of stroke
it is a reference to the treatment of individuals who have already had a stroke or transient ischaemic attack
what heart diseases are major risk factors for stroke
coronary heart disease
cardiomyopathy
heart failure
atrial fibrillation
how can atrial fibrillation be a risk factor for a stroke
atrial fibrillation can cause blood clots that can lead to a stroke
how can smoking be a risk factor for a stroke
smoking can damage blood vessels and raise blood pressure
smoking may reduce the amount of oxygen that reaches your body’s tissues
how can age be a risk factor for stroke
your risk of stroke increases as you get older
how can gender be a risk factor for stroke
woman are more likely to die from strokes,
also woman who take birth control pills are at slightly higher risk of stroke
how can race be a risk factor for stroke
strokes occur more often in african american, alaskan native, and american indian adults than in white, hispanic, or asian american adults
what are brain aneurysms?
aneurysms are balloon-like bulges in an artery that can stretch and burst
what are arteriovenous malformations
these are tangles of faulty arteries and veins that can rupture within the brain
when are arteriovenous malformations present
these may be present at birth, but are often not diagnosed until they rupture
how much does stroke cost the UK each year?
over 5 billion
what are symptoms of stroke
loss of power loss of sensation loss of speech loss of vision loss of coordination
if stroke is at the back of the brain what is the common clinical feature present
the loss of coordination
describe stroke symptoms
unable to speak in proper sentences weak muscles in their mouth and their face speech can become slurred loss of vision vision can be lost just in one eye
what is aphasia?
it relates to production of speech
what is a question that needs to be asked in relation to vision?
can you move your eyes across the midline?
what is a stroke
it is damage to part of the brain due to blockage of a blood vessel by thrombus or embolus
what is a stroke also due to
haemorrhage from rupture of a blood vessel
when does an ischaemic stroke occur?
it occurs as a result of an obstruction within a blood vessel supplying blood to the brain
what percentage of ischaemic strokes account for all strokes
87%
what are the vertebral arteries
they are the major arteries of the neck
what do the vertebral arteries typically originate from
the subclavian arteries
what is the role of the vertebral arteries
they provide the blood supply to the upper spinal cord, brainstem, cerebellum, and posterior part of the brain
what is the role of the internal carotid artery
it supplies the brain, eye and other internal parts
what is the role of the external carotid artery
it supplies the neck, face and other external parts
what does the carotid system suuply
it supplies most of the hemispheres and cortical deep white matter
what does the vertebrobasilar system supply
it supplies the brain stem, cerebellum and occipital lobes
what is the cortex of the brain?
it is the outer layer of the cerebrum, it is composed of folded grey matter and plays an important role in consciousness
what is a cortical homunculus
it is a distorted representation of the human body, based on a neurological map of the areas and proportions of the human brain dedicated to processing motor functions, or sensory functions, for different parts of the body
what causes an ischaemic stroke
a blocked artery
what are the causes of a haemorrhage stroke
leaking or bursting of a blood vessel
what are the causes of a transient ischaemic stroke
temporary disruption of blood flow to the brain
doesn’t cause permanent damage
what are the causes of stroke
blockage of a vessel with thrombus or clot
disease of vessel wall
disturbance of normal properties of blood
rupture of vessel wall
describe a haemorrhage stroke
haemorrhage
blood leaks into brain tissue
describe ischaemic stroke
clot stops blood supply to an area of the brain
what is carotid stenosis
it is narrowing of the carotid arteries
what are the carotid arteries
they are the 2 major arteries that carry oxygen-rich blood from the heart to the brain
what is carotid stenosis caused by
a build-up of plaque inside the artery wall that reduces blood flow to the brain
what else can cause carotid stenosis
an atheroma
i.e. carotid stenosis can be caused by a condition atherosclerosis
what is carotid stenosis also called
carotid artery disease
what is carotid stenosis most often caused by
atherosclerosis
when does a cardioembolic stroke occur
when the heart pumps unwanted materials into the brain circulation
what does a cardioembolic stroke result in
the occlusion of a brain blood vessel and damage to the brain tissue
what is a lacunar stroke
it is a type of ischaemic stroke
when does a lacunar stroke occur
it occurs when blood flow to one of the small arteries deep within the brain becomes blocked
what are rarer causes of stroke
carotid dissection: idiopathic or trauma
what is carotid dissection
it is a breakdown of the layers of the carotid artery that causes the wall to tear
what does a tear in the wall from carotid dissection may cause
stenosis and occlusion
what is meant my an occlusion
it is a flap of the vessel wall protruding into the opening
what part of the brain is affected by a stroke
the left or the right carotid territory vertebrobasilar territory cerebral hemispheres brainstem cortex deep white matter
what can you tell from the symptoms and signs observed of a stroke
what side of the brain is affected whether the lesion is in the brainstem whether the cortex is involved if the lesion is in the deep white matter what blood vessel is involved
why should localisation of a stroke be bothered with
it confirms the diagnosis of stroke
allows better selection of imaging
it gives an indication of cause
it gives an indication of prognosis
what are 4 subtypes of stroke
total anterior circulation stroke
partial anterior circulation stroke
lacunar stoke
posterior circulation stroke
what is a visual field defect
is is a loss of part of the usual field of vision
what does a visual field defect not include
severe visual impairment of either one eye or both
what is a unilateral field loss the result of
an optic nerve lesion anterior to the optic chiasm
what is bitemporal hemianopia
it is the medical description of a type of partial blindness where vision is missing in outer half of both the right and left visual field
what is homonymous hemianopia
it is the loss of half of the field of view on the same side in both eyes
when does homonymous hemianopia occur
it occurs frequently in stroke and traumatic brain injuries due to the way part of the optic nerve fibres from each eye crossover as they pass to the back of the brain
what is total anterior circulation stroke syndrome
it refers to the symptoms of a patient who clinically appears to have suffered from a total anterior circulation infarct, but who has not yet had any diagnostic imaging to confirm the diagnosis
what is partial anterior circulation stroke syndrome
it refers to the symptoms of a patient who clinically appears to have suffered from a partial anterior circulation infarct
what percentage of strokes are total anterior circulation strokes?
20%
what are things to remember with regards to stroke
the symptoms come on rapidly
and the symptoms depend on which part of the brain is affected
what are modifiable risk factors for stroke
high blood pressure
atrial fibrillation
what are non-modifiable risk factors for stroke
age
race
family history
state investigations of stroke
blood tests ECG CT MRI carotid doppler ECHO
what is thrombolysis
it is the dissolution of a blood clot, especially as induced artificially by infusion of an enzyme into the blood
what are contraindications to thrombolysis
age
what is stroke thrombolysis
it is if your stroke is caused by a blood clot
what is carotid endarterectomy
it is a surgical procedure used to reduce the risk of stroke by correcting stenosis in the common carotid artery or internal carotid artery
what can cause the formation of a blood clot in the artery
rupture of the plaque
what is aspiration pneumonia a complication of
pulmonary aspiration
what is pulmonary aspiration
it is when you inhale food, stomach acid, or saliva into your lungs
what is the penumbra?
it is the area surrounding an ischaemic event such as thrombotic or embolic stroke
what is thrombolysis
it is the dissolution of a blood clot, especially as induced artificially by infusion of an enzyme into the blood
what is collateral circulation?
it is the circulation of blood established through enlargement of minor vessels and anastomosis of vessels with those of adjacent parts when a major vein or artery is functionally impaired
basically describe collateral circulation
it is the circulation that occurs through the modified vessels
what is infarction
it is obstruction of the blood supply to an organ or region of tissue, typically by a thrombus or embolus, causing local death of the tissue
what is a thrombus
it is a blood clot formed in situ within the vascular system of the body and impedes blood flow
what is a CT angiogram
it is a test that uses X-rays to provide detailed pictures of the heart and the blood vessels that go to the heart, lung, brain, kidneys, head, neck, legs and arms
what are risks of thrombolysis include
brushing or bleeding at the access site
damage to the blood vessel
migration of the blood clot to another part of vascular system
kidney damage in patients with diabetes or other pre-existing kidney disease
what is a haemorrhage
it is an escape of blood from a ruptured blood vessel
what does haemorrhage depend on?
the size of the stroke
what is clot retrieval
it is surgical treatment for acute stroke that involves the mechanical removal of a blood clot from a patient’s brain
when is clot retrieval offered?
as a treatment for patients who have experienced a stroke as the result of narrowing of the arteries in their brain
what does the hyper dense MCA sign refers to?
focal increased density of the middle cerebral artery on CT and is a direct visualisation of thromboembolic material within the lumen
what is the middle cerebral artery
it is by far the largest cerebral artery and is the vessel most commonly affected by cerebrovascular accident
what is the stroke described as if it is caused by a blood clot
ischaemic stroke
how may an ischaemic stroke be treated
a clot-bursting drug to try and disperse the clot and return the blood supply to your brain
e.g.
plasminogen activator
or
alteplase
what does hemicraniotomy refer to
the surgical removal of hand of the cranium to enable brain surgery
how is an ischaemic stroke treated
tissue plasminogen activator
this is given intravenously in the arm
how does tissue plasminogen activator work
by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow
what is secondary prevention of stroke aimed at?
reducing the risk of recurrence after a first stroke or transient ischaemic attack
what is a transient ischaemic attack?
it is a brief episode of neurological dysfunction resulting from an interruption in the blood supply to the brain or the eye
what is sometimes a precursor of a stroke?
a transient ischaemic attack
what can a transient ischaemic attack be classed as?
a mini stroke
what is a transient ischaemic attack caused by
a temporary disruption in the blood supply to part of the brain, resulting in a lack of oxygen to the brain
what can a transient ischaemic attach cause
sudden symptoms similar to stroke
what is carotid endarterectomy
it is a surgical procedure used to reduce the risk of stroke by correcting stenosis in the common carotid artery or internal carotid artery
