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Cardiorespiratory CC > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke

A

Consequence of cerebrovascular disease that interrupts blood flow to part of the brain, causing ischemia and hypoxia

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2
Q

Haemorrhagic stroke

A

Parenchymal- into brain tissue

Subarachnoid- into subarachnoid space

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3
Q

Stroke death

A

3rd most common cause of death

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4
Q

Stroke symptoms

A

Numbness/weakness of face, arm or leg, especially on one side
Confusion, trouble understanding or speaking
Trouble seeing in one or both eyes
Dizziness, loss of balance or coordination
Severe headache

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5
Q

Symptoms Pneumonic

A 
FAST
Face
Arms
Speech 
Time
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6
Q

Types of stroke

A

TIA
Thrombotic
Embolic
Haemorrhagic

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7
Q

Ischaemic stroke forms

A

Thrombotic + Embolic

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8
Q

TIA

A

Confined to area of brain of eye perfused by a specific artery
Release of small emboli from thrombus –> temporarily block downstream vessel then quickly dissolve

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9
Q

TIA Time

A

Most last seconds to 10 mins
Symptoms more than 1 hour 25%
Resolved within 24 hours

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10
Q

Stroke Diagnosis

A

Physical exam
Blood test- cholesterol, C reactive protein
CT scan- shows haemorrhage, stroke etc
MRI- shows brain tissue damage

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11
Q

Cerebral thrombosis

A

Formation of blood clot in cerebral artery, normally at site of atherosclerotic plaque
If surface of plaque breaks open, collagen + TF exposed –> thrombus produced –> blocks blood supply

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12
Q

Thrombotic stroke formation

A

60% form during sleep

20% form over hours/few days

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13
Q

Arteriosclerosis

A

Thickening, hardening + loss of elasticity of the walls of arteries

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14
Q

Atherosclerosis

A

When inside of artery narrows due to build up of plaque

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15
Q

Thrombotic stroke occurrence

A

Most not due to emboli occur at site of atherosclerosis or arteriosclerosis in brain

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16
Q

Cerebral embolism

A

Usually occurs during activity
Consciousness usually preserved
Neurological signs develop rapidly

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17
Q

Embolic Stroke

A

Source of embolism almost always LEFT SIDE OF HEART

AF, MI, defective/ artificial heart valves (especially MV)

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18
Q

Myocardial Infarction

A

Causes Akinetic region in heart wall

Thrombus can form in immobile region of ventricle

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19
Q

Thrombotic + embolic strokes

A

85% of all strokes

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20
Q

Haemorrhagic Stroke

A

Intracerebral haemorrhage- sudden onset of neurological symptoms
Severe headache
Stupor or coma that progress with time
Usually hypertensive

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21
Q

Lacunar stroke

A

Occlusion of one of arteries that provides blood to the brain’s deep structures instead of cerebral cortex
E.g. basal ganglia, thalamus, pons, cerebellum
Cortical infarct signs (aphasia, neglect, visual field defects) always absent

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22
Q

Lacunar Strokes

A

15-20% of ischaemic strokes

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23
Q

Motor hemiparesis with dysarthria

A

Most common lacunar syndrome
33-50%
Infarct in posterior limb of internal capsule

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24
Q

Ataxia + hemiparesis

A

2nd most common form lacunar stroke

Infarct in posterior limb of internal capsule

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25
Dysarthria + clumsy hand
Infarct in anterior limb of internal capsule
26
Stroke Risk Factors
``` Hypertension Atrial Fibrillation Smoking Diabetes Hyperlipidaemia ```
27
Hypertension RF
35-50% stroke risk BP reduction 10mmHg systolic or 5mmHg diastolic reduces risk by 40% Lowering BP prevents both ischaemic + haemorrhagic strokes Major RF for athero + arteriosclerosis
28
Atrial Fibrillation RF
5% a year risk of stroke | Risk higher in those with valvular AF
29
Diabetes RF
Increases risk by 2 to 3 times
30
Hypercholesterolaemia (hyperlipidaemia)
Statins reduce stroke risk by 15-20% in those with high LDL cholesterol
31
Smoking RF
General inflammation of blood vessels Increased atheroma formation Hypertension
32
Obstructive sleep apnoea
Increases risk by up to 3 times | Especially in men
33
Low diet potassium + hypokalaemia RF
Increase risk | Foods high in K- nuts, potatoes, choc, bananas
34
Thiazides + loop diuretics RF
Block reabsorption of Na + water upstream from distal tubule Promotes increased distal tubular K secretion --> hypokalaemia
35
MCA
Prone to aneurysms + stroke | Lots of twists
36
Sodium Pump
Maintains nerve cell size + shape Removes Na from nerve cells --> water follows If doesn't work, brain nerve cells SWELL
37
Nerve cells
High SA/V ratio | Large SA- more sodium leakage into cells
38
Swollen brain cells
Brain is contained in rigid box = cranial cavity Decrease extracellular space Compresses capillaries + venules--> oedema + swelling Rise in ICP
39
Raised ICP
Sign of cerebral hypoxia Compresses cerebral veins Loss of blood flow Worsening hypoxia
40
Normal Extracellular space in brain cells
20%
41
Extracellular space in brain cells when swollen
5%
42
Tonsillar herniation
Rise in ICP Cerebellar tonsils extrudes through foramen magnum --> compression of lower brainstem + upper cervical spinal cord
43
Tonsillar herniation sign
``` Intractable headache head tilt neck stiffness Decreased consciousness Flaccid paralysis ```
44
Glial cells
Maintain homeostasis in brain environment | Remove potassium released into extracellular space by APs
45
Hypoxic brain- K
Potassium not removed from ECS by glial cells Increased extracellular K depolarises adjacent cells --> excess neurotransmitter release ATP levels low, so neurotransmitters not taken up --> remain in synaptic cleft or ECS
46
Excitotoxicity
Effects of excess release of excitatory neurotransmitter due to increased extracellular K
47
Glutamate
Main excitatory transmitter | Acts on NMDA + AMPA receptors
48
Excess NMDA stimulation
After 3-5 mins leads to excess influx of Ca into nerve cells --> fast excitotoxicity
49
Excess AMPA stimulation
Over several hours | Leads to slow (delayed) excitotoxicity
50
Excitotoxic Loop
In Hypoxia ATP levels drop + glutamate reuptake fails Post-synaptic glutamate receptors (especially NMDA) are overstimulated --> influx of calcium --> increase in metabolic demand on cell + uses more O2 --> higher demand in absence of O2 leads to free radical formation --> trigger cell death or apoptosis
51
Stroke focus
Three regions of brain around it Internal layer- cells face death Middle layer- Penumbra region, neurones are hypoxic and/or damaged but survival possible Outer layer- cells will survive
52
Penumbra region
Neurones hypoxic and/or damaged Survival possible Stroke focus
53
Stroke treatment strategies
Restore blood flow Combat excitotoxicity Combat free radical damage
54
Stroke treatment goal
Survival of neurones in penumbra region
55
Restore blood flow
Tissue plasminogen activators (thrombolysis) | Within 3-4 hours for most significant benefit
56
Intravenous fibrinolytic therapy at cerebral circulation dose
Within first 3 hours of ischemic stroke- substantial benefits Within 3.5-4.5 hours- Moderate net benefits
57
Intra-arterial fibrinolytic therapy
In 3-6 hour window offers moderate net benefits
58
Combat excitotoxicity
NMDA antagonists AMP antagonists Delay triggering of apoptotic pathways
59
NMDA agonists
Cerestat | Block NMDA receptors + fast excitotoxicity
60
AMP agonists
NBQX | Reduce slow excitotoxicity
61
Lithium
delay apoptosis
62
Reduce Free radical damaging
Antioxidants- Vit C + E Free radical scavenging enzymes- superoxide dismutase Cool down brain --> reduces O2 demand
63
Reduce Primary risk
Treat hypertension- ACE inhibitors, AR antagonists Treat AF- Aspirin <65yo, Warfarin >65yo Vascular disease- Statins

Cardiorespiratory CC (34 decks)

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