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clinical physiology > Stroke > Flashcards

Stroke Flashcards

1
Q

In simple terms, what is a stroke?

A

Loss of blood supply/oxygen to a brain region leading to death of neurones.

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2
Q

What are the two classifications of stroke?

A

Ischaemic and haemorrhagic

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3
Q

Which is more common, ischaemic or haemorrhagic stroke?

A

Ischaemic

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4
Q

Which typically has a more significant impact/threat to life, ischaemic or haemorrhagic stroke?

A

Haemorrhagic

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5
Q

Haemorrhagic strokes occur for approximately what percentage of stroke events?

A

20%

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6
Q

What percentage of people will die within one month following a stroke?

A

1 in 5 (20%)

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7
Q

What occurs in an ischaemic stroke?

A

An obstruction blocks blood flow to a part of the brain.

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8
Q

What occurs in a haemorrhagic stroke?

A

Weakened blood vessel ruptures, causing bleeding inside or around brain tissue.

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9
Q

Ischaemic stroke obstructions are usually due to either ____ or ____.

A

Thrombus or embolism.

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10
Q

A thrombus is usually associated with ____ ____.

A

Atherosclerotic plaque

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11
Q

TIA’s can be an indicator of underlying ____ ____.

A

Thrombotic disease.

Note: would also accept ‘cardiovascular disease’.

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12
Q

Haemorrhagic strokes are commonly associated with what chronic health condition?

A

Chronic hypertension

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13
Q

Aside from hypertension, what two other conditions are often associated with haemorrhagic stroke?

A

Aneurism or arterio-venous malformation

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14
Q

Why is significantly higher mortality and death associated with haemorrhagic rather than ischaemic stroke?

A

This type can significantly displace brain tissue and increase intracranial pressure (ICP)

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15
Q

Describe the neurotoxic domino effect

A

Loss of O2 and glucose results in rapid necrosis of the directly affected area and the damage extends beyond this area due to a neurotoxic effect; neighbouring and regional cells undergo apoptosis due to excitotoxicity.

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16
Q

Describe excitotoxicity

A

Dying cells release excessive amounts of glutamate (an NT) which hyperactivates surrounding cells and induces massive influx of calcium which triggers apoptosis (self destruction)

17
Q

Aside from excessive glutamate, what other substance is produced by the excitotoxicity process that further expands the damage zone?

A

Reactive free radical species

18
Q

What are some common conditions/lifestyle choices that lead to stroke?

A
  • Hypertension
  • Diabetes
  • Smoking

i.e. leading to atherosclerosis

19
Q

List some general symptoms of stroke

A
  • Confusion
  • Speech problems (dysphasia/aphasia)
  • Paralysis on opposite side to damaged hemisphere
  • Severe headache
  • ALOC
  • Visual disturbances
20
Q

What is aphasia?

A

Loss of speech/language abilities

21
Q

Aphasia is caused by damage to either or both of what two areas of the brain?

A

Broca’s area and Wernicke’s area

22
Q

Describe the presentation of a pt with damage to Broca’s area

A

Unable to speak but are able to understand speech of others

23
Q

Describe the presentation of a pt with damage to Wernicke’s area

A

Able to speak but speech is nonsensical, and unable to understand others

24
Q

Describe the difference in function between Broca’s area and Wernicke’s area

A

Broca’s area: speech

Wernicke’s area: makes sense of speech

25
Q

List six characteristics consistent with Broca’s aphasia

A
  • Halting/no speech
  • Repetition
  • Disordered grammar
  • Disordered syntax
  • Cannot pronouce individual words (mixes letters)
  • Comprehension intact
26
Q

List five characteristics consistent with Wernicke’s aphasia

A
  • Speaks fluently
  • Words, syntax, grammar correct
  • Makes no sense to listen to
  • Uses inappropriate words
  • Does not comprehend what others say
27
Q

List six things that could mimic a stroke

A
  • Hypoglycaemia
  • Tumours/lesions
  • Seizure
  • Electrolyte imbalance
  • Migraine
  • Conversion disorder (psychiatric, pt feels real symptoms)
28
Q

What is the purpose of the GCS?

A

To determine the extend of a pt’s brain dysfunction

29
Q

What is a TIA?

A

A short (transient) depletion of O2 in a brain area with symptoms that resolve

30
Q

What are the three questions when rx stroke?

A
  1. Ischaemic or haemorrhagic
  2. Time of event
  3. SPO2 value
31
Q

What symptoms might suggest haemorrhagic stroke?

A
  • N+V
  • Severe headache
  • ALOC
  • Symptoms indicative of increased ICP
32
Q

On non-contrast CT scans, what do white areas indicate?

A

Blood

33
Q

On non-contrast CT scans, what do dark shadows indicate?

A

Ischaemia

34
Q

What is the best method for early detection of ischaemic stroke?

A

Diffusion-weighted MRI (DWI) (measures diffusion of water molecules)

35
Q

Fibrinolysis is given to which kind of stroke, ichaemic or haemorrhagic?

A

Ischaemic

36
Q

Describe the action of fibrinolysis

A
  • Gives tPA (tissue plasminogen activator)
  • tPA is an enzyme that facilitates cleavage of active from inactive plasminogen
  • Active plasminogen becomes plasmin
  • Plasmin breaks down the fibrin clot

clinical physiology (11 decks)

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