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Medical Pathology > Stroke > Flashcards

Stroke Flashcards

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USMLE® Step 1 flashcards
1
Q

what supplies the brain?

A 
internal carotids (anterior 3/5 of brain) 
vertebral arteries (posterior 2/5 of brain)

uses up 20% of total body oxygen

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2
Q

what is a TIA?

A

transient ischemic attack - brief rapid period of inadequate cerebral perfusion leading to a sudden loss of neurologic function with no permanent defects and full resolution

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3
Q

what are the 2 causes of TIA?

A

intermittent vessel obstruction (plaque, thrombus) or temporary vasospasm (smoke, drugs, stress, migraine)

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4
Q

how do you dx a TIA?

A

carotid auscultation (listen to blood vessel in neck), carotid ultrasound or echocardiogram (heart ultrasound)

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5
Q

what are the symptoms of TIA?

A

hemiplegia, diplopia, amaurosis fugax, vertigo, loss of speech, understanding, or balance

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6
Q

what is a stroke?

A

5 in cause of death in US

disturbance of blood supply causing loss of brain function with permanent damage

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7
Q

how do you confirm a dx of stroke?

A

CT/CTA: confirm stroke + if ischemic / hemorrhagic
- metal imaging + no pregnancy use bc radiation

MRI: ID and localize the site and source of stroke
- no radiation so safe for pregnancy but no metal imaging

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8
Q

what are the two types of strokes?

how does it differ between adults and children?

A

ischemic (80-85%) with 40% mortality rate

Hemorrhagic (15-20%) with 80% mortality rate

Children: ischemic + hemorrhagic percentages are the same
- pay attention to other risk factors like clotting disorders, vascular abnormality, contraceptives

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9
Q

What are the two MOA of ischemic strokes?

A

1: blood vessel occlusion (thrombus, embolus, lacunar, dissection)
2. systemic hypoperfusion due to pump failure or hypovolemia

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10
Q

what is an embolic stroke and what causes it?

A

arteriovenous thrombosis + plaque fragments from carotid leading to ischemia and chronic afibrillation

It can be caused by fat particles, gas bubbles, bacterial endocarditis (roth spots) and IV substance abuse (insoluble in blood) ~ Talc Retinopathy whitens the retina

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11
Q

how do you treat ischemic strokes?

A

tPA: tissue plasminogen activator that dissolves the clot and restores blood flow BUT it can cause hemorrhage and has to be within 3 hours of stroke

only 1-7% used

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12
Q

what is the MOA of hemorrhagic strokes?

A

intracranial artery rupture leading to hypoxic and hydraulic damage (more fluid = high ICP)

sudden onset + severe HA from the increased fluid

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13
Q

what is the cause of hemorrhagic strokes?

A

HTN** or aneurysm, AVM, trauma

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14
Q

what are the 2 types of hemorrhagic strokes

A

Extra-Axial (inside skull but outside brain)

Intra-axial (inside brain) - rupture and hemorrhage into brain leading to hypoxic and hydraulic damage
- associated with HTN&raquo_space;> AVM, Berry Aneurysms and Trauma

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15
Q

What are the 3 types of extra-axial injuries?

A

epidural: caused by head trauma + middle meningeal artery (80%) with lenticular shape hematoma
- bleeds into space between skull and dura

Subdural: caused by A/D injury (vein > artery)

  • mostly elderly or young
  • crescentic shape hematoma

subarachnoid: more young than elderly; caused by saccular aneurysm rupture (80%) or trauma, AVM
- fluid into SAS – papilledema and HA

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16
Q

what arteries are most commonly affected with strokes?

A

middle cerebral artery: feeds the occipital lobe which leads to VFD + numbness, weak, speech, language

posterior cerebral artery: only VFD

17
Q

what are the 3 ways a brain can show injury

A

lose consciousness, seizures, localizing signs (loss of function)

18
Q

how do blood signals change over time?

A

over time, iron is broken down and density of blood changes

Acute (3 days): hyperintense
Chronic (14+ days): hypointense

19
Q

what are the localizing signs of acute CVA

A

sudden severe HA, hemiplegia, hypoesthesia (1 sided numb), aphasia, VFD, EOM restriction, confusion, bizarre behavior, personality change

20
Q

What does FAST stand for

A

Face
Arm
Speech
Time

21
Q

What is the left hemisphere responsible for?

A 
sensory/motor of the right side 
speech, language, comprehension
Analysis and Calculations
Time and Sequencing 
Aphasia + Dysarthria 
Right-sided Hemiparesis, VFD, Neglect
Poor Conjugate Right Gaze 
Difficulty reading and writing
22
Q

what is the right hemisphere responsible for?

A 
sensory and motor of left side 
Spatial Ability / Spatial Disorientation 
Creativity 
Context/Perception
Poor Conjugate Left Side
Left sided VFD, Neglect, Hemiparesis 
Recognize faces, objects, places 
Dysarthria possible
23
Q

What is the Frontal Lobe responsible for?

A 
Precentral Gyrus (motor cortex) 
Paralysis and motor defects 
FEF (Eye movements)
Inability to Express Language (Broca's Area) 
Personality / social changes 
Difficulty with problem-solving or decision-making 
inability to sequence events 
difficulty with impulse control 
low attention
24
Q

What is the Parietal Lobe responsible for?

A

Inability to name object
decreased spatial perception (L/R coordination)
sensory defects (postcentral gyrus: sensory cortex)
VFD: visual neglect (left sided neglect more common)
Difficulty drawing objects, reading, writing, math

25
Q

What is the temporal lobe responsible for?

A 
Prosopagnosia: faces
short and long term memory 
change in sex behavior 
very aggressive
hearing problems (auditory cortex) 
difficulty understanding spoken words (Wernicke's) 
VFD
26
Q

What is the occipital lobe responsible for?

A

VFD: hemianopia and quadrantanopia
loss of central vision (scotoma)
color recognition
Akinetopsia (MT/V5 Area): motion blindness

27
Q

why is left sided neglect more common ?

A

right side has spatial perception and so it is more common for patients to suffer from left sided neglect with a right PL lesion

28
Q

symptoms of a cerebellar stroke? which cerebellar arteries are most commonly affected?

A

vertigo or dizzy + HA, vomit, diplopia, Ataxia

SCA + AICA + PICA

29
Q

what are the cranial nerves

A

1: Olfactory
2: Optic Nerve
3: Oculomotor
4. Trochlear
5: Trigeminal - Face Numb
6: Abducens
7: Facial - Face Droop
8: Vesticulocochlear
9. Glossopharyngeal
10. Vagus - Hearing and Breathing Centers
11. Accessory
12. Hypoglossal

30
Q

what is the sympathetic effect of pupils

A

constriction

31
Q

what is receptive aphasia

A

Wernicke’s Area is affected (Left Temporal Lobe)

The person cannot understand spoken words - nonsensical word salad

32
Q

What is expressive aphasia

A

Broca’s Area affected (Left Frontal Lobe)

the person can understand but has poor production of words (labored speech)
- can read but cannot write

33
Q

what is dysarthria

A

motor cortex affected; patient can understand and say words out loud but itll be a slur or broken stutter (speech impairment) from tongue muscles

MCA feeds these areas for speech and language

34
Q

what isthe order of hearing something

A

Hear something to Ear - Wernickes (TL) - Brocas (FL) - Mouth - Say something

Medical Pathology (13 decks)

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