Stroke

Question 1

Determinants of Stroke

Answer 1

Modifiable:

• Hypertension
• Hyperlipidemia
• Alcohol Consumption
• HIstory of Smoking
• Other health conditions
• Physical inactivity
• Poor diet
• Waist to hip ratio

Non-Modifiable:

• Genetics
• Males
• Increasing age
• Maori and Pacific
• Socio-economic deprivation

Question 2

What is an Ischemic Stroke?

Answer 2

Blockage of the cerebral blood vessel –> less oxygen in the blood flow to selected areas of the brain

Question 3

Aetiology of an Ischemic Stroke

Answer 3

Myocardial Infarction
Arrhythmia
Atherosclerosis
Prosthetic Heart Valve 
Other Heart Conditions

Question 4

Pathophysiology of an Ischemic Stroke

Answer 4

Embolus:
blood clot breaks off of artery wall –> travels further up into the brain –> blocks small cerebral artery –> ischemia of brain tissue

Thrombus:
Atherosclerosis (narrowing of artery) –> less blood in brain –> starvation of cells –> cell death

Question 5

What is Pneumbra?

Answer 5

Area surrounding ischemic tissue (not dead yet) - can be salvageable

Question 6

What is a Hemorrhagic stroke?

Answer 6

Rupture of blood vessel with leakage of oxygenated blood (in the cerebral artery or subarachnoid artery)

Question 7

Aetiology of Hemorrhagic stroke

Answer 7

• Hypertension (increase in BP = rupture blood vessel)
• Blood Vessel Malformation (Weaker blood vessel = rupture easily)
• Head Trauma (knock head and rupture vessel)
• Blood disorders (excessive bleeding)
• Anticoagulant and Antiplatelet medication (takes longer for blood to clot = excessive bleeding)
• Other health conditions that rupture blood vessels or excessive blessive

Question 8

Pathophysiology of a Hemorrhagic Stroke

Answer 8

Small blood vessel weakens and bursts (due to tear or aneurysm) –> blood leaks into brain tissue –> leakage of blood damages nearby tissues –> hematoma expands, putting pressure on surrounding structures –> intracranial pressure –> tissue injury –> target tissues are not getting the blood needed –> tissue starts dying

Question 9

Progression of a Stoke

Answer 9

Function can improve with proper treatment

Difficult to predict extent of recovery

Acute event with sudden deterioration of function

Factors impacting on recovery:

• physical
• social
• cultural
• environmental
• behavioural
• economical

Question 10

Anterior Cerebral Artery

• What part of the body does it affect?
• Clinical Feats.

Answer 10

Affects opp side of the LOWER limb

• muscle weakness
• increase in muscle tone/spasticity
• sensory changes
• executive functions (problems controlling emotions, decision making, motivation, goal setting)

Question 11

Middle Cerebral Artery

• What part of the body does it affect?
• Clinical Feats.

Answer 11

Affects opp side of the face, mouth and UPPER Limb

• muscle weakness
• increase in muscle tone/spasticity (slurred speech may occur - dysarthria)
• sensory changes (visual field loss from opposite side due to neurons travelling back to occipital and parietal lobe)
• communication problems

Question 12

Posterior Cerebral Artery

-Clinical Feats.

Answer 12

Visual problems:

Can’t recognise signals coming from one side of brain (due to occipital cortex)–> vision loss (hemianopia)

disruption of association area –> can’t make meaning of visual info (visual agnosia)