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Year 1-Cardiovascular System > Stroke and Risk Factors > Flashcards

Stroke and Risk Factors Flashcards

1
Q

What is a stroke?

A

A sudden onset of neurological deficit (loss of function) .

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2
Q

How long does a stroke have to be present to be considered a stroke? (if that even makes sense).

A

24hrs

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3
Q

What is the difference between a stroke and a transient ischemic attack?

A

Transient ischemic attack has the same symptoms as stroke but lasting less than 24hrs.

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4
Q

What pathologically causes a stroke?

A

A blocked or ruptured blood vessel in the brain causing a failure of neuronal function leading (usually) to some deficit in brain function

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5
Q

What are some of the causes of a stroke?

A

Blockage with thrombus or clot
Disease of vessel wall
Disturbance of normal properties of blood
Rupture of vessel wall (haemorrhage)

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6
Q

What are strokes usually due to?

A

Infarction (85-90%)

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7
Q

What is the difference between a haemorrhagic stroke and an ischaemic stroke?

A

Haemorrhagic- blood leaking in the brain
Ischaemic- not enough oxygen getting to the brain

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8
Q

Where will there usually be an atheroma?

A

Bifurcation of arteries

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9
Q

In which artery would a clot breaking off and embolising cause a stroke?

A

Internal carotid- if an atheroma and clot formed and the clot broke off, it would travel up to the brain.

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10
Q

What is the condition in which a clot forms in the carotid artery and embolises to the brain known as?

A

Carotid disease

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11
Q

Give another example of a type of stroke due to large vessel occlusion.

A

Cardioembolic stroke

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12
Q

What is the commonest cause of cardioembolic stroke?

A

Atrial fibrillation

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13
Q

Describe what happens to cause a cardioembolic stroke.

A

Clot forms in the left atrial appendage.
Clots travels up the aorta and into the cerebral vessels.

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14
Q

Name two strokes caused by large artery disease.

A

Carotid artery disease
Cardioembolic stroke

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15
Q

What is a small vessel artery disease?

A

When one of the smaller arteries branching off from a larger artery becomes occluded.

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16
Q

What is lacunar stroke (small vessel artery disease) associated with?

A

Hypertension

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17
Q

What is a rarer cause of large vessel artery disease?

A

Lining of the blood vessel tears

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18
Q

What are some of the risk factors for a stroke?

A

Hypertension
Smoking
Diet
Exercise
Diabetes
Alcohol

19
Q

What are some of the pathological causes of stroke?

A

Haemorrhagic
Small vessel disease
Large vessel disease (atherosclerotic cerebrovascular disease)
Cardiac embolism

20
Q

What are some of the risk factors for haemorrhage?

A

Hypertension (60-70%)
Amyloid (15 -20%)*
Excess alcohol
Hypocholesterolaemia
Haemorrhagic transformation

*for interest- build up of protein (amyloid) in the organs

21
Q

What is ischaemia the result of?

A

Failure of cerebral blood flow to a part of the brain.

22
Q

What does transient mean?

A

Short, not permanent

23
Q

What can ischaemia result in?

A

Various degrees of hypoxia

24
Q

Is ischaemia transient?

A

It can be

25
Q

What is it called when hypoxia becomes prolonged?

A

Anoxia (no oxygen)

26
Q

What does anoxia result in?

A

Infarction

27
Q

What does hypoxia do to the brain?

A

Hypoxia stresses the metabolic machinery of brain cells, which malfunction but are still alive

28
Q

What happens in infarction?

A

Complete cell death leading to necrosis and therefore, the full cycle leading to a stroke has occurred.

29
Q

After a completed stroke, what can cause further damage?

A

Oedema

30
Q

What happens to cells when there isn’t enough oxygen?

A

Cells cannot produce as much energy.
Metabolism has to switch to anaerobic metabolism which greatly reduces ATP production and produces lactate

31
Q

What can lactic acid do?

A

Lactic acid is an irritant, which has the potential to destroy cells by disruption of the normal acid-base balance in the brain.

32
Q

What happens when the ATP-reliant ion transfer pump fails? (part of the ischaemic cascade).

A

Membrane becomes depolarised.
Influx of calcium, and efflux of potassium.

33
Q

If intracellular levels of calcium get too high, what does this trigger the release of? (part of the ischaemic cascade).

A

Glutamate- excitatory amino acid neurotransmitter

34
Q

What does glutamate do?

A

Stimulates AMPA receptors and calcium-permeable NMDA receptors, which leads to even more calcium influx into cells.

35
Q

What causes the release of glutamate?

A

High levels of intracellular calcium

36
Q

What does excess calcium in the cell lead to? (part of the ischaemic cascade).

A

Overexcites cells and activates proteases, lipases and free radicals formed as a result of the ischaemic cascade.

37
Q

What are proteases?

A

Enzymes which digest cell proteins

38
Q

What do lipases do?

A

Enzymes which digest cell membranes

39
Q

What can happen when phospholipases break down the cell membrane? (part of the ischaemic cascade).

A

It becomes more permeable so more ions and harmful substances enter cells

40
Q

What happens when the mitochondria breaks down? (part of the ischaemic cascade).

A

Releases toxins and apoptotic factors

41
Q

What do cells release if they go through necrosis? (part of the ischaemic cascade).

A

Glutamate and toxic chemicals

42
Q

What can happen as a result of the loss of vascular structure as part of the ischaemic cascade?

A

Breakdown of the protective blood brain barrier and contributes to cerebral oedema, which can cause secondary progression of the brain injury.

43
Q

Define excitotoxicity.

A

The toxic actions of excitatory neurotransmitters, primarily glutamate, where the exacerbated or prolonged activation of glutamate receptors starts a cascade of neurotoxicity that ultimately leads to the loss of neuronal function and cell death.

44
Q

Define penumbra.

A

Reversibly injured brain tissue around ischemic core

Year 1-Cardiovascular System (41 decks)

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