Stroke and TIA Flashcards
A stroke in which the focal neurological deficits worsen with time
Also called a stroke in evolution
progressive stroke
A stroke in which the focal neurological deficits persist and do not worsen over time.
completed stroke
Clinical syndrome of rapid onset of focal deficits of brain function lasting more than 24 hours or leading to death
stroke
Clinical syndrome of rapid onset of focal deficits or brain function which resolves within 24 hours
Amaurosis fugax
RIND – 72 hours
TIA Transient Ischemic Attack
What is the most important risk factor for stroke?
previous TIA or stroke
What is the most prevalent risk factor for stroke?
hypertension
____ stroke is when blood leaks into brain tissue
hemorrhagic
____ stroke is when a clot stops blood supply to an area of the brain
ischemic
85% of strokes are ____
ischemic
What type of stroke accounts for 20% of all strokes?
thrombotic
5 classical lucunar syndromes:
- Pure _____ stroke/hemiparesis
- _____ hemiparesis
- Dysarthria/_____ hand
- Pure sensory
- Mixed sensorimotor
5 classical lucunar syndromes:
- Pure motor stroke/hemiparesis
- Ataxic hemiparesis
- Dysarthria/clumsy hand
- Pure sensory
- Mixed sensorimotor
Cardioembolic stroke
- Embolus from the heart gets _____ in the intracranial vessels
- ______ is most commonly affected
- ____ ______ is the most common cause
- Others: MI, prosthetic valves, rheumatic heart disease
Cardioembolic stroke
Embolus from the heart gets lodged in the intracranial vessels
MCA is most commonly affected
Atrial fibrillation is the most common cause
Others: MI, prosthetic valves, rheumatic heart disease
Artery to artery embolism
- Thrombus formed on atherosclerotic plaques gets embolized to ______ vessels
- Carotid ______ atherosclerosis is the most common source
- Others: aortic arch, vertebral arteries, etc.
Artery to artery embolism
- Thrombus formed on atherosclerotic plaques gets embolized to intracranial vessels
- Carotid bifurcation atherosclerosis is the most common source
- Others: aortic arch, vertebral arteries, etc.
Blood flow
If zero leads to death of brain tissue within _____ minutes (time is brain)
<_____ml/100g tissue per minute leads to infarction within and hour
Blood flow
If zero leads to death of brain tissue within 4-10 minutes (time is brain)
<16-18ml/100g tissue per minute leads to infarction within and hour
Ischemic Penumbra
Tissue surrounding the core region of the infarction which is ischemic but _____ dysfunctional
Maintained by ______
Can be salvaged if reperfused in time
Primary goal of revascularization therapies
Ischemic Penumbra
Tissue surrounding the core region of the infarction which is ischemic but reversibly dysfunctional
Maintained by collaterals
Can be salvaged if reperfused in time
Primary goal of revascularization therapies
Higher mortality rates compared to ischemic stroke
Hemorrhagic stroke
Intracerebral Hemorrhage
- Results of chronic ______
- _____arteries are damaged due to hypertension
- In advanced stages vessel wall is disrupted and leads to leakage
- Other causes: amyloid angiopathy, anticoagulant therapy, cavernous hemangioma, cocaine and amphetamines
Intracerebral Hemorrhage
- Results of chronic hypertension
- Small arteries are damaged due to hypertension
- In advanced stages vessel wall is disrupted and leads to leakage
- Other causes: amyloid angiopathy, anticoagulant therapy, cavernous hemangioma, cocaine and amphetamines
Subarachnoid Hemorrhage
Most common cause is rupture of ______or Berry aneurysms
Other causes include arteriovenous malformations, angiomas, mycotic aneurysmal rupture
Associate with extremely severe______
Subarachnoid Hemorrhage
Most common cause is rupture of saccular or Berry aneurysms
Other causes include arteriovenous malformations, angiomas, mycotic aneurysmal rupture
Associate with extremely severe headache
Pathophysiology of hemorrhagic stroke:
- Explosive entry of blood into the brain ______structurally disrupts neurons
- White matter fiber tracts are split
- Immediate cessation of neuronal function
- ______ hemorrhage can act as a mass lesion and cause further progression
- Large hemorrhages can cause ______ coning and rapid death
Pathophysiology of hemorrhagic stroke:
- Explosive entry of blood into the brain parenchyma structurally disrupts neurons
- White matter fiber tracts are split
- Immediate cessation of neuronal function
- Expanding hemorrhage can act as a mass lesion and cause further progression
- Large hemorrhages can cause transtentorial coning and rapid death
Stroke syndromes divided into 3 categories:
- Large-vessel strokes within the ____ circulation
- Large-vessel strokes within the _____ circulation
- _____-vessel disease within either vascular bed
Stroke syndromes divided into 3 categories:
- Large-vessel strokes within the anterior circulation
- Large-vessel strokes within the posterior circulation
- Small-vessel disease within either vascular bed
Strokes in anterior circulation:
- _____ carotid artery + branches
- ______cerebral
- _____ cerebral
Strokes in anterior circulation:
-
internal carotid artery + branches
- anterior cerebral
- middle cerebral
Middle cerebral artery stroke in the _____ ______ area causes weakness or paralysis and sensory impairment over contralateral face, arm and leg
somatic motor area
Middle cerebral artery stroke in the _____ ______ area in the dominant hemisphere causes motor aphasia
motor speech
Middle cerebral artery stroke in ____ area causes expressive aphasia
Broca’s area
Middle cerebral artery stroke in ____ area causes ureceptive aphasia
Wernicke’s area
Middle cerebral artery stroke in ___ ____ causes conduction aphasia
parietal operculum
Middle cerebral artery stroke in _____ ______ causes homonymous hemianopia and paralysis of conjugate gaze to the opposite side
optic radiations
________is characterized by the loss of the ability to execute or carry out learned purposeful movements – disorder of motor planning
Apraxia is characterized by the loss of the ability to execute or carry out learned purposeful movements – disorder of motor planning
_____ is the loss of the ability to recognize objects, persons, sounds, shapes and smells while senses are not defective and no significant memory loss
agnosia is the loss of the ability to recognize objects, persons, sounds, shapes and smells while senses are not defective and no significant memory loss
If the stroke occurs ______ to the anterior communicating artery it is usually well tolerated secondary to collateral circulation
If the stroke occurs prior to the anterior communicating artery it is usually well tolerated secondary to collateral circulation
