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Stroke and TIAs Flashcards

1
Q

Explain the blood supply to the brain

A

The vertebral arteries originate from the subclavian arteries.

Each vertebral artery arises as the first branch from the corresponding left or right subclavian artery in the lower neck,

From their origin, the vertebral arteries ascend through the transverse foramina of the cervical vertebrae towards the base of the skull.

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2
Q

What are the steps of the Anterior Blood supply to the brain?

A

Right and Left Caroitd Artery
Cartoid Artery
Anterior and Middle Cerebral Artery

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3
Q

What is the Anterior Cerebral Artery?

A
  • Major artery in the brain.
  • Supplies oxygenated blood to the frontal lobe, parietal lobe, and corpus callosum.
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4
Q

What are the three segments of the Middle Cerebral Artery?

A

Anterior Cerebral Artery
Lenticulostriate Arteries
Internal carotid artery

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5
Q

What is the Middle Cerebral Artery?

A
  • Supplies oxygenated blood to the brain parietal, temporal lobes as well as deeper
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6
Q

What is the Posterior Blood supply of the brain?

A

Right and left vertebral artery
Basilar artery
Posterior cerebral artery

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7
Q

What does the Posterior Cerebral Artery do?

A

Supplies blood to the occipital lobe and brain stem

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8
Q

What is the posterior communicating artery?

A

Connects the brains anterior and posterior circulations providing blood to the brain and allowing for collateral circulation

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9
Q

What is collateral circulation?

A

Network of backup blood vessels that can take over when another artery or vein is damaged or blocked

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10
Q

What are the types of strokes?

A

Ischemic:
- Thrombotic
- Embolic
- Systemic

Haemorrhagic:
- Subarachnoid Haemorrhage
- Intracerebral Haemorrhage

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11
Q

List some facts about a Thrombus/Embolus cause of a stroke

A
  • Accounts for 85% of all strokes in UK
  • Occurs as a result of dislodged clot or embolism from a larger blood vessels which occludes a cerebral artery
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12
Q

List some facts of a Haemorrhagic cause of a stroke

A
  • Account for approx. 15% of strokes in UK
  • Occurs as a result of a ruptured blood vessel resulting in either intra or extra cerebral haemorrhage
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13
Q

What is a Thrombus?

A

A blood clot that forms in a vein or artery (Atherosclerosis)

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14
Q

What is a Embolus?

A

Thrombus that breaks free and travels to another part of the body (AF, DVT)

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15
Q

What is Systemic?

A

Reason for decrease blood to the brain (cardiac arrest, MI, shock)

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16
Q

How does an Ischemic Stroke develop?

A
  • Blockage of an artery occurs
  • No blood flow means cells do not receive glucose and oxygen
  • Leads to a build up of Sodium and Calcium
  • Sodium causes water to come into the cell leading to swelling
  • Calcium causes damage to the mitochondria and lysosomes which leads to a release of apoptosis factors and degradative enzymes
  • Immune cells than take damaged cells away causing inflammation
  • Inflammation damages to the blood brain barrier allow fluids and proteins to get into the brain tissue this causing swelling
  • The pressure causes brain to push to the unaffected side
  • Can also push base of the skull affecting breathing and consciousness
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17
Q

What is Apoptosis?

A

Process of programmed cell death that occurs in multicellular organisms and some single-celled microorganisms.

Its a tightly regulated process that destroys cells that are no longer needed or pose a threat to the organism

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18
Q

What are the symptoms if the Ischemic Stroke has developed in the anterior and/or middle cerebral artery?

A

Numbness
Sudden muscle weakness

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19
Q

What is the symptom if the Ischemic Stroke has developed in the Broca’s Area (frontal lobe?)

A

Slurred speech

20
Q

What are the symptoms if an Ischemic Stroke has developed int he Wernicke Area (temporal lobe)?

A
  • Difficulty understanding speech
21
Q

What is the symptom if the Ischemic Stroke has developed in the Posterior Cerebral Artery?

22
Q

What is a penumbra?

A

An area of viable tissues (cells)

23
Q

What is tissue necrosis

A

If blood supply is inhibited to a part of the brain an ischaemic core of cells can develop and die

24
Q

How is a stroke diagnosed?

A

CT scan - can show where blood is blocked
FLAIR MRI - can distinguish new from old strokes

25
What is a Haemorrhagic Stroke?
Occurs when a blood vessel in the brain ruptures, leading to bleeding in or around the brain. This disrupts normal blood flow, causing direct damage to brain tissues and increasing intracranial pressure.
26
What's an Intracerebral Haemorrhage?
Bleeding occurs within the brain
27
What's an Subarachnoid Haemorrhage?
Bleeding occurs in space between inner and outer layers of tissue that surround the brain
28
What's the Haemorrhagic Stroke Development?
- Rupture of a blood vessel ICH: due to hypertension etc SAH: Due to aneurysm burst or trauma - Blood leaks into brain - Increasing pressure on brain tissue, blood vessels and the skull - Any vessels downstream of this pressure are starved of blood, leading to ischemia - The pressure can cause brain herniation (movement of brain tissue) into the only space it can - Bleeding occurs in subarachnoid space
29
What is Flax Ceribri?
Sickle-shaped fold of dura mater that separates the two cerebral hemispheres of the brain
30
What is the tentorium cerebelli?
An invagination of the meningeal layer of the dura mater that separates the occipital and temporal lobes of the cerebral hemispheres from the cerebellum and brainstem
31
What is the foramen magnum?
Large opening in the skull that connects the brain to the spinal cord
32
What is Cushing Triad?
- Physiological response to increases intracranial pressure (ICP) that occurs when the nervous system attempts to compensate for diminished cerebral perfusion Hypertension Bradycardia Irregular Respirations (All a response to brain tissue ischemia)
33
Why does Hypertension happen in reference to Cushing Triad
The sympathetic nervous system is activated to maintain cerebral perfusion which increases SBP
34
Why does Bradycardia happen in reference to Cushing Triad?
- Parasympathetic nervous system activation - Increased SBP activates the parasympathetic nervous system, which slows the heart rate down
35
Why does irregular respirations happen in relation to Cushing Triad?
Increased ICP may put pressure on the brainstem, which lead to dysfunction of the respiratory centre
36
Why would an Ischaemic Stroke occur?
- Usually caused by Atherosclerosis - Prolonged aetiology - Long history of vessel disease - May be associated with heart condition - PMH of angina or previous strokes
37
Why would an Haemorrhagic Stroke happen?
- Usually the result of Cerebral Aneurism - Sudden aetiology - Common develops during exercise or high stress - May be associated with cocaine and other sympathomimetic amines - May be asymptotic prior to rupture
38
What is a Transient Ischaemic Attack?
- Cerebral Ischemia that does not inflict any permanent damage - Typical stroke symptoms can present with TIA - Complete resolution of symptoms - More than 1/3 of patients will suffer a stroke following a TIA - Symptoms rarely last longer than 1-2 hours - Big changes in the way Paramedic's deal with TIA seriously
39
Components of Stroke?
- Effects can be irreversible - Can be life threatening - Can be life altering - Ischaemic cells post 5 mins die - Cavitation in the brain can occur as a result of necrosis
40
Components of TIA?
- Temporary occlusion of a vessel - Described as 'angina of the brain' - Intermittent short episodic symptoms - Symptoms rarely last longer than 1-2 hours - Precursor for a stroke
41
What are some treatments?
Thrombolytic Enzymes - tissue plasminogen activator - Activates body's clot busting mechanism - Has time limit for usage Aspirin - Prevents more clots Surgery - physically remove clots - Mechanical embolus removal in cerebral ischemia - wire grabs clot and pulls it out - Suctional removal - wire breaks up clot and fragments removed with suction
42
What are some modifiable risks of a stroke?
- Diabetes - Sedentary lifestyle and poor diet - High cholesterol levels - Smoking - Drug abuse - Hypertension - MI - Atrial Fib - Oral contraceptive use
43
What are some unmodifiable risks of a stroke?
- Age - Genetics - Gender - Previous stroke and/or TIA - Race
44
What are some general stroke symptoms?
- Facial drooping - Unilateral limb weakness - Aphasia (loss of speech) or dysphasia - Aphagia (inability to swallow) - Fitting - Incontinence - Visual disturbance - Confusion - Fear - Unequal pupils - Loss of balance - Ataxia - Vomiting
45
What are some stroke mimics?
- Hypoglycaemia - Hypoxia - Hypotension - Hypothermia - Fitting - Toxins, sedatives or alcohol -vBells Palsy

Neuro (4 decks)

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