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Neuropathophysiology > Stroke, Bells Palsy, and Cerebral Edema (Exam 2) > Flashcards

Stroke, Bells Palsy, and Cerebral Edema (Exam 2) Flashcards

1
Q

What is a stroke?

A

injury to the brain due to reduced blood flow either through ischemic or hemorrhagic conditions

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2
Q

Where are the 4 common locations for a stroke?

A

1) hippocampus
2) cortex
3) cerebellum
4) brainstem

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3
Q

What is hypoxia in the brain?

A

reduced oxygen in brain tissue

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4
Q

What is ischemia?

A

transient or permanent interruption of blood flow

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5
Q

What is an infarction?

A

irreversible brain tissue damage (cell death)

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6
Q

What is a pernumbra?

A

“at risk” region of transition between necrotic tissue and the normal brain

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7
Q

What are the 3 types of strokes?

A

1) ischemic (global or focal/localized)
2) hemorrhage
3) lacunar

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8
Q

What is a global ischemic stroke?

A

-general reduction of blood flow to the entire brain
1) low oxygen levels in blood circulating in the brain (impaired oxygen carrying capacity (severe anemia or leukemia))
2) decrease perfusion (severe hypotension (acute shock))
3) complete lack of blood flow (cardiac arrest)
-severe global ischemia will result in widespread neuronal death
-survivors of severe global ischemic strokes remain in a persistent vegetative state and flat line indicating brain dead

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9
Q

What does respirator brain mean?

A

long term use of mechanical ventilation will result in autolytic process of brain tissue and liquefaction

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10
Q

What is a focal cerebral ischemic stroke?

A

-decreased or cessation of blood flow to a localized area of the brain due to an occlusion
-sustained ischemia leads to infarction
-extent of tissue damage caused by the stroke depends on the duration of the ischemia and the adequacy of collateral flow

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11
Q

Which artery is the most common location for a focal cerebral ischemic stroke?

test q

A

middle cerebral artery

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12
Q

What are the 2 types of a focal cerebral ischemic stroke?

test q

A

1) embolic (obstruction of an artery by something that traveled in the blood)
2) thrombotic (local formation of a thrombus within a vessel)

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13
Q

What is an embolic stroke?

A

-blockage of an artery in the brain caused by an emboli
-blood clot, fat, plaque, air, or bony fragment travel in the blood and occludes a vessel distant from its origin

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14
Q

What is a shower embolism?

boards q

A

fat embolism that occurs after fractures

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15
Q

What are some causes of embolic strokes?

A

-heart disease
-MI
-post heart or lung surgery
-post long bone fracture
-a fib

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16
Q

What is a thrombotic stroke?

A

-stroke caused by a thrombi/thrombus
-local development of a blood clot of plaque within the vessel
-does not travel, it occludes the lumen

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17
Q

What are the most common sites for a thrombotic stroke?

A

-carotid bifurcation
-origin of middle cerebral artery
-either end of basilar artery

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18
Q

What is a deep vein thrombosis?

A

thrombus that forms in the deep leg veins

19
Q

What are the risk factors for a thrombotic stroke?

A

-high BP
-high cholesterol
-diabetes mellitus
-atherosclerosis
-obesity
-smoking
-a fib
-sedentary lifestyle
-may be proceeded by “mini strokes” called transient ischemic attacks (TIA)

20
Q

What is a TIA?

A

-mini stroke caused by thrombus
-a warning sign for a potentially larger ischemic injury to the brain
-plaque reducing lumen of cerebral, carotid, or vertebral arteries
-sudden focal loss of neurological function with complete recovery within 24 hours
-can be asymptomatic

21
Q

What is a lacunar infarct?

A

-affects deep penetrating arterioles supplying basal ganglia
-caused by hypertension (arteriolar sclerosis)
-arterial lesions will occlude and cause small cavitary infarcts (lacunes)
-tissue loss of the subthalamic nucleus
-lakelike spaces (lacunae)
-can be silent or cause severe neurological impairment
-hemiballismus (unilateral chorea)

22
Q

What is a hemorrhagic stroke?

A

bleeding from vessels within the brain

23
Q

What is the most common cause of a hemorrhagic stroke?

A

ruptured aneurysm due to hypertension

24
Q

What are boarder zone infarcts or watershed infarcts?

boards q

A

-occur at the most distal reaches of the arterial blood supply
-border zones between arterial territories
-greatest risk is border zone between the anterior and middle cerebral artery (crescent shaped/sickle- shaped band of necrosis over the cerebral convexity)

25
Q

What are the clinical features for ischemic or hemorrhagic stroke?

A

sudden onset of:
-unilateral weakness, numbness, or paralysis in the face and arm
-slurred or garbled speech
-dizziness or loss of balance or coordination
-severe headache with no known cause
-cognitive dysfunction

26
Q

What is bells palsy?

A

-unilateral facial paralysis or weakness not caused by stroke
-no weakness or paralysis elsewhere
-swelling, inflammation, or compression of CN VII (facial nerve)
-one sided drooping of eyelid and corner of mouth
-inability to wrinkle forehead
-self limiting 2 weeks, many cases take longer or have repeat episodes

27
Q

What are the causes of bells palsy?

A

-sporadic
-bacterial like lyme disease
-viral like epsten barr (long latency can be 40-50 years later)

28
Q

What are the 3 layers of an artery?

A

1) tunica intima (endothelial tissue)
2) tunica media (smooth muscle)
3) tunica externa (connective tissue)

29
Q

What is a vertebral artery dissection?

A

-tear in the vessel causes an aneurysm and then hemorrhagic stroke or a blood clot and ischemic stroke
-usually due to a trauma
-can develop hours to days (rarely sudden unless theres a rupture)

30
Q

What is the order of a vertebral artery dissection pathogenesis?

dragging test q

A

1) endothelial tear forms blood clot (embolic or thrombotic)
2) clot decreases lumen
3) limits blood flow
4) hypoxic conditions
5) stroke

OR

1) endothelial tear causes aneurysm
2) subsequent trauma ruptures aneurysm
3) hypoxia
4) stroke

31
Q

What are the causes of a spontaneous vertebral artery dissection?

A

1) connective tissue disorders like marfan syndrome or EDS
2) atherosclerosis
3) trauma

32
Q

Who is high risk for a spontaneous vertebral artery dissection?

A

-chronic high BP
-smoking
-cardiovascular disease
-obesity
-long term contraceptives (20+ years)

33
Q

What are the general symptoms of a vertebral artery dissection?

A

-headache
-neck and face pain
-double vision
-droopy eyelid
-pulsatile whooshing sound in one ear
-weakness on one side of face

34
Q

A vertebral artery dissection can be mistaken for what due to weakness on one side of the face?

A

bells palsy

35
Q

What is the red flag symptom of a vertebral artery dissection?

A

pulsatile whooshing sound in one ear

36
Q

What are the 4 types of cerebral edema?

A

1) cytotoxic edema
2) vasogenic edema
3) osmotic edema
4) interstitial edema

37
Q

What are the 2 types of cerebral edema post stroke?

A

cytotoxic edema or vasogenic edema

38
Q

Which cerebral edema is caused from over hydration and kidney damage?

A

osmotic edema

39
Q

Which cerebral edema is caused by high BP and high intravascular pressure?

A

interstitial edema

40
Q

What is cytotoxic edema?

test q

A

-begins immediately post stroke
-decrease in oxygen decreases ATP and the sodium potassium pumps stop working so cells swell
-intracellular sodium builds up
-water in ECF flood into neuron to balance our sodium
-neuron swells so much it will die by rupturing
-sodium and calcium pumps will also stop working which causes intracellular calcium to build, glutamate will be released and cause excitotoxicity (too much intracellular calcium causes even more cell death)
-neuron can be saved if oxygen levels rise to permit aerobic ATP production

41
Q

What is vasogenic edema?

test q

A

-occurs 4-6 hours post stroke and can go on for days
-ischemic conditions and inflammation will break down BBB
-endothelial cells, basal lamina, and tight junctions become leaky
-astrocytes break down and are no longer supporting the blood vessels
-ECF inside blood vessel leaks out between tight junctions (some of this fluid adds to the cytotoxic edema and some builds up causing displacement or herniation of brain tissue)

42
Q

What is osmotic edema?

A

-caused by hyponatremia (over hydration)
-cells swell and can rupture, similar to cytotoxic edema because of an imbalance of sodium

43
Q

What is interstitial edema?

A

-caused by abnormally high intravascular pressure, high BP, and high atmospheric pressure
-the increased pressure pushes too much fluid through the choroid plexus in the ventricles which then pushes CSF across the ependymal lining of the ventricle into brain tissue

44
Q

What is hydrocephalus?

A

-accumulation of CSF within the ventricles
-caused by impaired CSF flow and reabsorption
-in the adult, ventricles will enlarge if CSF cannot drain
-brain tissue is damaged by compression
-head will enlarge in an infant prior to closure of sutures, if CSF cannot drain

Neuropathophysiology (16 decks)

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