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Neuroscience Unit 2 > Stroke (Cerebrovascular Disease) > Flashcards

Stroke (Cerebrovascular Disease) Flashcards

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1
Q

What might be a general issue with imaging to determine stroke?

A

It takes time, and may have difficult distinguishing new lesions from old ones.

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2
Q

What does the FAST acronym mean for strokes?

A

Face - does one side droop?
Arms - does one arm drift downward
Speech - is it slurred or strange
Time - if you see any of these signs, time is of the essence

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3
Q

What are the four levels of clinical evidence?

A
  1. Randomized controlled trial - double blind + placebo
  2. Non-randomized controlled trial
  3. Observational studies with control
  4. Observational studies without control
  5. Case studies
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4
Q

What level of blood flow defines an infarcation of the brain?

A

<10 mL / 100 g / min

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5
Q

What is the majority of strokes and what causes them?

A

70-80% of strokes are ischemic strokes, up to 25% are due to clots / plaques from other areas

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6
Q

What is a TIA?

A

Transient ischemic attack - ministroke, symptoms disappear in less than 24 hours and most last less than 30 minutes. Increases your risk of future strokes

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7
Q

What is a hemorrhagic transformation?

A

When an ischemic stroke becomes a hemorrhagic stroke due to pressure buildup.

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8
Q

What causes hemorrhagic stroke and who is it common in?

A

Accounts for 20-30% of strokes, more common in children. Greatest predisposing factor is hypertension.

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9
Q

What is a thunderclap headache?

A

Sudden, severe headache “worst headache of your life” caused by hemorrhagic bleeding into the subarachnoid space

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10
Q

What type of aneurysm typically occurs at the anterior communicating artery?

A

saccular / berry

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11
Q

What is a fusiform aneurysm?

A

aneurysm characterized by bulges on all sides

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12
Q

What is a false aneurysm vs dissecting aneurysm? What can these cause?

A

False - bulge in blood vessel but no true rupture of intima

Dissecting - tunica intima is torn, leading to blood in the vessel wall

Both can cause an ischemic stroke

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13
Q

What type of stroke do AV malformations cause? What structure is associated with them?

A

Hemorrhagic stroke, due to buildup of pressure

An AVM nidus is associated with them

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14
Q

Where is central venous thrombosis most common, and what is the most common genetic cause?

A

Common in superior sagittal sinus. Common in genetic mutations to clotting factors

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15
Q

What percentage of patients have a patent foramen ovale and why is this a stroke risk factor?

A

25% of patients, it is a risk factor because systemic venous clots will be able to get into the arterial system through the foramen ovale

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16
Q

What are other common causes of emboli from the heart?

A

Causes 15-20% of strokes

Atrial fibrillation, endocarditis, or MI

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17
Q

When is the penumbra?

A

Part of the brain which can potentially be rescued, surrounding the infarcted area. Delayed necrosis + apoptosis of cells

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18
Q

What are the risk factors for stroke?

A 
Hypertension
Heart disease, atrial fibrillation and especially rheumatic (from strep throat)
Diabetes
Smoking
Dyslipidemia
Previous stroke
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19
Q

What is non-contrast CT good for?

A

Hemorrhagic but not early ischemic stroke

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20
Q

What is perfusion CT good for?

A

Ischemic stroke and revealing penumbra

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21
Q

What is CT angiography good for?

A

Uses contrast, reveals flow in blood vessels

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22
Q

How do white matter, gray matter, and CSF appear on T1-weighted imaging?

A

White matter: light
Gray matter: Dark
CSF: Black

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23
Q

How do white matter, gray matter, and CSF appear on T2-weighted imaging?

A

White matter: dark
Gray matter: light
CSF: white

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24
Q

What is perfusion-weighted imaging good for? What sequence is it based off?

A

T2 - perfusion of tissue

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25
What is diffusion-weighted imaging good for? What sequence is it based off?
T2 - Early detection of ischemic stroke
26
What is susceptibility-weighted imaging good for? What sequence is it based off?
T2 - venous blood and iron
27
What is MR angiography imaging good for? What sequence is it based off?
T2 - Visualization of blood vessel flow
28
What is FLAIR imaging good for? What sequence is it based off?
T2 - Fluid-attenuated inversion recovery - detects demyelination
29
What is diffusion tensor imaging good for? What sequence is it based off?
T2 - used to delineate tracts within the brain
30
What is mismatch imaging used for?
Mismatch = Perfusion - diffusion weighted, aka areas with lack of perfusion - areas with ischemic stroke damage = area of penumbra
31
What is ultrasound good for?
Monitoring blood flow, also the sound waves increase the enzymatic reaction of thrombolytics
32
What is TPA used for and what is its major disadvantage?
Tissue plasminogen activator - used to break up ischemic strokes caused by clots. Major disadvantage: Must be given within 3 hours of stroke symptoms, and can be really dangerous if stroke was misdiagnosed and is actually hemorrhagic!!
33
What is inter-arterial thrombolysis?
Used in large vessel occlusion, often heparin and pro-urokinase, used after TPA would no longer be effective
34
What is balloon angioplasty and stenting?
Balloon opens narrowed vessel and stent is left in if needed
35
What is embolectomy and clot aspiration?
Use a wire to break up the thombus / embolus, then aspirate the pieces. Can be done with things which surround the clot or break it up mechanically (MERCI, PENUMBRA, SOLITAIRE)
36
How many neurons are lost each minute of ischemia?
1.9 million neurons per minute
37
What is the treatment for subarachnoid hemorrhage?
Clipping of aneurysm or using coiling
38
What is the treatment for cerebellar hemorrhage?
Occipital craniotomy
39
What is the treatment for intraventricular hemorrhage?
Ventriculostomy (insertion of tube)
40
What is the most common stroke region, and what is the most dangerous type of stroke in this region?
Anterior Brain Circulation Syndrome (70%) Most dangerous = massive cerebral infarcation. Embolic stroke is the worst because there is no time for collaterals to form (vs atherosclerotic)
41
What is the main cause of death in internal carotid embolic stroke? What will the patient do?
Edema and brain herniation patient's head and eyes will move towards the side of the lesion, and will have contralateral motor and sensory loss
42
What is the feature of an anterior choroidal artery stroke?
Usually a lacunar syndrome with pure motor or sensorimotor hemiparesis, since it supplies the posterior limb of internal capsule, LGN, and hippocampus
43
What is the most common artery to be affected in stroke? How is a large vs malignant infarct defined?
Middle cerebral artery Large: 2-3 territories Malignant - all territories
44
What causes acute complete MCA infarct, and what part of the body is spared?
Infarct in M1. Only part that is spared is low leg (supplied by anterior cerebral artery)
45
What two arteries branch from M1, and what is considered the "artery of stroke"? What does that cause?
1. Medial Lenticulostriate Arteries 2. Lateral Lenticulostriate Arteries (Artery of Stroke) - > Charcot's artery, causes the classical symptoms of stroke because it supplies the post. internal capsule and basal ganglia, including hemiparesis, hemihypesthia (sensory loss) and dysarthria
46
What causes complete superficial MCA infarct? How does this differ from acute complete MCA infarct?
Proximal M2 ischemia at MCA bifurcation. There are less cognitive deficits than M1.
47
What does superior (anterior) M2 stroke cause?
Contra arm and face sensory deficits, but NOT visual deficits (no temporal involvement)
48
What does inferior (posterior) M2 stroke cause?
Similar deficits but including visual deficits (hemianopsia or quantrantanopsia)
49
What infarcts are included in M3?
1. Leptomeningeal - highly variable | 2. Medullary perforating - infarct of centrum ovale, or cortical white matter
50
What are M4 infarcts?
Stroke of terminal branches supplying the cortex
51
What is the main infarct of the anterior cerebral artery?
Medial striate artery / recurrent artery of Heubner - supplies head of caudate + ant. limb of internal capsule. Causes weakness of contralateral arm / leg and hemichorea
52
What problems are more common in a posterior vs anterior circulation syndrome?
Posterior is more likely to cause visual / gaze problems
53
What is the most common of the vertebral artery infarcts?
Lateral medullary / Wallenburg syndrome (PICA loss)
54
What causes medial medullary syndrome / inferior alternating hemiplegia?
Anterior spinal artery infarction
55
What causes locked-in syndrome?
Infarct of basilar artery
56
What does posterior cerebral artery infarct cause?
Contralateral hemianopsia, possible macular stparing
57
What causes rostral lateral pontine syndrome?
Superior cerebellar artery infarct
58
What causes lower lateral pontine syndrome?
AICA infarct
59
What is a Lacunar stroke syndrome?
Small vessel disease, usually subcortical, which is common in vertebrobasilar system. Makes up 20% of all strokes, with better recovery than other strokes but high risk of further problems
60
What are the five types of lacunar strokes? Which two are most common?
1. Pure motor 2. Pure sensory - lesion of VP nucleus 3. Sensorimotor - internal capsule - common 4. Dysarthria - basilar pons lesion, with clumsy hands 5. Ataxic hemiparesis - common
61
What are the two types of watershed infarcts and what causes them generally?
Cause: Distal regions of two arterial systems, commonly hypotension 1. Cortical - superficial and wedge-shaped 2. Internal - central semiovale along lateral ventricle, single lesion
62
What does bilateral internal watershed injury cause?
Proximal upper and lower limb weakness -> man-in-the-barrel
63
What is a capsular warning syndrome?
Pure motor hemiparesis with repetitive TIAs, may be caused by small infarct of internal capsule such as lateral LSA. Precursor to a larger stroke

Neuroscience Unit 2 (19 decks)

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