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IPFC 4 Final > Stroke Pathophysiology > Flashcards

Stroke Pathophysiology Flashcards

1
Q

Definition of stroke

A

Work in progress
- trying to include all the clinical scenarios

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2
Q

What are the 2 types of classifications of stroke? Which one is more common
Subtypes?

A

Ischemic stroke (85%)
- including transient ischemic attack (TIA)

Hemorrhagic stroke (15%)
- intracerebreal hemorrhage
- subarachnoid hemorrhage
- subdural and epidural hematomas

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3
Q

Define ischemic stroke

A

Episode of neurological dysfunction caused by focal cerebral, spinal, or retinal infarction

  • Evidence of focal ischemic injury
  • Symptoms persisting 24hrs+
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4
Q

Define TIA

A

Same as ischemic stroke WITHOUT acute infarction
Symptoms lasting LESS than 24hrs
- “mini stroke”
- indicator or acute ischemia that can happen in near future

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5
Q

T/F is having symptoms alone good for diagnosis

A

True

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6
Q

What if a patients presents with no symptoms? What is it called

A

Silent CNS infaraction

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7
Q

Define thrombotic and embolic ischemic stroke

A

Thrombotic
- infarction located near the clot in the brain

Embolic
- Clot migrated from another source
- ex. Afib and valvular diseases

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8
Q

Define ischemic core or focal region

A

Tissue that has already sustained irreversible damage
- cannot be salvages

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9
Q

Define penumbra

A

Tissue at risk
- hypo-perfused tissue with disrupted function

May be salvaged by acute reperfusion therapy
- but delay can lead to permanent is irreversible

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10
Q

Which vessels off the aorta supply blood to brain? (2)

A

R common carotid artery
L common carotid artery

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11
Q

Which arteries in the head & neck supply blood to brain (2)

A

Vertebral artery
Internal carotid artery

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12
Q

Why is circle of willis important?

A

To be able to use alternate routes if a blockage happens

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13
Q

What are the 5 sources of ischemic stroke? %?

A

25% large artery
25% small artery (lacunes)
20% cardiogenic embolism (afib)

25% cryptogenic (unknown source)
5% Unusual dissections, arteritis

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14
Q

How can large artery atherosclerosis happen?

A

Commonly due to build of plaque

can be caused due to in-situ thrombosis or artery-artery embolization

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15
Q

Which large arteries are affected in stroke?

A

Internal carotid artery
Vertebral artery

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16
Q

How can small artery stroke happen (lacunar stroke)
Symptoms?

A

Endothelial dysfunction leading to occlusion in the small penetrating
- necrotic tissue from the infarct is removed by macrophages, resulting in a formation of a small cavity or lacune

Can be symptomatic or asymptomatic

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17
Q

How does cardiac embolism happen in afib?
Stats?
What are other reasons?

A

Stall blood in Left atrial appendage
Clot moves from L Atrium to L ventricle

Afib patients have 5 times greater risk
1 in 5 of all strokes can be due to Afib (20%)

Valvular heart disease
Patent Foramen Ovale
Usually attaches to a bifurcation point or narrowed vessel

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18
Q

Define intracerebral hemorrhage?
Where?
Cause?

A

Very fast neurological signs

within brain parenchyma or ventricular systems

Not caused by trauma
- Main cause is hypertension

19
Q

Define subarachnoid hemorrhage
Where
Cause

A

Where
- bleeding into subarachnoid space
- not related to trauma

Cause
- not related due to trauma
- aneurysmal rupture

20
Q

Define epidural and subdural hemotomas
Where
Cause

A

Where
- bleeding between the skull and dura
- outside of parenchyma
OR
- between the dura and the arachnoid mater

Cause
- result of trauma

21
Q

Epidural vs subdural hemotomas
Associated with Head fracture?
Which is worse?
Easier to diagnose?

A

Associated with Head fracture?
Epidural

Which is worse?
Subdural

Easier to diagnose?
Epidural

22
Q

How many % of patients die who have a stroke

Ischemic vs hemorrhagic?

A

15%

15% vs 30%

23
Q

What % recover completely from stroke?

A

10%

24
Q

Which gender is more likely to get a stroke? at what age is the spike?

A

Men
65+

25
Q

T/F stroke is not the leading cause of adult disability

A

False

26
Q

What is FAST for clinical presentation? What to ask patients?

A

Face drooping
- ask person to smile

Arm Weakness
- Ask person to raise both arms

Speech Difficulty
- ask person to repeat a simple phrase

Time to call 911

27
Q

What are signs and symptoms of stroke

A
  • Weakness on one side of body
  • numbness or tingling (face, arm, leg)
  • Trouble speaking/understanding
  • Vision problems, double vision, especially in one eye
  • Dizziness, losing balance
  • Neurological deficit: slurred speech, paralysis, blindness

Some patients: headache, vomiting, seizures, ECG abnormalities, stiff neck

28
Q

What are signs and symptoms of hemorrhagic stroke?

A

Similar to stroke but more severe

29
Q

What features are associated with anterior cerebral artery stroke (4)
Examples

A

Sensorimotor deficits (in the contralateral foot/leg)

Urinary incontinence

Language disturbaces
- dysarthria (unclear speach)
- Mutism (speaking in whispers)

Behavioural disturbances
- abulia (no reflex)
- distractibility
- mood changes

30
Q

What are features of middle cerebral artery stroke (most common in M1 and M2) in the M1

A

Hemiplegia: (paralysis, droopy)
Hemiaanesthesia: Loss of sensation
Hemianopia: visual field loss on same side of both eyes
Deviation of head and eyes to side of the lesion
Dystharia: slurred/slow speach (if Left hemisphere

31
Q

What are features of posterior cerebral artery stroke (3)

A

Mainly visusal fields
- homonymous Hemianopia
- partial or complete vision loss

Anomia: inability to name objects but can describe them

Memory loss (long or short-term) due to temporal lobe

32
Q

What are non-modifiable risk factors of ischemic stroke? (5)
Compare the features to likeliness

A

Age (doubling every 10 years after 55)
Race (Black > hispanics > Whites)
Sex (males > females)
Low birth weight (2.5kg)
Family history of stroke (paternal > maternal)

33
Q

What are modifiable risk factors (12)

A

Diabetes
Dyslipidemia
HTN
Smoking
CVD (CAD, HF, PAD)
Afib
Asymptomatic cartoid stenosis
Sickle cell disease
Diet factors (Na <2300mg/day, K < 4700mg/day)
Obesity
Physical inactivity
Postmenopausal hormone therapy

34
Q

What is the RRR of physical activity in stroke

A

40%

35
Q

How much does having HTN increase chance of getting stroke? How much does HTN control reduce stroke by?

A

If you have HTN, 3x higher risk of stroke

HTN control reduces risk of stroke by 60%

36
Q

What do the composite of all 10 risk factors control mean in stroke?

A

Contributes to 90% of overall risk of stroke
- 90% RRR

37
Q

What does the NIHSS (national institute of health stroke scale) measure?

A

Predictive of long-term outcomes post-stroke
7-day outcome
- 11 item scale
- maximum score 42

38
Q

What does the TIA-ABCD2 score help predict?

A

Helps predict recurrence of stroke post TIA (<24 hours of symptoms)

39
Q

What are brain imaging useful for? (4)

A
  • differentiating between ischemia vs hemorrhage
  • rule out stroke mimics (i.e tumour)
  • Assess status of large intracranial arteries
  • guide acute treatment
40
Q

When are the following used?
CT
CT angiography
MRI
Carotid Doppler

A

CT (computed tomography):
- readily accessible
- preferred when ruling out hemorrhage

CT angiography:
- used to locate a clot in large intracranial vessels

MRI (magnetic resonance imaging):
- NOT readily accessible, provides higher-res images than CT

Carotid doppler:
- to find clots in carotid artery (CT is preferred - more sensitive)

41
Q

Differentiate between ECG, Holter monitoring and echocardiogram

A

ECG:
- identify abnormal rhythm in a snapshot of time

Holter monitoring:
- identify abnormal rhythm over a period of time

Echocardiogram:
- visualize heart chambers and valves to rule out clots

42
Q

What are differential diagnosis of stroke (8)

A
  • Todd paralysis (post-seizure)
  • Brain abscess
  • Herpes simplex encephailitis
  • Hypoglycemia
  • Brain tumor
  • multiple sclerosis
  • Migraine
  • Conversion disorder
43
Q

What are goals of therapy with stroke (4)

A
  1. Minimize brain damage
  2. Prevent complications from stroke eg. pneumonia, VTE
  3. Reduce risk of recurrence
  4. Restore function and minimize long-term disability
44
Q

What is the purpose of neuroimaging (4)

A
  • Allows for differentiating between ischemia and hemorrhage
  • Rule out stroke mimics (tumour)
  • Assess status of large intracranial arteries
  • Guide acute treatment

IPFC 4 Final (6 decks)

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