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Neuro 4 (sam > Stroke Pathophysiology > Flashcards

Stroke Pathophysiology Flashcards

1
Q

Risk Factors for stroke

A 
Untreated atrial fibrillation 
hypertension
smoking
hyperlipidemia
DM
TIA
Previous stroke
Heavy Alcohol consumption
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2
Q

What is a TIA?

A

A small neurological event with symptoms that last less than 24 hours

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3
Q

What is the common cause of a TIA?

A

embolism or stenosis-related hypoperfusion

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4
Q

What percentage of people who experience a TIA will have a stroke within 5 years?

A

35%

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5
Q

What percentage of strokes can be categorized as ischemic?

A

85%

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6
Q

What percentage of strokes can be considered hemorrhagic?

A

12%

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7
Q

Main cause of ischemia in large vessels?

A

Arteriosclerisis

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8
Q

Main cause of ischemia in medium vessels?

A

Embolic (24%)

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9
Q

Main cause of ischemia in small vessels?

A

Lacunar

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10
Q

Main cause of ischemia in the microcirculation?

A

amyloid deposits

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11
Q

Main cause of ischemia in border zone?

A

hypoperfusion

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12
Q

two main causes of hemmorrhagic stroke?

A 
subarachnoid hemmorhage (3% of total)
Intracerebral hemorrhage (9% of total)
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13
Q

What branch of cerebral circulation is the cause of 90% of all strokes?

A

Middle Cerebral Artery

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14
Q

Biggest cause of stroke in america?

A

Untreated atrial fibrillation

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15
Q

What effect does rate of an ischemic stroke have on outcome?

A

The brain tolerates a shorter ischemic incident better than a longer incident. However an ischemic event that develops slowly over a long period of time has a chance for collateral circulation to develop

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16
Q

How does coagulation affect progression/extent of ischemic injury?

A

any hypercoagualbe state increases the extent and progression of micro thrombi, exacerbating vascular occlusion

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17
Q

How does temperature affect progression/extent of ischemic injury?

A

Higher temperature is associated with greater ischemic injury

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18
Q

How can glucose affect progression/extent of ischemic injury?

A

both hypo and hyperglycemia have negative effects on progression of ischemic injury

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19
Q

Normal cerebral blood flow levels?

A

50-60 mll/100gm/minute

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20
Q

What happens to the vasculature during an ischemic event?

A

In response to moderate ischemia, there is vasodialation and opening of collaterals to increase the extraction of oxygen and glucose from blood

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21
Q

What happens when cerebral brain flow falls below 20 ml/100gm/min?

A

Electrical silence ensues and symaptic activity is greatly diminished in an attempt to preserve energy stores

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22
Q

What is the area called when the Cerebral blood flow is below 20 ml/100gm/min?

A

the Pneumbra

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23
Q

What happens when the cerebral blood flow is less than 10 ml/100gm/min?

A

irreversible neuronal injury. This area is called the ischemic core

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24
Q

What is the window of opportunity?

A

Up to 3 hours after the original incident where the neurological deficits created by the ischemia can be partly or completely reversed by reperfusing the ischemic tissue.

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25
Q

What kind of metabolites accumulate after neurons are injured?

A

Lactic acid, glutamate, aspartate.

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26
Q

What effect do metabolites have on nearby neurons?

A

Noxious metabolites from injured neurons can injure adjacent healthy neurons

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27
Q

When does brain edema peak?

A

48-72 hours post onset

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28
Q

What type of infarcts are more likely to develop edema?

A

Large infarcts

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29
Q

How does brain edema happen?

A

The blood brain barrier breaks down and blood vessels become leaky

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30
Q

What is excitotoxicity?

A

an inflammatory cascade that eventually leads to cell death

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31
Q

What is dumped into the extracellular spaces in response to ischemia and injury and what does this result in?

A

glutemate, which results in the opening of calcium channels and Ca to rush into the cell

32
Q

What does the flood of calcium cause?

A

activates a series of destructive enzymes resulting in the loss of integrity of cell membrane.

33
Q

What does the flood of Ca trigger during excitotoxicity?

A

It triggers an inflammatory cascade and eventual cell death

34
Q

What is apoptosis?

A

programmed cell death

35
Q

How long after ischemic injury do apooptotic mechanisms begin?

A

within 1 hour

36
Q

What happens to blood vessels distal to the occlusion in an ischemic injury?

A

They become fragile and injured

37
Q

What is a red infarct?

A

When the occluding embolus either lyses spontaneously or breaks apart and migrates distally, restoring CBF which can result in conversion to a hemorrhagic stroke

38
Q

What are the three factors associated with a red infarct?

A

size of infarct (bigger, greater possibility)
Richness of collateral circulation (more collaterals, less chance)
use of anticoagulants (increases risk)

39
Q

Where dies atherosclerosis most often happen?

A

In the bifrucation of larger vessels (carotids, veterbrals, basilar)

40
Q

What is the cascade of events on atherosclerosis that leads to a potential ischemic event?

A 
damage to vessel wall
platelets congregate
thrombogenesis
plaque formation
thrombus and smooth muscle proliferation
blockage
41
Q

When is blockage of a large vessel considered significant?

A

> 70% blockage

42
Q

What sound can stenosis cause?

A

Bruits, a swishing sound which actually can cause more damage

43
Q

How can you assess for stenosis?

A

MRA and Doppler

44
Q

What can you use as a prophylaxsis for stenosis?

A

asprin

45
Q

What is the most common pathology that effects medium vessels?

A

Embolism, mostly affecting cerebral arteries

46
Q

What is the most common source of embolism?

A

the heart

47
Q

What is the most common cause of embolism?

A

atrial fibrillation

48
Q

What is A fib usually treated with and why?

A

Routinely treated with anticoagulation therapy because embolus formation is so common

49
Q

What is the prognosis with blockage of proximal vessel?

A

poor prognosis. can result in devastating impairments

50
Q

What is the most common cause of small vessel disease?

A

Lacunar, with changes in the intima and lipofusion deposits

51
Q

What is small vessel disease associated with?

A

hypertension and diabetes

52
Q

What areas does small vessel disease usually effect?

A

deep white matter area (including internal capsule)

53
Q

What type of deficits does small vessel disease usually produce?

A

isolated deficits

54
Q

What is the most common pathology seen in microvessel disease?

A

Amyloid deposits in arterioles and capillaries

55
Q

In what patients is microirculation disease most commonly present?

A

Patients with dementia or parkinsons

56
Q

What is a hypoperfusion stroke also called?

A

Watershed or borderzone stroke

57
Q

What is a hypoperfusion stroke?

A

Happens with pump failure (either MO or major blood loss)

58
Q

What is affected with a hypoperfusion stroke?

A

distal territory of each cerebral artery.

shoulder>leg>hand/face

59
Q

What are three treatments for an ischemic stroke?

A

tPA
Stents
Intra-arterial clot retrieval

60
Q

What is the timeframe when you can safely administer tPA?

A

up to 3 hours of witnessed stroke

61
Q

What is the risk of tPA?

A

conversion to hemorrhage

62
Q

What are the two types of aneurysms?

A

Berry

Charcot Bouchard

63
Q

What is a Berry?

A

Congenital weakness of vessel wall at branching pont

64
Q

WHere do most Berry aneurysms happen?

A

85% form on the anterior halfo f the circle of willis (subarachnoid)

65
Q

Where is a Charcot Bouchard aneurysm found?

A

found on penetrating vessels (inside brain)

66
Q

What type of hemorrhage does a burst aneurysm (Charcot Bouchard) produce?

A

primary intracerebral hemorrhage

67
Q

What is the prognosis if a burst hemorrhage is resorbed?

A

prognosis may be good. Usually better than the prognosis of ischemic stroke of same magnitude

68
Q

What affect does blood have on the brain?

A

It is damaging due to the iron in blood

69
Q

What usually causes a subarachnoid hemorrhage?

A

Cerebral artery on surface of brain

70
Q

What is a subarachnoid hemorrhage usually described as?

A

Worst headache of my life

71
Q

What are the two methods of treating aneurysms?

A

Coils or clips

72
Q

What are the two clinical scales to evaluate hemorrhages?

A

Hunt and hess-based on symptoms and function

Fischer-based on imaging

73
Q

What is an intraparenachymal hemorrhage?

A

When there is a bleed into substance of brain

74
Q

What is an A-V malformation?

A

Direct connect between arteriole and venule which increases risk for hemorrhage because of increased pressure on veins

75
Q

What is a dissecting aneurysm the result of?

A

Results from trauma to the vessell wall ie whiplash, coughing, wrestling, strangulation

76
Q

Where does the bleeding occur with a dissecting aneurysm?

A

between the layers of the arterial wall

77
Q

What affect does the clot have after a dissecting aneurysm?

A

It occupies space and potentially occludes the lumen of the vessel.

Neuro 4 (sam (7 decks)

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