Stroke Recovery

Question 1

What is primary prevention?

Answer 1

Steps taken to reduce the risk of stroke by controlling/reducing the person’s risk factors

Question 2

What is acute treatment?

Answer 2

Intervention in the light of stroke e.g. ischaemic stroke would lead to thrombolysis (tPA)

Question 3

What is secondary prevention?

Answer 3

Used after stroke occurrence to reduce further risk and to restore functionality

Question 4

Neural repair is most effective when what three things are present

Answer 4

1. Neuroplasticity
2. Behavioural activity/neurorehabilitation
3. Drug and cell-based therapies

Question 5

What is neuroplasticity/neurogenesis?

Answer 5

Restoration of the neuronal network

Question 6

Name two brain areas where neurogenesis takes place

Answer 6

Subgranular zone (SGZ) of the dentate gyrus

Subventricular Zone (SVZ)

Question 7

Neural stem cells proliferate into neural precursor cells and then do what four things?

Answer 7

1. Perpetuation
2. Differentiation - into glial cells (astrocytes, oligodendrocytes and microglia) and neurones
3. Integration - integration with other parts of the body
4. Migration

Question 8

Neurogenesis: Subgranular Zone (SGZ) of the dentate gyrus

• Where do the neural stem cells proliferate?
• Where do they migrate to?

Answer 8

1. In the SGZ of the hippocampal dentate gyrus

2. Migrate to the inner granule cell layer in the hippocampal dendate gyrus

Question 9

Neurogenesis: Subventricular Zone (SVZ)

- What is the route taken for neural progenitor cells?

Answer 9

1. SVZ to olfactory bulb via the rostral migratory stream (RMS) = migrate laterally towards the damaged area

Question 10

Name the three processes which take place in angiogensis

Answer 10

1. Vascular endothelial growth factor (VEGF)
2. VEGFR2 (in all endothelia)
3. Results in angiogenesis needed in repair

Question 11

Which CNS cell types contribute to CNS renewal?

Answer 11

Microglia

Question 12

What happens in primary activation of microglia?

Answer 12

Change to M1 phenotype

- Bring about neurotoxic effects involved in tissue injury

Question 13

What happens in delayed activation of microglia?

Answer 13

Change to M2 phenotype

- Causes tissue repair due to immune suppression

Question 14

A glial scar has two properties. What are these?

Answer 14

Neurotoxic

Neuroprotective

Question 15

Describe the neurotoxic effects of a glial scar

• Cells involved?
• What fails in this environment?
• What do the cells produce?
• What cell forms the glial scar?

Answer 15

Cells involved: microglia, oligodendrocytes and myelin debris

Axon regeneration fails and remyelination may also fail

Microglia produce: free radicals, nitric acid and arachidonic acid derivatives

Scar is formed by astrocytes

Question 16

Describe the neuroprotective effects of the glial scar

Answer 16

Forms a barrier between the glial reaction (apoptotic site) and healthy tissues

–> prevents further damage to the brain

Question 17

Name four possible risk factors in stroke

Answer 17

1. Hypertension
2. Atrial Fibrillation
3. Diabetes
4. Hyperlipidaemia