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Neuro II: Test 2 > Strokes! > Flashcards

Strokes! Flashcards

1
Q

2 major types of strokes?

A
  1. hemorrhagic = 15%
  2. ischemic = 85%
    - large artery thrombosis: d/t atherosclerosis and ischemia of the vessel- often internal carotid
    - embolic stroke
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2
Q

embolic stroke

A

types:
- from atherosclerotic plaque
- from thrombus

source:
1. heart: (often blood stasis –> thrombus formation)
- atrial fib, atrial septal aneurism, atrial myxoma,
- ventricular source: cardiomyopathy, MI, ventricular aneurism
- rheumatic mitral stenosis
- prosthetic valves
- endocarditis
- bicuspid aortic valves

  1. artery
    - carotid artery atherosclerosis/stenosis causes 5% of strokes
  2. lower extremity DVT w/ paradoxical emboli
    - d/t atrial septal defect
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3
Q

lacunar infarct

A

d/t HYPERTENSION!

  • may be b/c of atheroemboli or lipohyalinosis
  • affects SUBCORTICAL areas of brain that are supplied by small deep penetrating arteries that arising from the big arteries:
  • 15-25% of ischemic strokes
  • often asymptomatic
  1. lipohyalinosis:
    High pressure of large arteries transmitted to small arteries
    Hyperplasia of small vessel walls
    Hyalinization of the vessel walls
    Narrowing and then occlusion of the lumen
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4
Q

watershed infarcts

A

occur at area b/w MCA-ACA when BP drops: i.e. sepsis, bloodloss, dehydration

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5
Q

hypercoagulable disorders

A

Most of them cause venous clotting more than arterial clotting due to slower venous flow

Factor V Leiden mutation (most common) - the Leiden variant of factor V cannot be inactivated by the anticoagulant protein activated protein C, so clotting is encouraged

Protein C deficiency
Protein S deficiency
Antithrombin deficiency
Plasminogen deficiency
Prothrombin gene mutation
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6
Q

disorders more likely to cause arterial clotting?

A

Antiphospholipid antibody syndrome:

  • Anticardiolipin antibodies (ACA)
  • Lupus anticoagulants (LA)

Hyperhomocysteinemia

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7
Q

cocaine use?

A

causes SA bleeding and vasospasm stroke

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8
Q

hemiparesis

A

weakness of one side of the body

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9
Q

hemiplegia

A

– complete paralysis of one side of the body

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10
Q

Acalculia

A

difficulty to perform simple math tasks

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11
Q

Agnosia

A

inability to recognize objects, persons, sounds, shapes, or smells

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12
Q

Aphasia

A

inability to speak (motor or sensory)

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13
Q

Alexia

A

inability to read

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14
Q

agraphia

A

inability to write

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15
Q

dysphagia

A

inability to swallow

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16
Q

dysarthria

A

slurred speech

17
Q

Hemispatial Neglect

A

inability to attend to one side of the body or visual field

18
Q

Apraxia

A

– inability to perform a specific task

19
Q

Anosognosia

A

unawareness of or denial of the existence of disability

20
Q

Anomia

A

difficulty with recalling words or names

21
Q

ataxia

A

unsteady gait

22
Q

MCA syndrome

A

MCA supplies face portion of homunculus ** most common type **

  1. Motor Cortex + Sensory Cortex: upper limb and face
    - Contralateral hemiplegia/sensation loss (sometimes in face and upper extremity only)
    - Contralateral Homonymous Hemianopsia
  2. Temporal Lobe (Wernicke’s)
    and frontal lobe (Broca’s)
    - Dominant hemisphere: (usually left)
    Aphasia, alexia, agraphia, acalculia, finger agnosia, and right-left confusion.
    - Non-dominant side (usually right):
    hemineglect, dressing apraxia, anosognosia, and constructional apraxia
23
Q

ACA syndrome

A

anterior cerebral artery supplies the exremities portion of homunculus

motor cortex and sensory cortex: results in contralateral paralysis and loss of sensation of lower extremity

24
Q

PCA syndrome

A

posterior cerebral artery supplies the occipital and visual cortex

  1. Contralateral Homonymous hemianopsia
  2. Alexia without agraphia**
  3. Visual or color anomia
25
Q

lenticulostriate artery stroke

A

supplies striatum and IC — common location of lacunar infarcts secondary to unmanaged HTN

** contralateral hemiparesis/hemiplegia **

26
Q

AICA syndrome

A

“lateral pontine syndrome”
** facial nucleus most affected**

Lateral pons - CN nuclei VIII, VII, V:

  • ** paralysis of face** = “facial droop”
  • ** loss of ipsilateral pain/temp on face and contralateral pain and temp of body **

Middle and inferior cerebellar peduncles: ataxia and dysmetria of arm and leg

27
Q

PICA syndrome

A

= “lateral medullary syndrome” = “wallenburg syndrome”

Lateral medulla: vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguous, sympathetic fibers

  • decreased pain and temp from ipsilateral face and contralteral body
    • dysphagia, hoarseness, decreased gag reflex**
    • Horner’s syndrome **
  • ataxia, dysmetria
  • nystagmus, vertigo, hiccups
28
Q

basilar artery strokes

A

pons, medulla, lower midbrain, corticospinal and corticobulbar tacats, ocular CN nuclei

** results in locked in syndrome ** - have preserved consciousness, blinding, quadriplegia, loss of voluntary facial, mouth and tongue mvmts

29
Q

ASA

A

“medial medullary syndrome” - though its often b/l

  1. provides lateral corticospinal tract:
    - results in c/l hemiparesis of upper and lower limbs
  2. provides medial lemniscus:
    - decreased contralateral proprio
  3. caudal medulla - hypoglassal nerve
    - ipsilateral hypoglossal dysfunction, tongue deviates ipsilaterally (points to bad side! d/t collapse on other side of mm.)
30
Q

ventral pontine syndromes:

A

= basilar artery strokes

Ventral pontine syndrome (Raymond Syndrome)
Lateral gaze weakness
Contraletaral hemiplegia

Ventral pontine syndrome (Millard-Gubler Syndrome)
contralateral - upper and lower extremity weakness
Ipsilateral facial weakness

31
Q

amaurosis fugax

A

Transient mono-ocular blindness (in one eye)

Often warning sign of an impending stroke !!

Several causes:

  • Embolic (most often from carotid artery of the same side)
  • Hemodynamic
  • Ocular
  • Neurologic
  • Idiopathic
32
Q

TIA

A

“ministroke”

  • sx are same as the stroke but they only last 24 hours or less!
  • 15-40% result in infarcts and 10% of patients have the risk of CVA w/in 3 months!
33
Q

ddx and tx of stroke?

A

Always first do CT: rules out hemorrhage

Acute tx of stroke:

  • rtPA clot buster (only after CT)
  • aspiring
  • IV fluids
  • keep BP maintained
34
Q

Stroke vs Bell’s palsy

A

Stroke= ischemia of cortex = often only results in lower portion of face losing motor control (d/t c/l unilateral innervation), but can wrinkle upper forehead (b/c its innervated bilaterally)

Bell’s Palsy = loss of CN VII = ipsilateral facial weakness= “one sided facial droop” affects both upper and lower portion of face

35
Q

stroke risk factors? stroke prevention meds?

A

Age. Risk doubles with each decade after 55

Heredity (Family history)

Race
African Americans and Hispanics higher than Caucasians

Gender
More men has strokes in a given year in each age group
More than half of total stroke deaths occur in women

Personal h/o TIA, CVA, MI, any atherosclerosis

modifiable risks:

  • HTN, A fib, smoking, DM, carotid stenosis, hyperlipidemia
  • obesity, alcohol
stroke prevention meds? 
Antiplatelets agents
- Aspirin
- Clopidogril (Plavix)
- Aspirin/dipyridamole (Aggrenox)

Anticoagulation agents

  • Warfarin (Coumadin)
  • Heparin and LMWH
36
Q

main cause of lacunar strokes?

A

HTN!!!

Neuro II: Test 2 (11 decks)

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