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P&T 2 > Strokes and Vasculitis > Flashcards

Strokes and Vasculitis Flashcards

1
Q

Stroke (S)

A

When the blood supply to the brain is disrupted, leading to brain cell damage or death. It is a medical emergency that requires immediate attention.

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2
Q

Stroke Epidemiology

A

Stroke risk increases with age but one-quarter of all strokes occur before the age of 65.
Risk doubles every 10 years after 55
Stroke is the third most common cause of death (11% of all deaths in the UK) and the leading cause of adult disability worldwide.

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3
Q

Stroke anatomy

A

Majority of blood arrives through int carotid arteries
These supply to a circle of Willis
Brain receives smaller amounts of blood through vertebral arteries which run up the vertebral column and connect to basilar artery (feeds into circle of Willis)
Circle of Willis can be thought of as functioning like a distribution hub with multiple vessels emerging which supply different lobes of brain.

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4
Q

3 areas that can be affected:

A

80% of all strokes occur within the hemispheres - why they present with one sided body symptoms
10% can occur at the brainstem can be fatal as it can shut down the respiratory, cardiac, vasomotor systems.
5% at the cerebellum - balance/gait problems

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5
Q

Frontal lobes

A

Location of somatic motor cortex which is responsible for
initiating conscious movement.
A CVA affecting the frontal lobes typically results in hemiplegia (paralysis down one side) Paralysis down the left side (left hemiplegia) indicates a CVA affecting the right frontal lobe and vice versa.

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6
Q

Parietal lobes

A

Location of somatosensory cortex which is largely responsible for the sense of touch.
A CVA affecting the parietal lobes typically results in hemiparesthesia (numbness/lack of sensation down one side)
A CVA causing a numbness down the right cheek or right arms (right hemiparesthesia) indicates a likely event in the left parietal lobe and vice versa

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7
Q

Occipital lobes

A

Location of visual cortex which is responsible for vision.
The left occipital lobe is responsible for the right hand field of view in each eye and the right occipital lobe the left hand field of view in each eye.
A CVA affecting the occipital lobes typically results in loss of visual acuity or blindness.
A CVA affecting the left occipital lobe would typically result in visual deterioration in the right hand field of view and vice versa.
Blindness that results in from damage to the occipital lobes of the cerebral cortex is referred to as cortical blindness.
Occipital lobe strokes can also be associated with problems in visual interpretation and can cause visual hallucinations.

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8
Q

Temporal lobes

A

Location of auditory cortex damage can result in auditory
deficits.
The temporal lobes are also essential to visual memory and the formation of long-term memory.
Significant deafness usually only occurs if damage to both temporal lobes occurs which is rare in CVA, Temporal lobe strokes can also lead to significant long term memory loss (amnesia) and personality changes.

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9
Q

Stroke causes

A

Disruption of blood supply can be caused by
1. Thrombus formation
2. Atherosclerosis
3. Large artery stenosis
4. Cardio-embolic stroke
4. Vasculitis
5. Hypo-perfusion
Carotid and vertebral artery dissection - Dissection accounts for around 1 in 5 strokes
Venous stroke - Only 1% of strokes are venous

Ischaemic- 85%- blood clot disturbs blood flow
Haemorrhagic- weakened blood vessel supplying brain bursts

RF:
Smoking
Vasculitis
CV disease- angina, MI
Diabetes
Hypertension
Atrial fibrillation

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10
Q

Stroke Patho

A

Arterial disease and atherosclerosis is the main pathological process causing stroke.

Without steady supply of oxygen and glucose, cells get an inc build up of sodium and calcium
Inc sodium= osmotic effect- causing cytotoxic oedema
Inc calcium= free radicals which react with lipids in mitochondria and lysosome membrane= apoptosis of cells–> immune cells damage blood-brain barrier (inc permeability)= vasogenic oedema

Swelling pushes into unaffected side- cingulate herniation or slips out of skull base= cerebellar tonsil herniation –> pushes onto brain stem= affects breathing and consciousness

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11
Q

Stroke S&S

A

Sudden weakness of limbs
Sudden facial weakness
Sudden onset of dysphasia (speech disturbance)
Sudden onset visual or sensory loss

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12
Q

Stroke Investigations

A

CT, MRI

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13
Q

Stroke Mangament

A

FAST
Immediate CT to exclude intracerebral haemorrhage, aspirin 300mg after CT for 2 weeks
Start secondary prevention measures for CV disease
Rehab involves multidisciplinary team
More than ¾ survive for a year over half survive more than 5 years

The death rate following stroke is 20–25%.

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14
Q

Left hemisphere stroke

A

Right handed weakness/paralysis
Speech impairment
Visual problem inability to see in right visual field
Impaired ability to do maths/analyse problems
Impaired ability to read and write

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15
Q

Right hemisphere stroke

A

Left handed weakness/paralysis
Visual problems in left visual field
Difficulty judging distance

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16
Q

4 Main types of stroke

A

TIA
Cerebral Thrombosis
Cerebral Embolism
Cerebral Haemorrhage

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17
Q

Ischaemic strokes

A

More common
Damage done dependent on location and time brain suffers from reduced blood flow.
TIA - If symptoms resolves within 24hrs
Cerebral Thrombosis
Cerebral Embolism

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18
Q

TIA

A

“mini-stroke” or a “warning stroke.” A TIA occurs when there is a temporary disruption of blood flow to the brain.

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19
Q

TIA Epidemiology

A

More common in older people, loss of neural tissue can lead to dementia

20
Q

TIA Patho

A

Temporary disruption to blood flow and tissue perfusion in brain
For stroke to be classed as TIA, symptoms must resolve within 24 hours
Often atherosclerosis in an artery or one of its branches that supplies oxygen to brain
Associated with stress in middle-aged/older adults

21
Q

TIA S&S

A

Variable dependent on which area of brain is affected
Commonly involves numbness down one cheek, arm or leg
Visual disturbance
Slurred speech
Temporary dizziness or loss of balance
Brief confusion or memory loss

22
Q

TIA Investigations

A

CT, MRI

23
Q

TIA Management

A

Aspirin and other platelet medicines
Platelets are blood cells that help clot blood, therefore this medicine helps reduce blood clots
Usually resolve rapidly
Generally blood supply restored and effects disappear
Can lead to micro-infarctions, where tiny amounts of brain tissue die leaving microscopic infarctions

Usually minimal long-term damage

24
Q

Cerebral Thrombosis

A

When a blood clot forms in the cerebral circulation
Frequently seen in people suffering atherosclerosis or clotting disorders.
Atherosclerotic occlusion - hardening of the arteries
Rupturing of plaque can trigger thrombosis by exposing the supporting collagen fibres that support the endothelium.

25
Q

Virchow’s triad

A

A collection of three factors which predispose to thrombosis
1) Hypercoagulable blood e.g. in pregnancy
2) Endothelial injury e.g. damage to the lining of a blood vessel due to smoking or poorly controlled diabetes mellitus
3) Circulatory stasis where blood flow slows and stops commonly as a result of immobility

26
Q

Cerebral Embolism

A

An embolus is a piece of solid material that is freely circulating in the blood, located in the cerebral circulation.

Most emboli are blood clots which have formed in another region of the of the body before detaching and becoming mobile.
More rarely emboli can come form pieces of fatty plaque which have detached form occluded blood vessels, bone fragments which have punctured into blood vessels following a bone fracture.

Common in atrial fibrillation, people with
hypercoagulable blood e.g pregnant women.

27
Q

Cerebral Haemorrhage

A

Occurs when a blood vessel ruptures.
Can occur as a result of head trauma
A major risk factor is hypertension which places the cerebral arteries under increased strain and lead to aneurysm that may eventually burst.
Berry aneurysms common in cerebral circulation,
particularly at the regions where arteries bifurcate.

When a cerebral haemorrhage occurs the BBB (blood brain barrier) is breached and toxic materials such as urea, uric acid or other soluble toxins in the blood can directly damage neural tissue within the brain.

Intracranial haemorrhage is the most common
Creates a pool of blood within the brain that causes damage and raises the inter-cranial pressure causing hypoxia.

28
Q

Vasculitis

A

Inflammation of blood vessels
Causes thickening which reduces width of passageway for blood
Can lead to organ/tissue damage due to reduced flow

29
Q

Vasculitis Patho

A

Exact cause of vasculitis is often unknown.
However, it is believed to result from an abnormal immune response that leads to blood vessel inflammation. Immune complexes (antibodies bound to antigens) can deposit in the vessel walls, triggering an inflammatory reaction.
In some cases, genetic and environmental factors may contribute to the development of vasculitis.

30
Q

Vasculitis S&S

A

Fever
Fatigue
Weight loss
Skin rashes or ulcers
Joint pain or swelling
Muscle aches
Nerve pain or numbness
Kidney problems (e.g., blood in urine, decreased urine output)
Respiratory symptoms (e.g., cough, shortness of breath)

31
Q

Vasculitis Investigations

A

Blood tests.
Ultrasounds, CT, or MRI to evaluate blood vessels and affected organs

32
Q

Vasculitis Management

A

Treatment of vasculitis aims to control inflammation, manage symptoms, prevent organ damage, and induce remission
Immunosuppressive drugs e.g., corticosteroids

33
Q

PMR

A

Chronic inflammatory disorder that primarily affects the muscles of the shoulders, neck and hips but a systemic condition, meaning it can affect the entire body.
It is most commonly observed in individuals over the age of 50, and it is more prevalent in women than men.
Muscle Pain - discomfort is often worse in the morning or after periods of inactivity.
Stiffness - morning stiffness, which can be severe and limit movement. It may take an hour or more for the stiffness to improve.
Fatigue
Depression

34
Q

PMR and its link to TA/GCA

A

Around 5-15 percent of those with PMR will go on to develop TA.
Nearly half of those who are first diagnosed with TA also have symptoms consistent with PMR.

35
Q

TA (S)

A

Inflammation of the blood vessels most commonly affecting the arteries within the scalp and the head

36
Q

TA Epidemiology

A

More common in individuals over the age of 50, with the highest incidence in people aged 70 or older.
The female-to-male ratio in GCA is roughly 3.7:1. Smoking increases the risk 6-fold in women.

37
Q

TA Patho

A

Two main causes: damaged endothelium and autoimmune disease.

1) Damaged endothelium:
Exposed collagen tissue and increased blood coagulation leads to weakened, damaged blood vessel walls which can cause aneurysms, vessels wall heals and stiffens as fibrin deposits.

2) Auto-immune Direct method:
Body mistakes endothelial layer of blood vessel for foreign pathogen.
Indirect method: immune system damages healthy cells near vascular endothelium causing inflammation.

The lining of arteries becomes inflamed, causing them to swell. This swelling narrows your blood vessels, reducing the amount of blood — and, therefore, oxygen and vital nutrients — that reaches your body’s tissues.

38
Q

TA S&S

A

one-sided headaches, especially around the temples
scalp tenderness
visual changes, such as temporary blurring, double vision, or blindness
jaw pain when eating
tiredness
loss of appetite
flu-like symptoms
fever
fatigue
facial, tongue, or throat pain

39
Q

TA Investigations

A

Blood tests - High ESR
Temporal artery biopsy
Doppler ultrasound or MRA

40
Q

TA Management

A

The primary goal of GCA management is to prevent complications, particularly vision loss, and control inflammation.
Vision loss occurs in 15% of patients.
Leads to death by stroke or MI in roughly 2% of cases
Corticosteroids

41
Q

Other types of Vasculitis

A

-Eisonophilic granulomatosis with polyangitis (Churg-Strauss Syndrome)
-Rheumatoid vasculitis
-Buerger’s disease
-Bechet’s
-Kawasaki disease
-granulomatosis

42
Q

Eisonophilic granulomatosis with polyangitis (Churg-Strauss Syndrome)

A

Affects small blood vessels. Mainly damage to vessels of the kidneys and lungs.
Mainly affects 30-50
Adult-onset asthma is the most common sign.
Sinusitis/cold-like symptoms, fever, muscle and Jt P, fatigue, lung and kidney damage

Churg-Strauss syndrome is rare and has no cure, controlled with steroids and other powerful immunosuppressant drugs.

43
Q

Rheumatoid vasculitis

A

Rare complication of rheumatoid arthritis (RA) in which the blood vessels become inflamed due to an autoimmune process. The blood vessels most often involved are arteries that bring blood to the skin, nerves, and internal organs.
Rheumatoid vasculitis most often occurs in people with at least 10 years of severe disease

44
Q

Buerger’s disease

A

Affects the medium blood vessels creating blood clots in the small arteries of the fingers and toes.
Males over 45.
Ulcers and dead tissues in extremities due to reduced blood flow.
o Closely linked to smoking

45
Q

Bechet’s

A

Affects all blood vessels.
Affects 20-30 year olds.
Causes mouth and genital ulcers.
Skin papules, decreased vision, headaches, fever.
Swollen joints affecting knees, wrists and ankles.
Can lead to strokes.

46
Q

Kawasaki disease

A

Affects medium blood vessels, coronary arteries serving the heart.
4 of 5 crash symptoms, prolonged high fever.
Mainly affects children under 5

47
Q

Granulomatosis

A

Inflammation of the small blood vessels. Mainly affects nasopharynx, lungs and kidneys.
Chronic pain, saddle nose deformity, breathing difficulties, ulcers with bloody coughing and increased blood pressure

P&T 2 (13 decks)

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