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Clinical Neuropsych > Week 2 lecture 1- Vascular disorders > Flashcards

Week 2 lecture 1- Vascular disorders Flashcards

1
Q

Stroke

A

› Insufficient blood flow to maintain neurological
function
 Because arteries leading to the brain are blocked or ruptured
 Brain does not receive sufficient oxygen supply
 Producing cell death (irreversible) or cell damage (penumbra)

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2
Q

TIA- Transient Ischaemic attack

A

Artery is blocked
Same symptoms as stroke but temporary (less than 24 hours)

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3
Q

Penumbra

A

Zone of reversible infarction around core of irreversible infarction
Saving the penumbra is the goal of emergency stroke care
After 8 hours its more difficult

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4
Q

Types of stroke

A

A stroke is a CVA (Cerebrovascular accident)
-Ischaemic (infarction) 80%
-Haemorrhage (rupture) 20%
 intracerebral (within brain)
 extracerebral (outside brain)
-Lacunar infarct
 Small infarcts (<2cm) in deeper parts of brain (basal ganglia, thalamus, white matter) and in brain stem
 Caused by occlusion of a deep penetrating artery
 Account for 20% of all ischemic strokes
 Most common cause: atherosclerosis, often associated with hypertension (raised blood pressure)
 Usually better prognosis than for larger ischaemic stroke
-Silent stroke
 Brain injury of vascular origin on neuroimaging but not associated with symptoms
-Border zone infarcts
 Aka watershed cerebral infarcts
 At the border between the vascular territories (so in
the small branches at the ends of the arteries)
 Due to severely reduced blood
pressure/hypoperfusion (e.g. cardiac arrest)

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5
Q

Psychological consequences of stroke

A

ASPECIFIC (Global)
-related to integral functioning of the brain
-not specific for stroke
-Lack of attention and awareness
-Memory, attention, speed of processing

SPECIFIC
-related to specific location and hemisphere (more or less)
-relatively specific for stroke
-apraxia, agnosia, neglect, aphasia

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6
Q

Arteria cerebri anterior

A

-Frontal lobe
-Medial parietal lobe
-Deep frontal structures

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7
Q

Arteria cerebri media

A

-Part of temporal lobe
-Large part lateral parietal lobe
-Basal ganglia
-Part frontal lobe

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8
Q

Arteria cerebri posterior

A

-Occipital lobe
Ventral/inferior part temporal lobe
-Large part thalamus and midbrain

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9
Q

ipsilateral and contralateral

A

ipsilateral- same side
contralateral- opposite side

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10
Q

Definition of major neurocognitive disorder

A

-Significant cognitive decline from a previous level of performance
-Significant decline in cognitive function
-Substantial cognitive impairment
-Cognitive deficits interfere with independence in everyday activities

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11
Q

definition of Mild neurocognitive disorder

A

-Modest cognitive decline from a previous level of performance
-Mild decline in cognitive function
-modest impairment in cognitive performance
Cognitive deficits do not interfere with independence in everyday activities

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12
Q

DSM specifies 6 neurocognitive domains:

A
  1. Complex attention
     sustained attention
     divided attention
     selective attention
     processing speed
  2. Executive function
     planning
     decision making
     working memory
     responding to feedback/error correction
     overriding habits/inhibition
     mental flexibility
  3. Learning and memory
     immediate memory
     recent memory [including free recall,
    cued recall, and recognition memory]
     very-long-term memory [semantic; autobiographical]
     implicit learning
  4. Language
     expressive language [including naming, word finding,
    fluency, and grammar, and syntax]
     receptive language
  5. Perceptual-motor
     includes abilities subsumed under the
    terms visual perception,
    visuoconstructional, perceptual-motor,
    praxis, and gnosis
  6. Social cognition
     recognition of emotions
     theory of mind
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13
Q

Neuropsychological consequences of stroke

A

-Over 50% of people show deficits in cognitive
functions, behavior, and/or emotions after stroke
- Around 50% of people experiences depression after stroke
-Around 50% of people still experiences fatigue 2 years after stroke

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14
Q

Aims of neuropsychological assessment

A

 Screening for presence of neuropsychological deficits
 Examine neuropsychological profile
(strengths/weaknesses)
- Understanding (patient, relatives, professionals)
- Explaining why certain activities are hard
- Advice for rehabilitation options
 Measuring progress

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15
Q

Stages of neuropsychological assessment

A

› Acute stage (days)
› Rehabilitation stage (months)
› Chronic stage (years)

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16
Q

Acute stage of neuropsychological assessment

A

Extensive NPA not useful (unstable situation, takes too much effort)
 Advice: behavioral neurological screening, derive influence of cognitive deficits on daily life from observations (from therapists/nurses)
 Advice: MOCA (MMSE not sensitive enough)

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17
Q

Rehabilitation stage of NPA

A

Advice: at least brief NP screening according to guidelines NIP

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18
Q

Chronic stage of NPA

A

Screening for neuropsychological deficits still useful

19
Q

Core set of neuropsychological screening tests

A
  • Boston Naming Test (15-item versie)
  • 15 Word Test
  • Star Cancellation- Fine motor skills, neglect, visuospatial attention
  • TMT-A and TMT-B
  • Fluency (Animals, DAT)
20
Q

Subarachnoid haemorrhage

A

Burst of an aneurysm, expelling blood at high pressure into subarachnoid space around the brain
Sensation of being hit on the head and an exploding headache

21
Q

Causes of SAH

A

Traumatic: Head trauma
Non-traumatic:
-Burst of aneurysm
-Haemorrhage from AVM (Arteriovenous
malformation)
-Tumor
-Infections

22
Q

Treatment of SAH

A

Coiling: Filling up aneurysm with a wire
-Reduces pressure in aneurysm
-does not require neurosurgery but often the aneurysm is not fully occluded
-holds the best promise for the future
Clipping: Cuts off blood flow to the aneurysm
- Prevents bursting
-Much more invasive, requiring opening the skull and major neurosurgery
-high success rate in permanently occluding the aneurysm

22
Q

AVM-Arteriovenous malformation

A

Blood passes quickly from artery to vein, bypassing the normal capillary network

23
Q

Large brain

A

cerebrum

24
Q

small brain

A

cerebellum

25
Q

SAH damage may be the result of

A

 Blood around or inside the brain (hematoma)
 Hydrocephalus: increase intracranial pressure
 Surgery following the SAH
 Vasospasm: arteries go into spasm in
reaction to blood around them, may result in ischemia (loss of blood and oxygen)

26
Q

Acute symptoms of SAH

A

› Sudden onset of severe headache (often described as “worst headache of their life”)
› Popping or snapping sensation in head
› Nausea and vomiting
› Stiff neck
› Transient loss of vision or consciousness
› Seizures

27
Q

Neuropsychological consequences of SAH

A

› Vary from person to person
 Diffuse damage by blood spread around/in the brain or hydrocephalus
 More localized damage by vasospasm/ischemia or surgery
- More than half of victims die or become demented

28
Q

Psychosocial consequences of SAH

A

 Fatigue
 Lack of initiative, less interested, decreased self-confidence, anxiety, depression, irritability, headache,
lowered libido, sensitive to noise, attention/concentration problems

29
Q

Damage in cerebellum can lead to

A

 Cerebellar ataxia (disturbed balance and coordination)
 Ataxic dysarthria (badly articulated speech)
 Action or intention tremor
 Nystagmus

30
Q

UIA-Unruptured intracranial aneurysms

A
  • Identified during brain imaging and angiography following a SAH resulting the rupture of another aneurysm
  • Also occasionally found in nonsymptomatic adults who have undergone an MRI of the brain to screen for some unrelated problem
  • Controversial whether or not to treat them
31
Q

Spontaneous SAH

A

Rare form of stroke that usually occurs in previously healthy people
Most victims in 45-60 year age group, although it can occur at any age
Both sexes can suffer, but studies show that more women are affected than men

32
Q

Risk factors for rupture of cerebral aneurysms

A
  • Cigarette smoking
  • History of treatment for hypertension in addition to smoking (increased risk even further)
  • Other studies failed to find a find an association between hypertension and aneurysmal SAH
  • Clinical impression: Sudden rise in intracranial pressure (caused by sneezing, coitus, defacation), a transient rise in blood pressure associated with physical strain, sudden emotional shock
  • Many moderately stressful events or one extremely stressful event precede SAH much more frequently than hospitalization for illnesses such as orthopedic or skin problems
33
Q

Steps in SAH

A
  • Aneurysm ruptures
  • Blood is expelled under high pressure
  • Disperses around the brain in the space between the pia mater and the next covering, the arachnoid matter
  • Cerebrospinal fluid produced by the choroid plexus lying in the ventricles flows out into the subarachnoid space
  • Therefore, when an aneurysm ruptures into the subarachnoid space red blood cells are usually found in the CSF when a lumbar puncture is formed
34
Q

Pia mater

A

Fine covering that clings to the brain

35
Q

Arachnoid mater

A

Blood vessels within it give it a spidery appearance

36
Q

Subarachnoid space

A

Space between the pia mater and arachnoid mater, also communicates with subarachnoid space around the spinal cord

37
Q

Diagnostic signs of SAH

A
  • Red blood cells found in the CSF when a lumbar puncture is formed
  • Sudden and severe headache
  • Stiff neck caused by an inflammatory response to the blood around the base of the brain and spinal cord
  • Confirmation of an aneurysm in one of the arteries
38
Q

How an aneurysm is visualised

A
  • Using MRI angiography (MRI is used to visualise the arteries)
  • More invasive technique- Angiography
    o Injecting a radioactive die into vessels of the brain
    o Taking radiographs as the dye moves through the vessels, showing up their outlines
39
Q

Surgical treatment of SAH

A
  • 3-4 hour operation is performed under general anesthetic
  • Skull and dura are opened and the brain gently retracted to allow the surgeon to trace the artery back to the aneurysm
    o Dura: tough covering on the outside of the brain beneath the skull)
  • A small metal clip is placed over the neck of the aneurysm
  • Once this is done, there is almost no chance that the aneurysm will bleed again, and the patient is therefore “cured”
40
Q

Sometimes decision made not to treat aneurysm because:

A

o Patient too sick or very old
o Aneurysm is in a position that would be impossible to reach

41
Q

ischemic stroke

A

area of dead or damaged neural tissue

42
Q

hydrocephalus

A

The exit to the lateral ventricles is blocked by blood, causing the ventricles to dilate, thus increasing the pressure inside the head
-usually corrects spontaneously over time
-when it doesn’t a shunt is placed into the ventricle: allows CSF to drain safely into the abdominal or heart cavity

43
Q

SAH scale

A

Takes into account how alert and oriented the patient is and whether she has any neurological deficits such as hemiplegia or language difficulty
Reflects the severity of the hemorrhage
Also indicates complications after surgery

Clinical Neuropsych (10 decks)

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