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PSY325 > Week 3 -Cerebrovascular Disorders and TBI > Flashcards

Week 3 -Cerebrovascular Disorders and TBI Flashcards

1
Q

What are the two main forms of stroke?

A

Ischaemic

Hemorrhagic

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2
Q

What are the two types of traumatic brain injury?

A

Closed head injury

Penetrative head injury

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3
Q

What are the two stages of brain damage?

A

Primary injury:
damage occurring at the time of the impact

Secondary injury:
secondary effects of physiological processes initiated by the primary injury

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4
Q

Angela is a victim of strangulation and develops brain damage due to a lack of oxygen. What is she suffering from?

A

Anoxia/ Hypoxia

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5
Q

How much normal cardiac output does the brain use?

A

15% of normal cardiac output

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6
Q

What are the two vessels involved in the arterial supply of blood to the brain?

A

Internal carotid arteries

Vertebral arteries

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7
Q

What are the main divisions of the internal carotid system?

A

Middle cerebral artery

Anterior cerebral artery

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8
Q

What are the main divisions of the vertebral-basilar system?

A

Basilar artery

Posterior cerebral arteries (PCA)

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9
Q

What combination of arteries, which is often compared to a ‘circle’ shape, is critical for cerebral blood flow?

A

Circle of Willis

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10
Q

What are the different kinds of obstructive (ischaemic) stroke?

A

Cerebral thrombosis

Cerebral embolism

Transient ischemic attacks (TIAs)

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11
Q

What are the different kinds of hemorrhagic strokes?

A

Aneurysm

Hypertensive hemorrhage

Arteriovenous malformations

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12
Q

What is a cerebrovascular accident (CVA)?

A

A vascular disorder that results in brain injury

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13
Q

What is ischemia in relation to strokes and related disorders?

A

Insufficient or lack of blood flow to the brain

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14
Q

What is an infarction?

A

tissue death due to inadequate blood supply

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15
Q

What is an infarct?

A

Area of damaged or dead tissue from infarction

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16
Q

What is a penumbra?

A

Tissue surrounding infarct which may recover or die

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17
Q

What is excitotoxicity?

A

Excess activity in glutamate signaling pathways (excitatory) (NMDA receptors) resulting in cell death

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18
Q

What is Oedema?

A

Swelling of brain

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19
Q

Dwight is in the office and all of a sudden, he experiences weakness/numbness of his face, arms, and leg on the left side of his body. He also has difficulty speaking and understanding, is dizzy, has a loss of vision, and a headache. What is Dwight experiencing?

A

A stroke

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20
Q

Dwight survives his stroke, however, it is unsure how well he will recover. What factors are involved in stroke recovery?

A

Type of stroke

Size of blood vessel

Remaining intact vessels

Premorbid factors

Location

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21
Q

What are the two main types of stroke?

A

Obstructive (ischaemic) stroke

Hemorrhagic stroke

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22
Q

Dwight’s stroke was caused by a fatty plaque that caused a blockage of a blood vessel. What kind of stroke did he have?

A

An obstructive (ischaemic) stroke

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23
Q

Stanley had a stroke which was a result of bleeding into brain tissue (or a rupture of a blood vessel), this was because there was a weakening or malformation in the vessel wall. What kind of stroke did Stanley have?

A

Haemorrhagic stroke

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24
Q

What can cause ischaemic strokes?

A

Thrombosis

Embolism

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25
Q

What is a thrombotic stroke?

A

It is an ischaemic stroke caused by the occlusion of a blood vessel by a thrombus (clump of cells/tissue), often arteriosclerosis plaque.

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26
Q

What is an embolic stroke?

A

An ischaemic stroke, caused by the occlusion of blood vessels by embolism which has broken off from thrombosis in a larger blood vessel (often from the peripheral circulatory system).

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27
Q

How long does it take for an ischaemic stroke to fully develop?

A

can occur suddenly, 30mins

30% of cases occur over hours/days

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28
Q

What is the recovery rate for obstructive (ischaemic) strokes?

A

80%

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29
Q

Where do most thrombotic strokes occur?

A

Internal carotid or vertebral basilar arteries

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30
Q

Strokes have _____ effects on function.

A

Unilateral

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31
Q

What are the unilateral effects of obstructive (ischaemic) strokes?

A

Hemiparesis

Hemiplegia

Aphasias (left)

Unilateral neglect (often right)

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32
Q

What is hemiparesis?

A

Weakness in the vertical half of the body

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33
Q

What is hemiplegia?

A

Complete paralysis of vertical half of body

  • At 1 month, most have perceptual deficits as well, typically to hemispace to the side opposite to the lesion
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34
Q

What are aphasias (left)?

A

Expressive/receptive language disorders

  • Speech fluency returns within one month, if at all
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35
Q

What is hemispatial neglect?

A

Failure to attend to space at the opposite side of the lesion following unilateral damage to the brain

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36
Q

What is a transient ischaemic attack?

A

An episode of temporary obstruction of a blood vessel lasting less than 24hrs, many lasting only minutes and 50% lasting <1 hr.

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37
Q

What are the two types of transient ischaemic attacks?

A
  1. Those lasting <45 min with no evidence of infarct on CT
  2. Those lasting >45 min (average 6hrs or more) and show radiological evidence of infarction (CITS - cerebral infarction with transient signs)
38
Q

Michael experiences a transient ischaemic attack. What is the likelihood that he will develop a full-blown stroke?

A

30% of people will develop a full-blown stroke within the first months of a TIA.

39
Q

What are the risk factors that may have caused Stanley to develop a hemorrhagic stroke?

A

Hypertension/high blood pressure (chief risk factor)

Chronic use of oral anticoagulants (aspirin)

Cocaine and/or excessive alcohol use

40
Q

Stanley is addicted to alcohol and often treats himself to a bag of cocaine. The next morning, he feels hungover so he takes excessive amounts of aspirin. His behaviours could cause him to develop a stroke. What kind of stroke is he most likely to develop?

A

Haemorrhagic stroke

41
Q

What are the two primary mechanisms that cause arterial haemorrhage?

A
  1. Weakening of a vessel due to pathological aberrations secondary to hypertension (77-88% of cases)
  2. Rupture associated with vascular abnormalities, such as aneurysm, arteriovenous malformation (AVM), tumor or deficient coagulation of blood.
42
Q

What are the characteristics of an aneurysm that can cause risk for a ruptured aneurysm?

A

Women and older patients

Symptomatic aneurysms (>10mm)

Basilar artery aneurysms

43
Q

Jim has a severe headache is nauseous and vomiting. He also has a stiff neck and focal neurological pain. What is happening to Jim?

A

Aneurysm

44
Q

What is the mortality rate of an aneurysm?

A

50% within the first month

45
Q

What brain areas are most affected by a hypotensive haemorrhage?

A

Thalamus

Basal ganglia

brainstem

46
Q

Which haemorrhages tend to involve blood vessels at the base of the cerebral hemispheres?

A

Haemorrages associated with hypertension

47
Q

What are arteriovenous malformations (AVMs)?

A

AVMs are tangled masses of arteries and veins of congenital origin which grow, usually gradually and much like a tumour

48
Q

What is locked in syndrome?

A

A rare disorder frequently caused by ischaemic or haemorrhagic stroke in the basilar artery.

Loss of all motor function with the exception of eye movement

Cognition and consciousness remain fully intact.

49
Q

What is a penetrating head injury?

A

The skull is fractured, exposing the brain and allowing the entry of foreign matter (eg gunshot wound).

50
Q

What is a closed head injury (CHI)?

A

non‐penetrative blow to the head. Common causes include MVA, assaults, falls and sports. Can also be percussive (eg blast injuries).

51
Q

What are the two stages of TBI?

A

Primary injury

Secondary injury

52
Q

What is a primary injury of a TBI?

A

Damage occurring at the time of impact

53
Q

What is a secondary injury associated with TBI?

A

secondary effects of physiological processes initiated by the primary injury

54
Q

What is a contact force in relation to a primary injury?

A

(force of impact) is predominant cause of damage in static injuries where head is still and receives a blow. Rapid inward deformation of skull (may fracture) with compensatory outward deformation in adjacent areas, followed by rebound effects.

55
Q

What are the inertial forces associated with a primary injury?

A

Translational acceleration

Rotational acceleration

Angular acceleration

Coup injury

Contre-coup injury

Diffuse axonal injury

56
Q

What is translational acceleration?

A

Head moves in a straight line with brain centre of gravity

57
Q

What is rotational acceleration?

A

Brain rotates around centre of gravity eg. sports

58
Q

What is angular acceleration?

A

Combination of translational and rotational forces

59
Q

What is a coup injury?

A

A site of initial impact

60
Q

What is a contre-coup injury?

A

The brain rebounds against the opposing side of skull, causing further damage

61
Q

What is a diffuse axonal injury?

A

Rapid deceleration forces lead to widespread damage throughout the brain. Axons get torn, twisted and broke.

62
Q

In relation to primary injury, what are intra-cranial hemorrhages?

A

Large blood vessels may be torn on impact, these haemorrhages create haematomas within the skull:

63
Q

What are the different kinds of haematomas are created by haemorrages?

A

Epidural haematomas (EDHs)

Subdural haematomas (SDHs)

Intracerebral haematomas (ICHs)

64
Q

What are epidural haematomas (EDHs)?

A

Between skull and dura matter. Often due to contact injury. Most often arterial

65
Q

What are subdural haematomas?

A

Between dura matter and arachnoid membrane. Produced by torn veins or brains surface and inner side of dura

66
Q

What are intra-cerebral haemaomas?

A

Formations within the brain

Usually occur in frontal and temporal lobes, but also basal ganglia
and cerebellum.

Often result from rupture of blood vessels in the brain and are
associated with DAI.

Delayed traumatic ICH occur within 72 hrs post‐injury.

67
Q

Brain swelling, cell death, hypoxia, dysregulation of the blood-brain barrier and infection are examples of what kind of injury?

A

A secondary injury

68
Q

What is a cerebral oedema?

A

Excess fluid in the brain leading to swelling of the brain and intracranial pressure (ICP).

69
Q

What are the two kinds of oedemas?

A

Vasogenic

Cytotoxic

70
Q

What is a vasogenic oedema?

A

Occurs when damage to the brain and surrounding membranes leads to increased extracellular fluid.

71
Q

What is a cytotoxic oedema?

A

Occurs when a neuron’s (brain cell) membrane pump fails, leading to increased intracellular fluid.

72
Q

What is the process of cell death?

A

Necrosis

Apoptosis

73
Q

What is necrosis?

A

Passive death of cells as a result of damage. Occurs within hours of injury. Leads to inflammation and possible damage of surrounding cells.

74
Q

What is apoptosis?

A

Programmed death (active self destruction) that occurs when cell is damaged. Requires sufficient resources and may take days. No inflammation or damage to surrounding cells.

75
Q

What is the apoptotic process?

A
  1. cell shrinks
  2. material is divided into vesicles
  3. scavenger cells clean up the debris
76
Q

What are three key indicators of injury severity?

A
  • Length of loss of consciousess
  • Depth of coma, measured y glasgow coma scale
  • Length of post traumatic amnesia
77
Q

How is the depth of a coma measured?

A

Glasgow Coma scale

78
Q

What are some problems with estimating the severity of a TBI?

A
  • Time of assessment
  • Reliability of information
  • Medical intervention
    (Ventilation/analgesics/anaethetics)
  • Drug/alcohol use
  • Dementia/elderly
79
Q

What are some cognitive problems associated with TBI?

A 
Attention and concentration
• Speed of information processing
• Memory (short term and long term) • Executive function
‐ Motivation
‐ Planning
‐ Inhibition
‐ Decision making
• Word‐finding and speech production impairment
80
Q

What are some emotional and behavioural effects of TBI?

A

Lack of emotional control (eg anger outbursts)
• Emotional lability
• Emotional blunting
• Lack of emotional awareness (reduced empathy)
• Disinhibition
• Failure to pick up on social cues
• Lack of insight/awareness
• Change in sex drive (increase or decrease)
• Personality changes (mostly secondary to the above)

81
Q

What are some psychosocial outcomes of TBI?

A
  • Relationships – increased strain on, or total breakdown of relationships
  • Work – reduced capacity, poor decision making
  • Social activities – withdrawal from activities and/or change in
82
Q

What are some clinical outcomes of TBI?

A
  • Depression
  • Anxiety
  • Personality disorders • PTSD
83
Q

What brain structure in ischemic strokes was associated with specific cognitive domains in a study done by Sagnier et al (2019)?

A

fronto-temporo-insula with basal ganglia and thalamus

84
Q

What artery supplies blood to the lateral surface of the cortex (in particular, the frontal-parietal areas)?

A

middle cerebral artery

85
Q

What deficits are associated with stokes on the right side of the brain?

A

Visuospatial

86
Q

What deficits are associated with stokes on the left side of the brain?

A

Language

87
Q

What are some unilateral effects of obstructive (Ischaemic) stroke?

A

Hemiparesis

Hemiplegia

Aphasias (left)

Unilateral neglect (often right)

88
Q

Why does hemispatial neglect occur?

A

Unilateral damage to the brain

Most commonly to the right hemisphere’s parietal lobe

89
Q

What are the several kinds of mechanical forces that have been identified as causing closed head injuries?

A

Contact forces

Inertial forces (translational acceleration, rotational acceleration, agular acceleration)

Coup injury

contre-coup injury

diffuse axonal

90
Q

Intracerebral haematomas are often associated with _______?

A

Diffuse Axonal Injuries

PSY325 (11 decks)

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