Week 7 Flashcards
sensory afferent pathways
spinothalamic, posterior column, spinocerebellar
spinothalamic afferent pathway transmits __
pain & temperature to cerebrum via thalamus
posterior column afferent pathway transmits __
touch, pressure, vibrations to cerebral cortex
spinocerebellar afferent pathway transmits __
kinesthesia / proprioception to cerebellum
descending efferent pathways
corticospinal & corticobulbar tracts
TIA
transient ischemic attack
TIA is defined as __
transient neurological dysfunction by focal brain, spinal cord or retinal ischemia without acute infarction under 24 hours
Amaurosis fugax
Transient one-sided visual loss due to atherothrombotic disease in ICA proximal to the ophthalmic artery
causes of Amaurosis fugax
carotic dissection
aortic embolism
atherothrombotic disease in ICA
risk of recurrent stroke after TIA is done via __
ABCD2 score to identify patient at high risk of ischemic stroke in first 7 days after TIA
stroke is defined as when __
interrupted blood flow to an area of the brain, resulting
in permanent neurological damage
types of strokes
ischemic (80%)
- embolism
- thrombosis
hemorrhagic (20%)
ischemic stroke pathophysiology
lack of sufficient blood flow to perfuse cerebral tissue due to narrowed/blocked arteries
significance of ischemic penumbra
potential to reverse neurological impairment with post stroke therapy as ischemic core is unsalvageable whereas the penumbra is
functioning brain is dependent on __
continuous blood supply for oxygen & glucose & remove end product metabolism
ATP is needed to __
- maintain neuronal integrity
- keep Ca2+ & Na+ outside cell, K+ inside cell
clinical syndromes of anterior stroke
lacunar & hemispheric syndrome
clinical syndromes of posterior stroke
lacunar
medullary
pontine
cerebellar
top of basilar
lock in
neuroanatomy ascending tract pathways
dorsal column-medial lemniscal pathway, anterolateral, spinocerebellar
cortical signs
aphasia
apraxia
gaze preference
homonymous hemianopia
visual extinction
agnosia
acalculia
hemispheric syndrome clinical symptoms
- presence of higher cortical dysfunction
- lateralization = label on side of lesion
aphasia & right sided weakness =
left hemispheric syndrome
left sided weakness, numbness & left visual neglect =
right hemispheric syndrome
lacunar syndrome clinical symptoms
- absence of higher cortical dysfunction
- lateralization = label on side of deficit
lacunar syndrome mainly affects
basal ganglia, internal capsule, thalamus, pons
cincinnati stroke scale includes identifying ___
FAS = face, arms, speech
prehospital notification done if stroke discovery time is less than 6 hrs
blood investigation of stroke includes
- blood glucose level
- bilateral blood pressure differential
- pulse oximetry
- ECG
- brain imaging
assessment tool for stroke monitoring is ___
NIHSS monitoring
what is the neuro imaging exam ordered for stroke
CT brain + angiography
MRI/MRA
Doppler carotid / transcranial doppler US
DSA
decompressive craniectomy
surgical removal of skull portion to allow outward herniation of infarcted brain tissue before compression of healthy brain tissue occurs
decreased intracranial P & improve cerebral perfusion
hemorrhagic stroke pathophysiology
blood vessel rupture leading to compressed brain tissue from expanding hematoma leading to loss of blood supply to affected tissue
types of hemorrhagic stroke
intracerebral & subarachnoid hemorrhage
primary cause of hemorrhagic stroke
uncontrolled hypertension & cerebral amyloid angiopathy
secondary cause of hemorrhagic stroke
vascular abnormalities, aneurysm rupture, neoplasms
volume of ICH formula
longest axis (A) x longest axis perpendicular to A (B) x number of slices x slice thickness (C)
(A x B x C) / 2
spontaneous IVH + obstructive hydrocephalus intervention is __
EVD
spontaneous ICH < 30 mL, GCS > 3, IVH requiring EVD intervention is __
EVD + thrombolytic
spontaneous ICH < 30 mL, IVH requiring EVD intervention is __
neuroendoscopy + EVD + thrombolytic
FLAIR can be used to detect __
edema a few hours after onset; not routine in stroke imaging
DWI-FLAIR mismatch
infraction visible on DWI but not FLAIR
DWI-FLAIR used to estimate __
onset time in wake-up / unwitnessed strokes
rTPA
recombinant tissue plasminogen activator
each hour where treatment fails, brain loses __
3.6 years of normal aging
each minute where treatment fails, ___ neurons die
1.9 million
keep SBP ___ mmHg post rTPA
< 180/105
stroke unit care closely monitors for __ complications
pneumonia, deep vein thrombosis, pulmonary embolism, urinary tract infection
large artery artherosclerosis
brief & recurrent obstructive vascular process in extracranial / intracranial arteries associated with stenotic atherosclerotic lesion
what antiplatelets are given for stroke
aspirin, dipyridamole, clopidogrel, ticlodipine
what is given with aspirin
dipyridamole
clopidogrel AKA __
plavix
anticoagulants given for stroke are __
NOACS = apixaban, rivaroxaban, dabigatran
warfarin
LDL lower agents
anything that ends with “-statin” & ezemtimibe
indications for LDL lowering agents
stabilize plaque & keep bad cholesterol < 1.8 mmol/L
improve endothelial dysfunction
antihypertensive meds
ACE = angiotensin converting enzyme
angiotensin II receptor blocker
beta blocker
Ca2+ channel blocker
early rehab within 24 hrs of acute stroke must be done __
with caution who are severely affected or had ICH
medical guidelines to drive vocationally with TIA
single TIA = only once free of TIA for 6 months
multiple TIA = “ for > 1 year
medical guidelines to drive privaltey with TIA
single TIA = only once free of TIA for 1 months
multiple TIA = “ for > 6 months
seizure definition
transient occurrence of signs or symptoms due to abnormal excessive neuronal activity in the brain
neurons in a seizure may be __
abnormally developed, damaged, functioning abnormally due to environmental factors
typical signs of seizure
loss of awareness, abnormal movement & sensations
most seizures self abort after __
several seconds to mins
types of partial seizures
simple, complex, with secondary generalization
types of generalized seizures
generalized tonic clonic seizure, absence, myoclonic
status epilepticus is when __
seizure >5 mins & risk of neuronal injury is high; emergency situation
epilepsy vs seizure
Epilepsy is a disease with a tendency to have recurrent unprovoked seizures
seizure is 1 event
seizure 1st aid is done by putting patient in __
recovery position
how to prevent seizure recurrence
anti-epileptic drug & lifestyle modification
what drugs alter neuronal excitability
Na+ channels, GABA, Receptors
common side effects of AEDs
fatigue, toxicity, rash, weight gain, hair fall, low platelets,
Broca’s area
expressive speech area
Wernicke’s area
comprehensive area for both written & spoken language
left hemisphere of brain
responsible for mathematical, problem solving & logical reasoning
right hemisphere of brain
artistic ability, creativity, spatial relationship, emotional and behavioural characteristics
limbic system
emotional reactions & feelings
functions of cerebral spinal fluid
1) provides a cushion for the brain & spinal cord;
2) supplies nutrient to nervous system tissue; and
3) removes waste products from cerebral metabolism
brain excitatory molecules
dopamine, serotonin
brain inhibitory molecules
gamma-aminobutyric acid (GABA)
spinal cord inhibitory molecules
glycine
ischemic stroke
total occlusion of a cerebral blood vessel by atheroma (thrombus) or embolus
hemorrhagic stroke
Ruptured cerebral vessels leading to compression of brain tissues from an expanding haemotoma
5 mins of ischemia leads to __
irreversible nerve cell damage
classic signs of acute stroke
FAST
- facial droop
- arm weakness
- slurred speech
- time (call 995)
pharmacotherapy for ischemic stroke
- IV rTPA within 4.5 hours of stroke onset
- antiplatelet therapy for non-cardioembolic stroke
- anticoagulation therapy for cardioembolic stroke
- statins to stabilize plaque & improve endothelial dysfunction
Endovascular therapy for large vessel occlusion with
symptoms onset within __
6 hours
pharmacotherapy for long term CVRF control
- antiplatelets
- anticoagulants
- statin according to SPARCL trial
Convulsive status epilepticus
recurrent or continuous seizures without
recovery of consciousness.
Impaired respiration and intense muscle activity can lead to severe hypoxia, hypoglycemia, acidosis and decreased blood pressure
EEG use in seizures
determine type & location
routine blood study in seizures
identify metabolic causes
neuroimaging study in seizures
identify structural abnormalities
seizures managed using __
pharmacotherapy = anti-epileptic drugs & sedatives
vagus nerve stimulation
cerebellum function
movement, posture, equilibrium
medulla function
respiratory & cardiovascular control center
grey matter parts
- anterior horns = motor neurons
- lateral horns = visceral motor neurons
- posterior horns = receives sensory info
