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Basic Pathology > Stroke 1 > Flashcards

Stroke 1 Flashcards

1
Q

What percent of body weight does the brain make up?

A

2%

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2
Q

The brain requires around ____ percent of your cardiac output in order to receive sufficient oxygen.

A

15

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3
Q

How much oxygen does your brain require?

A

About 20% of the body’s total oxygen.

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4
Q

Describe the arteries that supply the brain and where they supply them.

A

Internal Carotid arteries supply the anterior 3/5ths of the brain.

Vertebral arteries join to form the Basilar artery and it supplies the posterior 2/5ths of the brain which contains the cerebellum and brainstem.

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5
Q

Describe neurons energy supply in the brain. What do they require? What happens if they do not get the required amount?

A

They are mostly aerobic and require oxygen and glucose. They need a continuous supply because they are not able to store glucose or oxygen. If they do not receive it within a few minutes, it could lead to irreversible injury.

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6
Q

If oxygen and glucose are depleted in the brain, what would this create?

A

Oxidative Stress

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7
Q

If brain experiences ischemia, what could this cause?

A

mitochondrial dysfunction

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8
Q

If the brain has excess glutamate, what could this cause?

A

Glutamate can act as a neurotoxic neurotransmitter and can cause cell death.

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9
Q

If the brain has excess intracellular calcium, what could this cause?

A

Cell injury/death

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10
Q

If the brain has a lot of ROS, what could this cause?

A

mitochondrial dysfunction

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11
Q

If the brain undergoes re-perfusion injury of vessels, what could this lead to?

A

An increase in ROS which could lead to mitochondrial damage.

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12
Q

Definition of Transient Ischemic Attack (TIA).

A

A brief period of inadequate cerebral blood flow.

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13
Q

How long does a Transient Ischemic attack last?

A

Usually has rapid onset and resolves within 5 minutes.

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14
Q

How long does it take to fully recover from TIA?

A

within 24 hours

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15
Q

What is the difference between a TIA and a mini-stroke?

A

a TIA has no permanent defects

a mini-stroke is a series of small strokes that have permanent defects

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16
Q

What causes a transient ischemic attack? (2)

A

Intermittent vessel obstruction caused by clots, thrombosis, or plaques.

Temporary vasospasm due to drugs, stress, smoking, and migraines can also cause TIAs.

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17
Q

Within one year, ___ of patients experiencing a TIA will have a full blown stroke if left untreated.

A

35%

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18
Q

TIA symptoms (7)

A

1) Hemiplegia/paresis (paralysis) of arm, leg, face
2) Diplopia
3) Transient loss of vision (Amaurosis fugax)
4) Vertigo
5) Loss of speech
6) Loss of understanding
7) Loss of balance

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19
Q

What may lead us to diagnose TIA? (DDX - differential diagnosis) (3)

A

Migraines
Seizures
History of similar episodes

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20
Q

Symptoms that may defer us from diagnosing a TIA. (5)

A

1) Lightheadedness
2) Tightness in the chest
3) Stomach upset
4) History where TIA was ruled out
5) Speed of onset. If slow, not a TIA.

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21
Q

How to check if someone is having a TIA.

A

Carotid auscultation with a stethoscope. Will sound like a whooshing sound.
Carotid ultrasound. Will appear colder color and can see plaque blocking the vessel.
Echocardiogram

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22
Q

Definition of Stroke

A

A disturbance of blood supply causing loss of brain function that leads to permanent damage to neurons.

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23
Q

Stroke ranks ____ in cause of death in the US.

A

5th

24
Q

What age group is at a greater risk for stroke?

A

Older adults. Every 10 years after 55, the risk of stroke doubles.

25
Q

What ethnicity is at higher risk for strokes?

A

African Americans
American Indians

26
Q

What area of the country is at higher risk for strokes?

A

Southeastern US or areas that have low-level education.

27
Q

What are some stroke risk factors? (8 main)

A

1) Hypertension (biggest risk factor)
2) Diabetes
3) Obesity
4) Heart Disease
5) Atherosclerosis
6) High cholesterol
7) Smoking
8) Previous stroke or TIA

28
Q

What are the two types of stroke? What are the percentages that they occur and mortality rate?

A

1) Ischemic Stroke
-makes up 80-85% of all strokes
Mortality rate is 40%

2) Hemorrhagic Stroke
-makes up 15-20% of all strokes
Mortality rate is 80%

29
Q

What artery is the most common cerebral artery affected by stroke? What percent does it make up of strokes? What is the second most affected artery affected by stroke?

A

Middle cerebral artery.
Makes up about 50-75% of strokes.

Second most common artery affected is the posterior cerebral artery.
Makes up about 8.5% of strokes.

30
Q

What is the primary and secondary mechanism of action of Ischemic Strokes?

A

Primary: Blood vessel occlusion. Most common is thrombotic.

Secondary: Systemic Hypoperfusion (pump failure/hypovolemia)

31
Q

What are the 5 A’s of True Neuro-Ophthalmic Emergencies?

A

1) Papilledema
2) Aneurysmal 3rd Nerve Palsy
3) Giant Cell Arteritis
4) Carotid Artery Dissection
5) Pituitary Apoplexy

32
Q

What are watershed areas? What are the watershed areas in the brain?

A

Most at-risk areas for stroke. Usually between major arteries and are minimally perfused.
Watershed areas in the brain are…
1) Anterior Cortical Border Zone (between anterior cerebral artery and middle cerebral artery)
2) Internal Border Zone (between middle cerebral artery and lateral cerebral artery)
3) Posterior Cortical Border Zone (between middle cerebral artery and posterior cerebral artery)

33
Q

What is the ischemic core?

A

The most severe part of the stroke.
It is less than 15% of normal blood flow.
Least likely to recover.

34
Q

What is the ischemic penumbra?

A

Least severe part of a stroke
Where the blood flow is 15-40% of normal.

35
Q

What could cause an embolic stroke? (7)

A

1) Artery/Vein thrombosis (most common)
2) Plaque fragments from carotid arteries (can show up in eyes)
3) chronic atrial fibrillation
4) fat particles
5) gas particles
6) bacterial endocarditis
7) IV substance abuse (talc abuse) (can show up in eye)

36
Q

What is a hemorrhagic stroke? What percent do they make up? What kind of injuries can it cause?

A

A stroke is caused by broken blood vessel bleeding.
Makes up 15-20% of strokes.

Can cause hypoxic and hydraulic injuries.

37
Q

4 common causes of hemorrhagic strokes

A

1) Hypertension (most important)
2) Aneurysm
3) Arterivenous malformation
4) Trauma

38
Q

Symptoms of hemorrhagic stroke

A

Sudden and severe headache

39
Q

Two types of hemorrhagic strokes. (Where are they found)

A

both extra-axial and intra-axial
(outside and inside brain tissue)

40
Q

between skull and dura mater

A

epidural

41
Q

between dura mater and arachnoid mater

A

supdural

42
Q

between arachnoid mater and pia mater (CSF flows here)

A

subarachnoid

43
Q

What are epidural extra-axial hemorrhagic strokes most associated with? What artery is usually the culprit and what percent?

A

Most associated with head trauma.
Middle meningeal artery 80% of time.

44
Q

What are subdural extra-axial hemorrhagic strokes most associated with? Who are they more common in?

A

Usually associated with acceleration/deceleration injuries like car accidents. Affects the veins more than the arteries.
More common in alcoholics and the elderly.

45
Q

What are subarachnoid extra-axial hemorrhagic strokes most associated with? Who are they more common in? What are two common symptoms?

A

Most associated with saccular aneurysm rupture (80% of time) and trauma.
More common in the young than in the elderly.
Symptom = severe headache and papilledema (swollen optic nerve)

46
Q

What are intra-axial cerebral hemorrhages associated with?

A

1) Hypertension (most important)
2) A/V malformations
3) Berry Aneurysms
4) Trauma

47
Q

What can Woburn-Mason Syndrome cause in the eye?

A

Can cause AV malformations in the back of the eye.

48
Q

In younger individuals (<50 YO) what are some risk factors that are more important other than the usual risk factors? (3)

A

Clotting disorder
Vascular abnormalities
Cardiac embolism

49
Q

If a person has an acute stroke, how would the hospital detect and diagnose that? What are the pros and cons of each diagnostic tool?

A

CT Scan: can confirm the diagnosis of stroke and what type.
Pro: cheaper, faster, metal imaging, bone detail, 2D/3D imaging
Con: poorer soft tissue detail, radiation exposure, not safe for pregnancy

MRI: identify and localize the site of stroke and find the source
Pro: very safe, good soft tissue imaging, no radiation, 2D/3D imaging, good for pregnancy
Con: expensive, no metal imaging, poor bone detail, takes a long time

50
Q

1st and 2nd rule for treating stroke

A

1st: Ischemic or hemorrhagic stroke?
2nd: tailor treatment depending on type of stroke

51
Q

How do you treat an Ischemic stroke? When should it be administered?

A

Give a Tissue Plasminogen Activator (tPA) intravenously one time. This dissolves the clot and restores blood flow.
Should be administered within 3 hours of onset but only 1-7% of patients are able to receive this treatment.

52
Q

Hemorrhagic Stroke treatment (3)

A

1) Control blood pressure (easiest)
2) Surgery (cauterization, coiling/clipping, drainage of hematoma)
3) Discontinue anticoagulant therapy

53
Q

What is the best stroke treatment?

A

Prevention
(most importantly hypertension)

54
Q

What is the five-year survival rate for someone who experienced a stroke?

A

50%

55
Q

What is the largest chance of recovery after they have been diagnosed with a stroke?

A

0-3 months.

Basic Pathology (16 decks)

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