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Neuroscience IV > Stroke > Flashcards

Stroke Flashcards

1
Q

Name several top risk factors for stroke.

A
  1. A Fib
  2. Unregulated hypertension
  3. TIA
  4. Heart disease
  5. Diabetes
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2
Q

How is a transient ischemic attack different than stroke?

A

It lasts less than 24 hours and resolves completely.

-Caused by embolus from heart or other large vessel

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3
Q

What are the two types of stroke, and which is more prevalent?

A

ISCHEMIC (88%)

HEMORRHAGIC (12%)

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4
Q

Ateriosclerotic is a large vessel stroke. What are embolic and lacunar?

A

Medium and small vessels respectively.

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5
Q

What factors worsen ischemic stroke?

A
  1. Rate: fast onset and long duration
  2. Inadequate systemic BP for perfusion
  3. Hypercoagulation
  4. Hyperthermia
  5. Hyperglycemia
  6. Collateral circ
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6
Q

Normal CBF = 50ml/100gm/min. WHen it falls below 20ml, what happens?

A
  1. Electrical silence to preserve energy
  2. Penumbra (CBF = 25-50% normal)
    - period where impairment due to ischemia is partially or fully reversible
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7
Q

During stroke, noxious metabolites are released after neuron breakdown and injury of adjacent neurons. What happens after?

A

Leaky BBB

  • causes brain edema 48-72 hours after onset
  • leads to larger infarcts, further damage
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8
Q

Why do neurons dump glutamate which leads to metabolite excitotoxicity?

A

In response to ischemia. Calcium then floods the cells which results in membrane damage.

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9
Q

One hour after onset apoptosis occurs. What is its trigger?

A

Influx of calcium.

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10
Q

How does conversion to hemorrhagic stroke occur?

A

Damaged brain blood vessels from ischemia rupture after blood flow is restored, called a “red infarct”.

  • less collateral circ
  • large infarct
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11
Q

What is the most common site of large vessel disease? What % of blockage is required for it to be significant?

A

Bifurcation of vessels.

70%

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12
Q

Describe the pathogenesis of large vessel disease.

A
  1. Damage to vessel wall
  2. platelet congregation
  3. thrombogenesis
  4. plaque formation
  5. blockage
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13
Q

What is the most common pathology of medium sized vessel disease?

A

Embolism, mostly affects cerebral arteries from heart-made embolis
-a fib is culprit for embolus formatoin

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14
Q

T/F embolus formation is common at bifurcation points of vessels.

A

True.

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15
Q

What is the most common pathology with small vessel disease?

A

Lacunar

  • changes in the intima
  • lipofusion deposits
  • hypertension, diabetes
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16
Q

What area of the brain is most commonly affected by small vessel disease?

A

Deep white matter

  • inc internal capsule
  • isolated deficits
17
Q

Microvessel disease is common with dimentia and PD. What type of deposits in arterioles and capillaries cause it?

A

Amyloid deposits.

18
Q

tPA is a good treatment for acute stroke. What is its effective window?

A

3 hours by IV

6 hours locally & intra-arterially

19
Q

Name two types of hemorrhagic aneurysms.

A

Berry

  • congentital weakness
  • mostly in ant half of circ Willis

Charcot Bouchard

  • burst aneurysm found on penetrating vessels in brain
  • prognosis good if hemorrhage resorbed
20
Q

What type of hemorrhage is the result of a berry aneurysm?

A

Subarachnoid

21
Q

What are common causes of TIA?

A

Embolism

Stenosis-related hypoperfusion

22
Q

What arteries come off the internal carotid for anterior circulation?

A

MCA, ACA, posterior communicating

23
Q

What arteries are included in the vertebral basilar system?

A

PICA, basilar, PCA

24
Q

What is the penumbra?

A

Area surrounding the core of infarction

  • Some preservation of energy metabolism
  • 25 to 50% CBF of normal

Reversible in 3 hours

25
Q

What is a “red infarct” and its associated factors?

A

When occluding embolus lyses and migrates distally, resulting in hemorrhage.

  • size
  • richness of collateral circ
  • use of anticoagulents
26
Q

With hypoperfusion (watershed / borderzone) stroke, what are common sequellae?

A
  1. Pump failure from MI

2. Distal territory of cerebral artery affected

27
Q

Why is a berry aneurysm the worst headache of your life?

A

The blood pushes on the arachnoid space which is innervated, causing severe pain.

28
Q

T/F: Brain tissue is not damaged by contact with blood.

A

False, iron is damaging.

29
Q

What is an intraparenchymal hemorrhage?

A

Bleed into substance of brain, direct contact

30
Q

T/F: A dissecting aneurysm is from trauma to the vessel?

A

True.

Neuroscience IV (7 decks)

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