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Brain and Behaviour PBL > PBL5 > Flashcards

PBL5 Flashcards

1
Q

what is amlodipine

A

 Ca2+ blocker.
 Acts on myocardial cells in smooth muscle.
 Causes vasodilation.

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2
Q

what are the side effects of amlodipine

A
  • abdominal pain
  • palpitations
  • nausea
  • oedema
  • headaches
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3
Q

what is warfarin

A

 Vitamin K antagonist.
 Lowers the amount of vitamin K present in the body.
 Vitamin K is needed for blood to clot.
 Warfarin is monitored by INR.

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4
Q

what monitors warfarin

A

INR

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5
Q

how do you work out a pack year history

A

 Pack years = years smoked x packs smoked per day.
 15 pack year = 1 pack per day for 15 years.
 15 pack year = pack a day for 15 years / 2 packs a day for 7.5 years.

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6
Q

what is the INR (international normalised ratio)

A

 Prothrombin time (PT) is the time taken for blood to clot.
 PT varies under different circumstances.
 INR is a standardized result available for comparison.
 A higher INR means the blood takes longer to clot.
 Normal physiological values = 0.8 – 1.2.

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7
Q

what is global aphasia

A

 Complete loss of all aspects of spoken and written language.
 Associated with a lesion in Broca’s and Wernicke’s area.
 Broca’s and Wernicke’s area are connected by the arcuate fasciculus.

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8
Q

what is a stroke

A

a lack of blood supply to the brain

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9
Q

what is atrial fibrillation

A
  • this is a cardia arrhythmia that is often associated with rapid heart rate and detected by abnormalities on an ECG
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10
Q

what is the epidemiology of stroke

A 
 200/100,000 per year.
 Rate o stroke dramatically increases between the ages of 75 and 84.
 70% strokes occur in >65s.
 Stroke causes 11% of deaths in the UK.
 Costs £7 billion / year.
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11
Q

what are the two types of stroke

A
  • ischaemic

- haemorrhage

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12
Q

what are the risk factors to stroke

A

 Smoking.
 Atrial fibrillation.
 Hypertension.

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13
Q

what is the physiology of stroke

A

 Hypertension and smoking increase atherosclerotic plaque formation.
 Plaques can then rupture and block vessels causing occlusion.
 AF can result in stagnant blood pooling in the atria.
 This block can be carried into the circulation (embolus) and block vessels in the
brain.

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14
Q

describe the blood supply to the brain

A

Anterior Circulation:
 Blood reaches the brain from the internal carotid arteries.
 Internal carotid arteries divides at the optic chiasm into the anterior and middle
cerebral arteries.
 The ophthalmic artery branches off from the internal carotid artery proximally to
supply the eyes.
 Internal carotid arteries provide 80% of blood for the brain.

Posterior Circulation:
 Vertebral arteries supply the other 20% of blood to the brain.
 Basilar and posterior cerebral arteries make up posterior circulation.
 Posterior circulation supplies the hind brain and some aspects of the temporal lobe.

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15
Q

what do the medial cerebral arteries give of

A

lateral and medial strait arteries

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16
Q

what do the lateral and medial strait arteries supply

A

 These arteries supply the corpus striatum and internal capsule.
 This is where all axons going to or from the cortex pass.

17
Q

what do the MCA supply

A
  • Primary motor cortex.
  • Primary somatosensory cortex.
  • Primary auditory cortex.
  • Primary area for olfaction.
  • Posterior parietal cortex.
  • Broca’s and Wernicke’s language areas.
18
Q

what blood vessel is affected

A

left cerebral artery

19
Q

what is the cause of

  • global pahasia
  • right side facial drop
  • lack of power on the right side
  • equivocal plantar reflex
  • lack of sensation
A

Global Aphasia:
 Broca’s and Wernicke’s areas are affected.
 The arcuate fasciculus is also affected.
 This leads to language and speech difficulties.

Right Sided Facial Droop:
 Corticobulbar tract damage.
 This innervates the facial motor nucleus.
 UMN lesion so contralateral impact.

Lack of Power on Right Side:
 Left primary motor cortex has been damaged.
 Works contralaterally.

Equivocal Plantar reflex:
 A Babinski sign indicates pyramidal (Corticospinal) damage.
 Too early to tell in acute stroke.
 Reflexes may become hyper-reflexic later.

Lack of Sensation:
 On right side of body.
 Damage to the somatosensory centre on the left.
 Contralateral.

20
Q

what is blood colour without contrast in a CT

A

white

21
Q

what is blood with contrast in a CT

A

black

22
Q

what does the CT show

A

 The CTs show no haemorrhage meaning the stroke was ischaemic. - blood would have shown up if it was haemorrhage
 As time goes on infarcted tissue becomes darker on a CT in an ischemica stroke, these only become visible at 3-6 hours
 As the CT scan was normal is shows the stroke was recent, 3-6 hours ago.

23
Q

what is the treatment for stroke

A

 First step for acute stroke without CT scan evidence is 300mg aspirin.
 Antiplatelet therapy can also be used to stop new cots forming.
 Aspirin should be continued for 2 weeks, after which Warfarin should be used.
 Surgery is an alternative procedure to treat stroke.
 Thrombolytics such as tPA should also be used.

24
Q

what does tPA do

A
  • it activates actives which breaks down thrombosis
  • tPA converts plasminogen to plasmin
     Plasmin promotes thrombolysis by cleaving fibrin.

 This results in clot degradation.
 Ischaemia is therefore reduced.
 tPA should only be used for up to 4.5 hours after stroke.
 After this their effectiveness diminishes heavily.
 Thrombolytics may increase the risk of intracranial haemorrhage.

25
Q

what is the prognosis

A

 If thrombolysis is performed within 5 (or 3-4.5) hours there is a good chance of recovery.
 If intervention was not successful, then full recovery is unlikely.
- some revascualrisaiton of the brain may occur
- stroke rehabilitation - this is the process by which patients with disability strokes undergo treatment to help them return to normal life by regaining and relearning the skills

26
Q

what is bendroflumethazide

A
  • this is a thiazide diuretic that is used to treat hypertension causing vasodilation of blood vessels thereby reducing blood pressure
  • it works by inhibiting sodium absorption in the kidney
27
Q

why is the stroke most likely ischemic

A
  • Atrial fibrillation and high blood pressure are both risk factors for ishemica stroke
  • untreated hypertension can damage the blood vessel walls leading to thromboembolism
  • AF can result in stagnant blood int he left atrium which can lead to thrombus formation, if the clot becomes mobile it is called and embolus
28
Q

what is used to reduce the chance of a stroke

A

warfarin

29
Q

when is tTPA lienced

A
  • only within 4.5 hours after onset after symptoms as after this they can become ineffective

Brain and Behaviour PBL (5 decks)

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