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Neuro Unit 1 > A 5 Mechanisms of Stroke > Flashcards

A 5 Mechanisms of Stroke Flashcards

1
Q

What is the distribution (percentage-wise) of each type of stroke?

A
  • Ischemic: Arterial 81% (of these, 25% each belong to: Atherosclerotic, Cardioembolic, Lacunar, Other) and Venous 2%
  • Hemorrhagic: Intracerebral 13% Subarachnoid 5%
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2
Q

-Ischemic strokes usually have focal, or general symptoms? Positive or negative?

A
  • Focal

- Negative

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3
Q

T/F Perfusing the brain at a consistent (low) flow can allow some neurons to live for as long as an hour before then dying?

A

True (these would be in the penumbra, and would probably have reversible paralysis or other similar symptoms)

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4
Q

T/F Perfusing the brain at a low flow can kill some neurons within minutes?

A

True

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5
Q

TIA has what 2 definitions?

A
  • Symptoms last less than 24 hrs

- No brain injury on imaging

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6
Q

After a TIA, across a week, month, year, what are approximate risk of having a stroke?

A
  • Highest in first week
  • 15-30% within a month
  • 40-50% within a year
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7
Q

Where do clots in the brain usually form?

A

-Bifurcations (turbulent flow)

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8
Q

What are 3 procedures used to treat a blocked artery in the brain?

A
  • Endarterectomy
  • Angioplasty & stent
  • Thrombolytics
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9
Q

Which type of stroke are anticoagulants most effective against?

A

Cardioembolic

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10
Q

Which two arteries receive most cardioembolisms?

A

MCA, PCA

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11
Q

Would an embolus to the brain come from the right or left side of the heart?

A

Either. (“Paradoxical embolus” from the right)

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12
Q

On a brain scan, how would you distinguish between a cardioembolic stroke and an amyloid angiopathy hemorrhage ?

A

Cardioembolic=multiple vascular territories

Amyloid angiopathy hemorrhage=Multiple territories within one lobe

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13
Q

What leads to a lacunar stroke?

A
  • Thickened arterial wall (hypertension, diabetes)

- Occlusion

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14
Q

What area of the brain is damaged by a lacunar stroke?

A
  • Basal ganglia (Putamen, caudate), thalamus, pons, internal capsule
  • Less than 15 mm white matter
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15
Q

“Other causes” of stroke are most common in what age group?

A

young

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16
Q

What happens after an arterial dissection? What would it look like on an angiogram?

A

1) Clot forms at the edge of an intimal flap and the artery may occlude, or there could be severe hemorrhage.
2) Like a narrowing and then little or no blood flow beyond that point

17
Q

Superior sagittal sinus thrombosis affects the brain how?

A
  • Lots intracranial pressure

- Bilateral infarct

18
Q

-What dies each minute in an acute ischemic stroke?

A
  • 1.9 million neurons
  • 14 billioin synapses
  • 7.5 miles myelinated fibers
  • May not need exact stats but this was one of the “objectives” of his lecture
19
Q

How long might it take to see an acute infarct on a CAT scan?

A

-4 days ish

20
Q

What does the dense artery sign indicate?

A

thrombus

21
Q

Is diffusion or perfusion MRI better at finding at-risk brain tissue?

A

perfusion

22
Q

What are potential neuroprotectives?

A

magnesium

23
Q

What symptoms of a hemorrhagic stroke are different than ischemic?

A
  • Not always different clinically
  • “worst headache of life”
  • Stiff neck
  • cardiac symptoms from catecholamines
  • Lots intracranial pressure (esp locally, and also diffusely, causing herniation)
24
Q

What are the 2 mechanisms of a hemorrhagic stroke?

A
  • Arteriopathy of a small vessel (hypertension, amyloid angiopathy, aneurysm, etc)
  • Hematological (anticoagulants, genetic, etc)
25
Q

Control of blood pressure and management of edema are the best TREATMENT (not prevention) for which kind of stroke?

A

-Hemorrhagic (iron is a target to reduce edema)

26
Q

What is the best, and worst kind of strokes to have?

A
  • Venous

- Hemorrhagic

27
Q

How long might it take to see a hemorrhagic stroke (subarachnoid) on CT?

A
  • After 1 day 98% are identifiable
  • After 7 days, only 50% are identifiable
  • (Recall ischemic may take 4 days ish to become visible)
28
Q

How long after a hemorrhagic stroke can xanthocrhomia detect it?

A
  • Up to 3 weeks

- Requires lumbar puncture (test tube compare to water)

29
Q

For SUBARACHNOID hemorrhagic strokes, what is the best treatment?

A
  • Secure the aneurysm

- Then manage the other probs like in any hemorrhagic stroke (recall B.P. and edema)

30
Q

Small vessel disease results in which 2 types of stroke?

A

Lacunar stroke

Hypertensive inter-cranial hemorrhage

31
Q

Small vessel disease leads to what 2 kinds of stroke?

A
  • Lacunar (endothelial dysfunction)

- Hemorrhagic (charcot-bouchard microaneurysm), esp. subarachnoid hemo

Neuro Unit 1 (9 decks)

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