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The Nervous System: Pathology > Cerebral Infarction (clinical) > Flashcards

Cerebral Infarction (clinical) Flashcards

1
Q

Define stroke

A

Is a sudden onset of focal or global neurological symptoms caused by ischema or haemorrhage and lasting more than 24 hours

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2
Q

What is the two many causes of strokes

A

Ischaemic 85%

Haemorrhage 15%

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3
Q

Define Transient ischaemic attack

A

Term used when stroke symptoms resolve within 24 hours

Most TIAs last within 1-6mis

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4
Q

What is the causes of ischaemic stroke

A

Large artery atherosclerosis (e.g. Carotid)
Cardioembolic (e.g. atrial fibrillation)
Small artery occlusion (Lacune)
Undetermined/Cryptogenic
Rare causes:
-Arterial dissection
-Venous sinus thrombosis

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5
Q

What is the causes of haemorrhage stroke

A

Primary intracerebral hemorrhage

Secondary hemorrhage

  • Subarachnoid hemorrhage
  • Arteriovenous malformation
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6
Q

What is the cause of a primary intracerebral haemorrhage

A

Hypertension

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7
Q

What is the pathophysiology of stroke

A

Failure of cerebral blood flow to a part of the brain due ti interruption of the blood supply to the brain resulting in various degrees of hypoxia

Prolonged hypoxia becomes anoxia (no oxygen)

Anoxia then causes infarction leading to complete cell death and necrosis

This is a stroke

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8
Q

What further damage can result from a stroke

A

Oedema

Secondary haemorrhage

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9
Q

What affect does hypoxia have on the brain

A

Stresses the brains cell metabolism

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10
Q

Define ischemic penumbra

A

the penumbra is the area surrounding an ischemic event “ischaemic core” such as thrombotic or embolic stroke

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11
Q

What is the non modifiable risk factors for a stroke

A

Previous stroke
Being old
Being male
Family history

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12
Q

What is the modifiable risk factors for a stroke

A

Hypertension

Smoking

Cholesterol (diet)

High BMI/obesity

Alcohol

Diabetes

Impaired cardiac 
function

Oral contraceptive

Hyper-coagulable states

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13
Q

What is the most important modifiable risk factor for stroke

A

Hypertension

as stroke risk is directly related to your blood pressure levels

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14
Q

How does hypertension increases your stroke risk

A

Chronic hypertension worsens atheroma and affects small distal arteries

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15
Q

What contributes to the LDL- Cholesterol deposition in the arterial wall

A

Hypertension
Smoking
Diabetes

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16
Q

What is involved in the anterior circulation

A

From: 2 x Internal carotid arteries

2 x Anterior Cerebral Artery (ACA)
2 x Middle Cerebral Artery (MCA)

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17
Q

What is involved in the posterior circulation

A

From: 2 Vertebral arteries
1 Basilar

3 pairs of cerebellar arteries
2 Posterior cerebral artery (PCA)

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18
Q

How does the arterial blood supply anastomose in the brain

A

Through the circle of willis via anterior and posterior communicating arteries

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19
Q

Where does the borderzone anastomoses occur

A

between peripheral branches of
anterior, middle and posterior
cerebral arteries

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20
Q

What is symptoms of arterial cerebral artery

A

Contra-lateral:

paralysis of foot and leg

sensory loss over foot and leg

impairment of gait and stance

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21
Q

What is potential symptoms of middle cerebral artery occlusion

A

Contralateral:

  • paralysis of face/arm/leg
  • sensory loss face/arm/leg
  • homonymous hemianopia

Gaze paralysis to the opposite side

Aphasia if stroke on dominant left side

Unilateral neglect and agnosia for half of external space if non dominant stroke

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22
Q

What side of the brain is usually a dominant stroke

A

Left - as most people usually right handed

Would be right dominance if patient is left handed

23
Q

What is the specific symptom of middle cerebral occlusion on the dominant (left) side -patient is right handed

A

hemiplegia - paralysis on one side of the body

homonymous hemianopia,

dysphasia - language disorder

24
Q

What is the specific symptom of middle cerebral occlusion on non dominant stroke (right side)
- the patient is right handed

A

Left Hemiplegia

Homonymous hemianopia

Agnosia - neglect syndrome

  1. Visual agnosia
  2. sensory agnosia
  3. Anosagnosia (denial of hemiplegia)
  4. Prosopanosia (failure to recognise faces)
25
Q

Where is Broccas area and wernickes area both located if patient is right handed

A

On left side - both found on dominant side of the brain

26
Q

If patient is left handed and presents with a stroke with speech difficulties, what hemisphere is affected

A 
Right hemisphere 
(as presents with right sided dominance due to left handedness)
27
Q

What supplies blood supply to the basal ganglia

A

Middle cerebral artery with branches to smaller arteries

medial and lateral lenticulostriate

28
Q

Where does a lacunar ischaemic stroke occur

A

In the small arteries suppling the basal ganglia

29
Q

What is symptoms of lacunar stroke

A

Pure motor stroke

Pure sensory stroke

Dysarthria - clumsy hand syndrome

Ataxic hemiparesis

30
Q

What is a lacunar stroke devoid of

A

Cortical signs

31
Q

What does the posterior circulation supply

A

Brain stem
Cerebellum
Thalamus
Occipital and medial temporal lobes

32
Q

What is the symptoms of brain stem dysfunction

A

Coma,
vertigo,
nausea/vomiting,
cranial nerve palsies, ataxia - loss of full body movement

Hemiparesis, hemisensory loss

Crossed sensori-motor deficits

Visual field deficits

33
Q

What is the purpose of ischaemic stroke therapies

A

Restore blood supply.

Prevent extension of ischemic damage.

Protect vulnerable brain tissue

34
Q

What is the treatment administrated for ischaemic stroke

A

Aspirin

Heparin

Tissue Plasminogen
Activator (TPA)

Thrombectomy

Stroke unit

35
Q

What is the most effective stroke treatment

A

Thromboectomy

36
Q

What is the 8 different components of a stroke unit

A 
Clinical staff
Stroke nurses
Physiotherapists
Speech and Language therapists
Occupational therapists
Dietitian
Psychologist
Orthoptist
37
Q

What is a tissue plasminogen activator

A

Enzyme that helps dissolve blood clots

38
Q

What is the strict criteria for tissue plasminogen activator

A

< 4.5 hours from symptom onset.

Disabling neurological deficit.

Symptoms present > 60 minutes.

Consent obtained

39
Q

What is the exclusion criteria for IV tissue plasminogen activator

A

Anything that increases the possibility go haemorrhage

BP >185 systolic or >110 diastolic

Glucose <2.8 or > 22mmol/L

40
Q

What is the disadvantages of tissue plasminogen activator

A

Hard to find the balance and not cause an over bleed

Benefit from TPA declines with time

41
Q

What is the four classifications of stroke

A

Total Anterior Circulation Stroke (TACS)

Partial Anterior Circulation Stroke (PACS)

Lacunar Stroke (LACS)

Posterior Circulation Stroke (POCS)

42
Q

What is presentation of LACS

A

+/- Motor (2/3 face, arm leg)

+/- Sensory loss (2/3 face, arm, leg)

43
Q

What is presentation of PACS

A

+/- Motor (2/3 face, arm leg)

+/- Sensory loss (2/3 face, arm, leg)

Will have 1 of:

  • Hemianopia
  • Dysphasia
  • Neglect
44
Q

What is the presentation of TACS

A

+/- Motor (2/3 face, arm leg)

+/- Sensory loss (2/3 face, arm, leg)

Will have Hemianopia
and Dysphasia or Neglect

45
Q

What is presentation of POCS

A

+/- Motor (2/3 face, arm leg)

+/- Sensory loss (2/3 face, arm, leg)

+/- Hemianopia/Dysphasia /Neglect

Brain stem or cerebellar signs

46
Q

What are TIAs

A

Warning sign of a stroke - with 10% stroke recurrence within the first 2 weeks

47
Q

What is an effective treatment for carotid artery stenosis to prevent a stroke occurring

A

Carotid endarterectomy

48
Q

What is preventative treatment to reduce the relative risk of a stroke

A 
Antiplatelets
Antihypertensives
Statins
Endarterectomy
Warfarin - for AF
49
Q

What investigations occur for a stroke

A

Routine blood test

CT/MRI head scan

EEG

ECHO

Carotid doppler ultrasound

Cerebral angiogram/venogram

Hyper-coagulable blood screen

50
Q

What is the gold standard investigation for stroke and why

A

CT

  • quick
  • can determine if ischaemic or hemorrhagic
51
Q

How is biopsy useful in stroke investigation

A

Temporal artery biopsy can show giant cell arthritis

52
Q

What can be misdiagnosed as a stroke

A

Post-ictal states (e.g. Todd’s paralysis)

Hypoglycemia

Intracranial masses

Vestibular disease

Bell’s palsy

Functional hemiparesis

Migraine

Demented patients with UTIs

53
Q

What is the management of an acute stroke

A

Prevention of stroke recurrence.

Prevention of complications related to stroke.

Rehabilitation.

Re-integration into the community

54
Q

Define lipoyhallnosis

A

Small-vessel disease in the brain, that due to the sensitivity of hypertension results in lacuna stroke

The Nervous System: Pathology (25 decks)

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