Cerebrovascular Disease

Question 1

Paresis

Answer 1

partial paralyasis/weakness

Question 2

Hemiparesis

Answer 2

incomplete paralysis affecting one side of the body

Question 3

Hemiplegia

Answer 3

Paralysis of one side of the body

Question 4

Aphasia

Answer 4

loss of ability to speak/write

Question 5

Aphasia

Answer 5

loss of ability to speak/write

Question 6

Apraxia

Answer 6

inability to execute motor act

Question 7

Dysarthria

Answer 7

poorly executed speech

Question 8

Agnosia

Answer 8

loss of recognition (shapes/people)

Question 9

Hemianopia

Answer 9

Blindness for 1/2 vision field

Question 10

Dysphagia

Answer 10

Difficulty swallowing

Question 11

Blood supply to the brain includes branches of the aorta, internal carotid artery and vertebral artery

Answer 11

Carotid artery divides into ACA, MCA and PCA

Question 12

Circle of Willis

Answer 12

protect brain from ischemia by providing collateral blood flow and alternative blood flow pathways.

Question 13

Regulation of CBF is by

Answer 13

vasodilation and constriction in response to O2, H+ and CO2 changes

Question 14

CVD is defined as

Answer 14

any abnormality of the brain caused by pathological process in the blood vessels

Question 15

Brain utilises

Answer 15

15-20% of CO per min

Question 16

CVA can be classified as

Answer 16

Ischemic or haemorrhagic

Question 17

Patho of ischemic stroke

Answer 17

Occlusion of the intracranial artery/ vessel lumen due to thrombus or emobli causing occlusion. Increased CO2, reduced O2 = increased blood brain volume which causes a headache. Loss of O2 decreases ATP and forms lactic acid, proteases and phospholipase enzymes are activated which decrease pH and can cause acidosis. This also leads to an increase in ROS, Na, Ca which draws fluid in and causes cytotoxic edema. The damage depends on the location and duration

Question 18

Transient ischemic attack

Answer 18

resolves in 24 hours and self resolves - warning sign of CVA, minimal long term issues

Question 19

4 lobes of the cortex

Answer 19

Frontal - movement, execute function,
Parietal - Sensory info
Temporal - Hearing, memory, smell, language, recognition
Occipital - vision

Brainstem - HR, BP , Breathing, GI, Conciousness
Cerebellum - muscle coordination, balance

Question 20

Smoking can cause a stroke by

Answer 20

tabacco irritants damaging the endothelium in the CVA, which becomes a site for atherosclerosis, plaque forms and obstructs blood flow

Question 21

Strokes happen when

Answer 21

there is a sudden and complete blockage of a cerebral artery

Question 22

Plaques sit in the lumen and have constant stress from blood flow and can become unstable, can rupture and cause a thrombogenic reaction

Answer 22

chemicals that enhance the clotting process such as thromboxane, endolthelin create a clot which obstructs and completely occludes the vessel

Question 23

Embolism

Answer 23

breaks off from one location, gets lodged in another area away from its original site, typically with a smaller diameter.

Question 24

Stagnant blood flow can form a clot due to

Answer 24

Atrial fibrillation or heart attack, it formed in the left atrium it has a direct route to the brain

Question 25

If a clot forms in a vein or the right atrium

Answer 25

it can get lodged in the pulmonary artery and cause pulmonary embolism

Question 26

Lacunar stroke

Answer 26

often deep branches of the MCA feeding the basal ganglia, giving pure motor or sensory deficit

Question 27

Thrombotic stroke

Answer 27

thrombus in the cerebral arteries due to atherosclerosis, inflammatory disease or stenosis

Question 28

Risk factors modifiable

Answer 28

``` Smoking - increases risk by 50%, Increased alcohol, Obesity, Hyperlipidemia, HTN, Unstable DM, Heart disease, Decreased activity, Chlamydia pneumonia ```

Question 29

Risk factors non modifiable

Answer 29

Age, Gender, genetics, ethnicity

Question 30

Ischemic penumbra

Answer 30

is preserved for some time due to collateral circulation at the circle of willis and surrounds the ischemic core of necrotic tissue, it can survive if blood flow is restored quickly enough

Question 31

Due to lack of glucose and oxygen

Answer 31

high build-u of sodium and calclium in the cells causing cytotoxic edema due to H2o following Na = build up of ROS of membranes causing cellular damage

Question 32

Over a period of 4-6 hours

Answer 32

inflammation damages the BBB, increasing CSP which can push onto brainstem and affect breathing and conciousness

Question 33

ACA stroke

Answer 33

numbness, sudden muscle weakness, leg

Question 34

MCA stroke

Answer 34

Face, numbness / sudden muscle weakness

Question 35

Broca's area

Answer 35

slurred speech / difficulty understanding

Question 36

PCA stroke affects

Answer 36

Vision/language

Question 37

Symptoms acronym

Answer 37

F acial drooping A rm weakness S speech difficulties T ime

Question 38

Diagnosis of stroke

Answer 38

CT or MRI or angiography | rule out haemorrhage

Question 39

Treatment of stroke

Answer 39

reestablish blood flow quickly, particularly in penumbra. - Thrombolytic enzymes (a-TPA) - activates body's clot busting mechanisms - time limit of 4.5 hours - binds to fibrin of a thrombus and converts to plasmin which initiates fibrinolysis (clot breakdown) ASPIRIN - prevents MORE clots SURGERY - physically remove clot, endovascular coil or clipping

Question 40

A stent can be placed

Answer 40

to prevent further strokes

Question 41

Monro - Kellie Hypothesis

Answer 41

sum of intracranial volumes of brain, blood and CSF remains constant, an increase in one component must be offset by a decrease in another component by decreasing CSF

Question 42

Post stroke treatment

Answer 42

Antihypertensives, Anticoagulants, unless hemorrhagic, Lipid-lowering if ischemic (statins).

Question 43

Two types of hemmorhagic stroke

Answer 43

intracerebral - within the brain tissue, | subarachnoid - area surrounding the brain

Question 44

Patho of hemorrhagic stroke

Answer 44

``` weakened blood vessel, bleeding, increase in CBP, compression, spasm, ischemia, ```

Question 45

o2 therapy is contraindicated in stroke

Answer 45

because it can cause ROS due to the blockage - oxygen won't reach the required area