Ch 26 Stroke Flashcards
(100 cards)
1
Q
Stroke or CVA
A
sudden onset of impairment in neurologic functioning due to severe decrease of blood supply to the brain
2
Q
What a stroke caused by
A
Ischemia or hemorrhage
3
Q
What does ischemia do
A
It provides an infarct in the brain related to occlusion- (thromboembolic)
4
Q
Transient ischemic attack
A
Brief episodes of neurologic dysfunction resulting from focal cerebral ischemia
Lasts less than an hour but up to 24 hours
Warning sign of a future stroke
5
Q
Chronic persistent symptoms of a stroke depend on what factors
A
Location and size of stroke age hand preference previous stroke time post stroke other med factors
6
Q
Prenatal stroke
A
Occurs between 20 weeks gestation to first 28 days of life
7
Q
Childhood strokes
A
strokes occurring 1 month - 18 years
8
Q
Intraventricular hemorrhage is excluded from pediatric stroke
A
-
9
Q
Subdural and epidural hemorrhages arising from trauma or excluded in pediatric strokes
A
-
10
Q
Most common stroke types in adults
A
Thromboembolic ischemic stroke 88%
11
Q
Thromboembolic ischemic stroke can originate from where
A
Site of occlusion (thrombus)
or at a distance from the occlusion (embolus)
12
Q
Which part of the brain is typically most affected in thromboembolic ischemic stroke
A
The anterior circulation in 80%
- anterior cerebral arteries (ACA)
- middle cerebral arteries (MCA)
posterior circulation 20%
- Posterior cerebral artery (PCA)
13
Q
Middle cerebral artery encompasses what percentage of the brain
A
50-60
14
Q
What percentage of strokes are accounted for by hemorrhagic stroke
A
12%
- 9% intracerebral hemorrhage
- 3% SAH
15
Q
Mortality rate of subarachnoid hemorrhage
A
50% in the first 6 mos after stroke
16
Q
What is affected in the brain usually by intracerebral hemorrhage
A
They are localized deep in the area and affect small penetrating arteries
Slow leak
gradual symptom onset
17
Q
Etiology for deep intracerebral hemorrhage
A
Hypertension
18
Q
Two common reasons for stroke and younger adults
A
Aneurysm or AVM
19
Q
Most common cause of subarachnoid hemorrhage
A
Aneurysm
20
Q
Which kind of stroke is more common in children
A
Ischemic and hemorrhagic stroke or equally common in children
21
Q
Two major forms of infarct in children
A
Arterial ischemic stroke (AIS)
- MORE COMMON!!!!
cerebral Sinovenous thrombosis (CSVT)
- more common in neonates than in older kids
22
Q
The most common location of arterial ischemic stroke for children
A
MCA territory
subcortical infarction
23
Q
Which type of stroke is less common in children
A
Ischemic stroke in posterior circulation < anterior circulation
24
Q
How long does it take to produce neuronal damage in ischemia
A
6 to 8 minutes
25
How long would it take for microscopic changes to be seen after ischemia
Six hours
| swelling happens after that
26
Does the zone of ischemic damage or infarct recover
No
27
Does the surrounding ischemic penumbra recover after a stroke
Yes, if blood flow is restored within six hours
28
What leads to better outcome for ischemic stroke
faster treatment
29
tPA in adults
Dissolves occlusive clot and increase blood flow to the surrounding ischemic penumbra
Needs to be used within 3 to 4 1/2 hours of symptom onset
30
TPA used in children
Controversial because of lack of strong evidence base
31
What can happen after a hemorrhagic stroke
Brain herniation and death can occur if intracranial pressure is not managed
32
Examples of secondary injury after ischemic stroke
vasospasm
33
Risk factors for stroke
```
Age - risk doubles every decade after 55 years
Hypertension - 3 to 6 x
Atrial fibrillation - untreated 3-5x, treated 1.5x
Family history - 3 x
Prior transient ischemic attacks
cocaine use
smoking
sleep apnea
serum lipid abnormality
obesity
diabetes
```
34
Risk factors for stroke in childhood
| - Perinatal ischemic stroke
```
Maternal infertility
preeclampsia
prolonged rupture of membranes
chorioamnionitis
congenital heart disease
Bacterial meningitis
```
35
Most common cause of perinatal CSVT
infection
36
Risk factors for stroke in childhood
| - childhood ischemic stroke
Cardiac disease
sickle cell
infection
37
Risk factors for stroke in childhood
| - hemorrhagic stroke
Trauma - most common cause of intracranial hemorrhage in children
AVM or brain tumors - can cause non-traumatic hemorrhagic stroke
38
Mortality due to stroke increase or decrease
decrease
39
stroke prevalence increase or decrease
increase
40
Strokes more common with what factors
age
| females
41
Gender difference in stroke incidence
Females have higher stroke incidents than males only later in life
42
Racial difference in stroke incidence
Blacks higher than Whites
43
Gender difference in incidence of stroke in childhood
Boys more than girls
44
Mortality rate for a childhood stroke increase or decrease
increase
45
Mortality rate for ischemic stroke in childhood
10%
46
Mortality rate for hemorrhagic stroke and children
25-35%
47
What factor is associated with poor outcomes after childhood stroke
Post stroke epilepsy
48
recurrence rate for childhood stroke
10-25%
lower for perinatal strokes
49
What are the determinants of severity in stroke
```
Age of patient,
size and location of infarct or hemorrhage
acute treatment (tpa, surgery)
medical comorbidities
previous stroke
secondary medical events
```
50
Presentation of hemorrhage
Headache, nausea, vomiting
| loss of consciousness, coma
51
Deficits associated with anterior circulation strokes
```
Hemiparesis,
hemi anesthesia,
aphasia,
visual spatial deficits,
visual field cuts if visual pathway is affected
```
52
Deficits associated with middle cerebral artery MCA
Hemiparesis in superior branch of MCA
| visual field cuts in inferior branch of MCA and PCA
53
Left MCA superior infarct deficits
Brocas aphasia
right face and arm weakness
working memory and executive functions
54
Left MCA inferior infarct deficits
```
Wernickes aphasia,
right visual field deficit,
right face and arm sensory loss,
limb apraxia,
parts of Gertsmann syndrome
```
55
Left MCA deep infarct deficits
Right pure motor hemiparesis
| large infarcts could produce aphasia
56
Left MCA stem infarct deficits
```
Same as left MCA deep territory with
R hemiplegia,
R hemianesthesia,
R hemonymous hemianopia
global aphasia
Left gaze preference
```
57
Right MCA superior branch infarct deficits
Left face and arm weakness
impaired working memory and executive function
some left hemi neglect
58
Right MCA inferior branch infarct deficits
```
PROFOUND L hemineglect
L visual field and somatosensory deficits
L motor neglect
anosognosia
Vs
```
59
Right MCA territory infarct deficits
Left pure motor hemiparesis
| large infarcts produce L hemineglect and VS deficits
60
Right MCA stem infarct deficits
```
Same as right MCA territory infarct
L hemiplegia
L hemianesthesia
L homonymous hemianopsia
profound L hemineglect
VS deficits
anosognosia
right gaze preference
```
61
Left ACA infarct deficits
```
R leg weakness
R leg sensory loss
grasp reflex
executive function deficits
transcortical motor aphasia
```
62
Right ACA infarct deficits
```
L leg weakness
L leg sensory loss
grasp reflex
executive function deficits
may have left hemiplegia
```
63
Left PCA infarct deficits
Right homonymous hemianopsia
64
Rights PCA infarct deficit
Left homonymous hemianopsia
65
Most common presentation of AIS in childhood
Seizures #1
Hemiparesis
altered mental status
Focal neurological signs
66
Posterior strokes presentation
Ataxia
vomiting
vertigo
67
Hemorrhagic stroke presentation in infants and young children
Non-specific features,
altered mental status,
convulsions,
less common focal neurological signs
68
Outcome after subarachnoid hemorrhage
85% of adults need supervision
| 33% continue to have cognitive impairment and impaired ADL after six months
69
CT is most sensitive to what kind of stroke
Acute intracerebral hemorrhage
CT is not as sensitive to ischemic damage especially in the first 24 hours
70
Normal CT is a good indicator of whether the stroke produced damage. True or false
F
71
while MRI can be normal for a few hours after stroke, what can detect infarct within minutes of symptom onset
DW MRI!
72
What kind of imaging is more sensitive for ischemic stroke
MRI is more sensitive than CT
73
What type of imaging is sensitive to lacuna infarcts
MRI
74
Other test to identify etiology of ischemic or hemorrhagic stroke?
cerebral angiography
MRA
CT anteriography
- both can identify aneurysm and AVM in the case of hemorrhage or vessel narrowing in the neck or head for ischemic stroke
75
How is Doppler ultrasound useful for stroke assessment
-identify carotid artery narrowing in the neck
76
How is electrocardiograms useful for stroke assessment
evidence of cardiac ischemia
| arrhythmias
77
first thing to assess after stroke in an evaluation
Language
78
rate of depression in adults after stroke
20-30%
79
A common mechanism of occlusion due to embolism or thrombosis?
artherosclerosis 动脉硬化
80
artherosclerosis动脉硬化
a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls.
81
Treatment of AVM
```
surgical
endovascular embolization (threading a catheter to the malformation's feeder artery to block blood flow with glue)
```
82
treatment of hemorrhage
discontinue anticoagulants
anti hypertensive meds
intraventricular catheter
endovascular coil insertion
83
treatment of strokes in children
similar to adults
antithrombotic drugs in ischemic stroke
not enough research on tPA
84
primary goal of LT management of childhood stroke
prevent recurrence
85
how to prevent secondary stroke
antithrombotic drugs
aspirin
chronic blood transfusion
86
treatment of cerebral arteriopathy
anti inflammatory and immunosuppresive meds
| bone marrow transplant
87
when does the greatest degree recovery occur
soon after stroke
1-3 mons post > 4- 6 mos post
most recovery would happen by 1 year
88
independent risk factor for morbidity and mortality of stroke?
depression
89
Common complication of childhood stroke
Motor weakness, spasticity, dystonia
90
Do children with acute aphasia improve over time
yes
91
Patient fully recover after a stroke?
No. 70% of stroke survivors report persistent diffuse or non-use of their upper limb up to four years after stroke
92
Which type of aphasia is associated with higher incidence of frustration and depression after stroke?
higher incidence of depression and frustration in Broca's aphasia (possibly because but higher incidence of depression of the left frontal damage)
93
which age group has the poorest outcome after stroke?
after perinatal stroke
94
younger children are less likely to demonstrate...
classic aphasia symptoms or aphasia syndromes
95
focal lesions are NOT necessarily more benign for younger children
but it may result in less localizing and more diffuse pattern of impairment
96
endarterectomy
most well established intervention for carotid stenosis
97
lesion in area that is associated with worst cog outcome in childhood AIS (arterial ischemic stroke)
Left temporal and basal ganglia
98
CT is the least sensitive to
Acute ischemia
99
most common cause of childhood ischemic stroke?
cerebral arteriopathy #1
congenital heart disease also a common cause
100
cause of cerebral sinovenous thrombosis?
bacterial meningitis
