Chapter 9 - Cerebrovascular Disorders

Question 1

Brain lesions

Answer 1

• pathologic or traumatic discontinuity of brain tissue
• entails a loss of function
• caused by trauma or disease
• recovery can occur if neurons are not killed

Question 2

Anoxia

Answer 2

• complete absence of O2 supply to the brain that can cause neuron death
• caused by things like heart attacks, near-drowning, CO poisoning

Question 3

Hypoxia

Answer 3

• reduced but not complete absence of O2 supply to the brain that causes altered function of neurons
• caused by acute cardiac crisis or high elevations

Question 4

Hydrocephalus

Answer 4

• ventricles abnormally enlarged due to increased/decreased CSF production/absorption, or blockage of CSF flow
• nausea, headache, etc

Question 5

Communicating hydrocephalus

Answer 5

presence of blood mixing w/ CSF due to hemorrhage or infection
- interferes w/ the reabsorption of CSF

Question 6

Obstructive hydrocephalus

Answer 6

blockage of the circulation of CSF
- tumors, children can be born with this, etc

Question 7

Stroke (CVA)

Answer 7

• brain damage as a result of reduced blood flow w/n and to the brain
• highly variable symptoms like weakness, partial paralysis, headache, double vision, etc

Question 8

Transient Ischemic Attack

Answer 8

• temporary lack of O2 to the brain
• time-limited set of symptoms like weakness, headache, double vision, confusion, etc
• does not kill neurons, so not considered a stroke, recovery w/n 24 hours

Question 9

Do infarctions cause neuronal death?

Answer 9

yes

Question 10

Thrombosis

Answer 10

• type of infarction
• clot/thrombus forms in and obstructs an artery
• most commonly seen in the middle cerebral artery

Question 11

What is a common cause of a thrombosis?

Answer 11

atherosclerosis - buildup of plaque in arteries

Question 12

Embolism

Answer 12

• type of infarction
• clot forms in one area of the body and travels to another
• a.k.a. traveling thrombosis

Question 13

Hemorrhage

Answer 13

• rupturing of a blood vessel, puts pressure on surrounding tissue
• usually occurs during waking hours
• very poor prognosis

Question 14

What is usually the first diagnostic test given to diagnose cerebrovascular disease?

Answer 14

• CT scan
• can distinguish btwn hemorrhagic and non-hemorrhagic stroke

Question 15

What is the most accurate diagnostic test given to diagnose cerebrovascular disease?

Answer 15

angiography

Question 16

What factors are involved in stroke recovery?

Answer 16

• size of blood vessel (major artery=more damage)
• remaining intact vessels (account for level of compensation)
• premorbid factors (health and family Hx)
• location (determines symptoms and Tx)

Question 17

What are some treatments for cerebrovascular disease?

Answer 17

• anticoagulants to dissolve blood clots
• blood pressure medications
• surgery

Question 18

Tissue plasminogen activator (tPA)

Answer 18

• breaks down clot
• only eligible if admitted w/n 4 hours
• FDA approved

Question 19

What are some preventions for cerebrovascular disease?

Answer 19

• lifestyle changes like exercising, healthy eating, lowering alcohol intake, no smoking, etc.

Question 20

Disinhibition

Answer 20

• cognitive impairment seen in strokes
• lack of inhibition and insight, impulsiveness

Question 21

Attentional deficits

Answer 21

• cognitive impairment seen in strokes
• difficulty sustaining attention, with selective attention
• easily distracted

Question 22

Motor and sensory impairment

Answer 22

• cognitive impairment seen in strokes
• contralateral to side of stroke
• general slowing of movements, difficulty moving, potential paralysis
• deficits in senses

Question 23

Memory problems

Answer 23

• cognitive impairment seen in strokes, especially if hippocampus is affected
• recently created memories are typically lost
• limbic system is very vulnerable

Question 24

Deficits in abstract reasoning

Answer 24

• cognitive impairment seen in strokes
• if frontal area is affected:
  
  • difficulty planning, problem solving, forming new concepts, etc.

Question 25

What are the cognitive deficits seen in right brain strokes?

Answer 25

• symptoms are more subtle, making them harder to diagnose
• spatial and nonverbal processing deficits
• contralateral motor and sensory impairment
• emotional and visuospatial deficits

Question 26

What are the cognitive deficits seen in left brain strokes?

Answer 26

• commonly caused by blockage of middle cerebral artery
• R side weakness or paralysis
• impairment in speaking or understanding speech
• impairment of written language

Question 27

Depression

Answer 27

• common after L side stroke
• pt. mourns loss of function
• occurs 6-12 mnths after stroke

Question 28

Apathy

Answer 28

• common after R side stroke
• pt. becomes less expressive, monotonous

Question 29

Euphoria

Answer 29

• common after R side stroke
• pt. will act as if nothing has happened

Question 30

Impulsive emotional and behavioral displays

Answer 30

• more likely to occur after a R side stroke, but can occur after L as well
• EX: taking more time before speaking, odd eating behaviors

Question 31

What other emotional and behavioral changes can occur after a stroke?

Answer 31

• lack of initiation/motivation
• poor judgement (damage to frontal lobe)
• apraxias