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Brain and Behavior Exam 3 > Lec 60 Clinical Aspects of Stroke > Flashcards

Lec 60 Clinical Aspects of Stroke Flashcards

1
Q

What is mortality from stroke?

A

20%

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2
Q

What is definition stroke?

A

acute neuro dysfunction of vascular origin with sudden [seconds] or rapid [hrs] occurence of symptoms and signs coresponding to involvement of focal areas of brain

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3
Q

What are two main types of stroke?

A

ischemic and hemorrhagic

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4
Q

What are risk factors for stroke?

A
  • HTN
  • heart disease
  • previous stroke
  • diabetes
  • carotid bruit
  • smoking
  • oral contraceptives
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5
Q

What are non-modifiable risk factors for stroke?

A

hispanic and african american
diabetes
male gender
over age 55

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6
Q

What diseases should you think if you see sudden onset persistent focal deficit?

A
  • ischemic stroke
  • intracerebral hemorrhage
  • partial seizure
  • tumor or abscess with bleed
  • hypoglycemia
  • MS
  • migraine
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7
Q

What is ischemic stroke?

A

blood supply to focal part of brain interrupted, brain cells deprived of glucose and oxygen

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8
Q

What are major causes of ischemic stroke?

A
  • small or large artery thrombus

- embolus

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9
Q

What is acute treatment for ischemic stroke?

A

thrombolysis

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10
Q

What are the 5 categories of ischemic stroke?

A
  • large artery atherosclerosis
  • embolism
  • small vessel disease
  • stroke of other determined etiology
  • stroke of undetermined etiology
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11
Q

What are lacunar infarcts?

A

small infarcts defined by small size, typically in deep structure such as internal capsule, basal ganglia, thalamus, brainstem

secondary to chronic hypertension

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12
Q

What happens if you have lesion of either frontal lobe?

A

intellectual impairment
personality change
urinary incontinence
hemiparesis

if left = broca’s aphasia

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13
Q

What is effect of lesion to left temporo-parietal?

A 
alexia
agraphia
wernicke's aphasia
right-left disorientation
homonymous field defect
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14
Q

What is effect of lesion to right temporal?

A

confusional state
failure to recognize faces
homonymous field defect

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15
Q

What is effect of lesion to either parietal?

A

contralateral sensory loss or neglet
agraphaesthesia
homonymous field defect

if right:

  • dressing apraxia
  • failure to recognize faces

if left:
limb apraxia

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16
Q

What is effect of lesion to occipital?

A

visual field defects
visuospatial defects
disturbance of visual recognition

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17
Q

What areas of brain affected by MCA [middle cerebral artery] stroke?

A

motor cortex of upper limb and face

sensory cortex of upper limb and face

temporal lobe [wernicke]; frontal lobe [broca]

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18
Q

What are symptoms of MCA stroke?

A

contralateral paralysis - upper limb and face

contralateral loss of sensation – upper and lower limb and face

aphasia – if in left hem [dominant]
hemi- neglect – if in right hem

– posterior frontal, temporal, parietal lobes

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19
Q

What are symptoms of ACA stroke?

A

contralateral paralysis – lower limb

contralateral loss of sensation – lower limb

[sensory + motor cortex involved]

– frontal pole, mesial frontal lobe

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20
Q

Between ACA and MCA stroke which has more leg paralysis/sensation loss?

A

MCA!

Arm = ACA
leg = MCA
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21
Q

What are symptoms of lenticulo-striate artery stroke?

A

contralateral hemiparesis/ hemiplegia

= common location of lacunar infarcts secondary to chronic HTN

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22
Q

What are signs of left [dominant] cerebral hemisphere stroke?

A 
aphasia
left gaze preference
right visual field deficit
right hemiparesis
right hemisensory loss
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23
Q

What are signs of right [non-dominant] cerebral hemisphere stroke?

A 
neglect = left hemi-inattention
right gaze preference
left visual field deficit
left hemiparesis
left hemisensory loss
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24
Q

What are symptoms of internal carotid artery occlusion?

A
  • produces ACA and MCA symptoms
  • preceded by amarosis fugax = monocular visual loss due to temporary reduction in retinal artery/opthalmic artery/ciliary artery blood flow = curtain coming down on vision
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25
Q

What are symptoms of posterior cerebral artery stroke?

A

contralateral homonymous hemianopia with macular sparing

if dominant = get alexia without agraphia

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26
Q

What is alexia?

A

acquired dyslexia = cant understand writing

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27
Q

What happens if stroke affecting PCA bilaterally?

A

anton’s syndrome = cortical blindness = pt blind but unaware of deficit

28
Q

What part of brain is affected if PCA stroke?

A

occipital lobe

29
Q

What are symptoms of basilar artery stroke?

A

have: preserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth, tongue movements

== locked-in syndrome

30
Q

Do emboli more frequently cause stroke in posterior or anterior circulation?

A

anterior circulation

thus –> most posterior circulation strokes due to thrombi

31
Q

What are symptoms of PICA stroke?

A

wallenberg [lateral medullary] syndrome –> N/V, headache ataxia, ipsilateral paralysis of tongue, dysphagia, hoarseness, decreased gag reflex, ipsilateral horner syndrome, lost pain and temp sensation from ipsilateral face and contralateral body

don’t pick a [PICA] horse [hoarseness] that can’t eat [dysphagia]

32
Q

Nucelus ambiguus effects are specific to which artery lesion?

A

PICA lesion

“Don’t pick a [PICA] horse [hoarseness] that can’t eat [dysphagia]”

33
Q

What part of brain is affect by PICA stroke?

A

lateral medullar [vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus]

34
Q

What types of artery strokes will cause acute cerebellar infarction?

A

PICA, AICA, SCA

can develop life-threatening edema

35
Q

What is a carotid artery dissection?

A

separation of layers of artery wall supplying blood to head and brain
blood can enter separation between layers –> cause occlusion and ischemia

can be spontaneous or traumatic

36
Q

What are symptoms of carotid artery dissection?

A 
headache
neck pain
horners syndrome
transient vision loss
ischemic stroke
37
Q

What are signs of anterior inferior cerebellar artery stroke?

A

lateral pontine syndrome
- N/V, paralysis of face, decreased lacrimation, salivation, taste from anterior 2/3 tongue, corneal reflex, ipsilateral horner syndrome, ipsilateral hearing loss

38
Q

Facial nucleus effects are specific to which artery lesion?

A

AICA lesion

“facial droop means AICA’s pooped”

39
Q

lateral pontine syndrome comes from which type of artery lesion?

A

AICA

40
Q

lateral medullary syndrome [wallenberg] occurs with which type of artery lesion?

A

PICA

41
Q

medial medullary syndrome occurs with which type of artery lesion?

A

ASA

42
Q

What are signs of anterior spinal artery stroke?

A 
medial medullary syndrome 
- contralateral hemiparesis [upper and lower limbs]
- decreased contralateral proprioception
ipsilateral hypoglossal dysfunction
--> tongue deviates ipsilaterally
43
Q

What specific lesions in ASA stroke common?

A

commonly bilateral

- caused by infarct paramedian branches of ASA and vertebral arteries

44
Q

What part of brain affected by ASA stroke?

A

lateral corticospinal tract
medial lemniscus
caudal medulla [hypoglossal]

45
Q

What is a transient ischemic attack [TIA]?

A

reversible focal dysfunction –> usually lasts minutes but defined as < 24 hrs [stroke = more time]

46
Q

What usually causes a subarachnoid hemorrhage?

A

trauma,
ruptured aneurysm [berry, marfans]
arteriovenous malformation

47
Q

What happens in subarachnoid hemorrhage?

A
  • rapid time course
  • “worst headache of life”
  • —> neck stiffness, neck pain, light intolerance, N/V
  • bloody or yellow spinal tap
  • 2-3 days after –> risk of vasopasm due to blood breakdown and rebleed
48
Q

What do you see with subarachnoid hemorrhage on CT?

A

subarachnoid blood in sulci

intraventricular blood layering in posterior horn of lateral ventricle

49
Q

How do you treat subarachnoid hemorrhage?

A

surgical emergency

- cerebral angiography, aneurysmal clipping/ interventional coiling

50
Q

What usually causes mycotic aneurysm

A

infection, bacteremia, septic embolization

51
Q

What is charcot-bouchard?

A

microaneurysm
associated with chronic HTN
affects small vessel [lenticulostriates]

52
Q

Where does berry aneurysm usually occur?

A

branch point in circle of willis

–> junction anterior communicating artery and anterior cerebral artery

53
Q

What are risk factors for aneurysm?

A

chronic HTN, smoking, family history

54
Q

How do you treat aneurysm?

A

surgical emergency

55
Q

What is intracerebral hemorrhage?

A

occurs when blood vessel in brain parenchyma ruptures –> accumulation blood within brain tissue

56
Q

WHat are most common sites for intraparenchymal hemorrhage?

A 
thalamus
basal ganglia
internal capsule
pons
cerebellum
 == charcot-bouchard of lenticulostriate vessels

but can also be lobar

57
Q

What commonly causes lobar hemorrhages [not subcortical]?

A

amyloid angiopathy

58
Q

What causes intraparenchymal/intracerebral hemorrhage?

A

systemic hypertension
amyloid angiopathy
vasculitis
neoplasm

59
Q

What are complications of reversible cebreal vasoconstriction syndrome [RCVS]?

A
  • TIA
  • ischemic stroke
  • intracerebral hemorrhage
  • berry aneuryism
60
Q

Does early ischemic infarct show on CT?

A

may not!

61
Q

When do you treat stroke with tPA [tissue plasminogen activator]?

A
  • if within 3-4.5 hr of onset and no hemorrhage/risk of hemorrhage
62
Q

Are most strokes ischemic or hemorrhagic? most common cause?

A

mostly ischemic

mostly due to clot occluding an artery

63
Q

What is treatment at < 3 hours after stroke?

A

IV tPA [tissue plasminogen activator]?

64
Q

What is treatment at 3-6 hrs after stroke?

A

IA tPA

combination bridging IV /IA tPA

65
Q

What is treatment at > 6 hrs after stroke?

A

mechanical clot extraction

66
Q

What are potential drawbacks of IV thrombolysis?

A
  • reperfusion injury
  • risk of ICH
  • low rate recanalization
  • high rate reocclusion
67
Q

What are benefits/drawbacks of IA [intra-arterial] thrombolysis?

A

benefits: greater freq of recanalization, can use lower dose of thrombolytic, deliver agent directly to site of occlusion
drawbacks: additional risks of angiogram, increased “door to needle” time

Brain and Behavior Exam 3 (32 decks)

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