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

Lec 60 Clinical Aspects of Stroke Flashcards

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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
What are symptoms of posterior cerebral artery stroke?
contralateral homonymous hemianopia with macular sparing | if dominant = get alexia without agraphia
26
What is alexia?
acquired dyslexia = cant understand writing
27
What happens if stroke affecting PCA bilaterally?
anton's syndrome = cortical blindness = pt blind but unaware of deficit
28
What part of brain is affected if PCA stroke?
occipital lobe
29
What are symptoms of basilar artery stroke?
have: preserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth, tongue movements == locked-in syndrome
30
Do emboli more frequently cause stroke in posterior or anterior circulation?
anterior circulation thus --> most posterior circulation strokes due to thrombi
31
What are symptoms of PICA stroke?
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
Nucelus ambiguus effects are specific to which artery lesion?
PICA lesion "Don't pick a [PICA] horse [hoarseness] that can't eat [dysphagia]"
33
What part of brain is affect by PICA stroke?
lateral medullar [vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus]
34
What types of artery strokes will cause acute cerebellar infarction?
PICA, AICA, SCA can develop life-threatening edema
35
What is a carotid artery dissection?
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
What are symptoms of carotid artery dissection?
``` headache neck pain horners syndrome transient vision loss ischemic stroke ```
37
What are signs of anterior inferior cerebellar artery stroke?
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
Facial nucleus effects are specific to which artery lesion?
AICA lesion | "facial droop means AICA's pooped"
39
lateral pontine syndrome comes from which type of artery lesion?
AICA
40
lateral medullary syndrome [wallenberg] occurs with which type of artery lesion?
PICA
41
medial medullary syndrome occurs with which type of artery lesion?
ASA
42
What are signs of anterior spinal artery stroke?
``` medial medullary syndrome - contralateral hemiparesis [upper and lower limbs] - decreased contralateral proprioception ipsilateral hypoglossal dysfunction --> tongue deviates ipsilaterally ```
43
What specific lesions in ASA stroke common?
commonly bilateral | - caused by infarct paramedian branches of ASA and vertebral arteries
44
What part of brain affected by ASA stroke?
lateral corticospinal tract medial lemniscus caudal medulla [hypoglossal]
45
What is a transient ischemic attack [TIA]?
reversible focal dysfunction --> usually lasts minutes but defined as < 24 hrs [stroke = more time]
46
What usually causes a subarachnoid hemorrhage?
trauma, ruptured aneurysm [berry, marfans] arteriovenous malformation
47
What happens in subarachnoid hemorrhage?
- 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
What do you see with subarachnoid hemorrhage on CT?
subarachnoid blood in sulci | intraventricular blood layering in posterior horn of lateral ventricle
49
How do you treat subarachnoid hemorrhage?
surgical emergency | - cerebral angiography, aneurysmal clipping/ interventional coiling
50
What usually causes mycotic aneurysm
infection, bacteremia, septic embolization
51
What is charcot-bouchard?
microaneurysm associated with chronic HTN affects small vessel [lenticulostriates]
52
Where does berry aneurysm usually occur?
branch point in circle of willis | --> junction anterior communicating artery and anterior cerebral artery
53
What are risk factors for aneurysm?
chronic HTN, smoking, family history
54
How do you treat aneurysm?
surgical emergency
55
What is intracerebral hemorrhage?
occurs when blood vessel in brain parenchyma ruptures --> accumulation blood within brain tissue
56
WHat are most common sites for intraparenchymal hemorrhage?
``` thalamus basal ganglia internal capsule pons cerebellum == charcot-bouchard of lenticulostriate vessels ``` but can also be lobar
57
What commonly causes lobar hemorrhages [not subcortical]?
amyloid angiopathy
58
What causes intraparenchymal/intracerebral hemorrhage?
systemic hypertension amyloid angiopathy vasculitis neoplasm
59
What are complications of reversible cebreal vasoconstriction syndrome [RCVS]?
- TIA - ischemic stroke - intracerebral hemorrhage - berry aneuryism
60
Does early ischemic infarct show on CT?
may not!
61
When do you treat stroke with tPA [tissue plasminogen activator]?
- if within 3-4.5 hr of onset and no hemorrhage/risk of hemorrhage
62
Are most strokes ischemic or hemorrhagic? most common cause?
mostly ischemic | mostly due to clot occluding an artery
63
What is treatment at < 3 hours after stroke?
IV tPA [tissue plasminogen activator]?
64
What is treatment at 3-6 hrs after stroke?
IA tPA | combination bridging IV /IA tPA
65
What is treatment at > 6 hrs after stroke?
mechanical clot extraction
66
What are potential drawbacks of IV thrombolysis?
- reperfusion injury - risk of ICH - low rate recanalization - high rate reocclusion
67
What are benefits/drawbacks of IA [intra-arterial] thrombolysis?
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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