Lecture 4: Stroke I

Question 1

What percent of body weight is the brain

Answer 1

2%

Question 2

what areas requires high oxygen demand

Answer 2

brain, cardiac output, and total body oxygen

Question 3

which vessels are in the anterior 3/5 of the brain

Answer 3

internal carotids

Question 4

which vessels join to form the basilar artery and are in the posterior 2/5 of the brain ; run through the cerebellum and brainstem

Answer 4

vertebral arteries

Question 5

which artery is mainly assoc. with visual probs.

Answer 5

posterior cerebral artery

Question 6

which two molecules need to be continually fed to the brain for it to function properly

Answer 6

glucose and oxygen

Question 7

the brain has what type of neurons

Answer 7

aerobic

Question 8

oxidative stress can cause …

Answer 8

excess glutamate ( neurotoxic neurotransmitter) ; excess ic Ca -> compromised ic signaling; re-perfusion injury -> forms ROS causing mitochondrial dysfunction

Question 9

what is a less severe form of stroke ; brief period of inadequate cerebral perfusion

Answer 9

Transient Ischemic Attack (TIA)

Question 10

this attack involves sudden focal loss of neurologic function; rapid onset and resolution usually followed by full recovery in 24 hours

Answer 10

TIA

Question 11

this attack can be caused by intermittent vessel obstruction and temporary vasospasm

Answer 11

TIA

Question 12

what % of pts will have a full on stroke if TIA not treated

Answer 12

35 %

Question 13

These symptoms are of what disorder: hemiplegia, diplopia, transient loss of vision , vertigo, loss of speech, loss of understanding, loss of balance

Answer 13

TIA

Question 14

this is transient loss of vision ; blood flow issue to the eye where the vision blacks out and then comes back

Answer 14

Amaurosis fugax

Question 15

what is a differential Dx of TIA

Answer 15

migraines, seizures, hx of similar episodes

Question 16

what are some features of non TIA events

Answer 16

lightheadedness, chest tightness, stomach upset, Hx of similar episodes where TIA was ruled out , SPEED OF ONSET

Question 17

this is a disturbance of blood supply causing loss of brain function

Answer 17

stroke

Question 18

this is the #4 cause of death in the US and #6 worldwide

Answer 18

stroke

Question 19

what are people who are at high risk for stroke

Answer 19

older adults ( >65 usually), African americans, american indians, Alaska natives, low level education, Southeast US

Question 20

what are some risk factors for Stroke

Answer 20

HTN ( modifiable), Age, Patent foramen ovale , etc

Question 21

this describes a structure that is congenital and delivers oxygenated blood from mother into the arterial circulation of the fetus- it should close after birth and sometimes it doesn’t- when it doesn’t the venous circulation passes into the arterial circulation

Answer 21

patent foramen ovale

Question 22

what are the two types of strokes

Answer 22

ischemic and hemorrhagic

Question 23

which type of stroke is more common ( 80-85 %) and has mortality rate of 40%

Answer 23

ischemic ( blood supply has been cut off in some way)

Question 24

which type of stroke is less common ( 15-20%) and has mortality rate of 80%

Answer 24

hemorrhagic ( when a bv burst or breaks open and blood leaks into other areas)

Question 25

what is the most common cerebral artery affected by CVA

Answer 25

Middle Cerebral Artery

Question 26

with ischemic stroke , what are the diff types of blood vessel occlusions you can have

Answer 26

thrombotic, embolic, lacunar, and dissection ( carotid or vertebral)

Question 27

with ischemic stroke , what are the diff types of systemic hypoperfusion you can have

Answer 27

pump failure, and hypovolemia

Question 28

these areas of ischemic stroke are most at risk areas; no redundant blood supply ; minimally perfused area ; between major arteries

Answer 28

watershed areas

Question 29

this area of ischemic stoke has blood flow

Answer 29

ischemic core

Question 30

this area of ischemic stroke has blood flow between 40-15 % normal ; least severe pt of CVA' some collateral blood flow possible

Answer 30

ischemic penumbra

Question 31

this disorder involves plaque fragments from carotids; chronic atrial fibrillation; fat particles; gas bubbles; bacterial endocarditis; IV substance abuse

Answer 31

embolic stroke

Question 32

this type of stroke deals with intracranial artery rupture ( hypoxic and hydraulic damage)

Answer 32

hemorrhagic stroke

Question 33

common causes of this stroke include HTN, aneurysm , AV malformation, and trauma; sudden onset and severe

Answer 33

hemorrhagic stroke

Question 34

what are the two locations of a hemorrhagic stroke

Answer 34

extra-axial ( outside brain tissue) and intra- axial ( inside brain tissue)

Question 35

what are the three locations of an extra-axial hemorrhagic stroke

Answer 35

epidural, subdural, and subarachnoid

Question 36

this type of extra- axial hemorrhagic stroke is caused by head trauma and involves the middle meningeal artery

Answer 36

epidural

Question 37

this type of extra- axial hemorrhagic stroke is usually due to acceleration/deceleration injury and is found in elderly and alcoholics

Answer 37

subdural

Question 38

this type of extra- axial hemorrhagic stroke is congenital or traumatic and can cause severe HA -> papilledema

Answer 38

subarachnoid

Question 39

this type of hemorrhagic stroke involves rupture and hemorrhage into the brain ( hypoxic and hydraulic injury )

Answer 39

intra-axial cerebral hemorrhagic stroke

Question 40

these disorders are associ with what type of hemorrhagic stroke: HTN, AVM, Berry aneurysms, trauma

Answer 40

Intra-axial cerebral hemorrhagic stroke

Question 41

what % of strokes happen in adults less than 65 YO

Answer 41

25 % ( majority are ischemic) , 45% are hemorrhagic

Question 42

what causes strokes in adults less than 65 YO

Answer 42

trauma, oral contraceptives, pregnancy, post partum, HTN, DM, obesity, smoking, atherosclerosis

Question 43

which two types of ischemic strokes are involved in young adults

Answer 43

carotid artery and vertebral artery dissection

Question 44

this type of dissection can be traumatic or spontaneous; symptoms include HA or neck pain, horners syndrome, transient vision loss, ischemic stroke

Answer 44

carotid artery dissection

Question 45

this type of dissection is similar to carotid artery dissection

Answer 45

vertebral artery dissection

Question 46

what is it called when the intenal wall of the bv becomes compromised from a tear and the blood pushes over the inner lining and causes a fake valve to occur and cuts off blood supply

Answer 46

dissection