Stroke

Question 1

What is a stroke?

Answer 1

Cerebral vascular accident (CVA) that results in brain tissue death

Question 2

What are the potential reasons that a stroke may occur?

Answer 2

Blood flow to an area of the brain is cutoff
Toxic blood comes into contact with brain tissue

Question 3

There are two types of hemorrhagic strokes based on location, what are they?

Answer 3

Subarachnoid (in the subarachnoid space)
Intracerebral (deep in the brain tissue)

Question 4

Subarachnoid hemorrhage details

Answer 4

Bleeding in the subarachnoid space
Most often caused by burst aneurysm

Question 5

During a hemmorhagic stroke, blood can also pool …

Answer 5

In the ventricles which can cause hydrocephalus

Question 6

Intracerebral hemmorhage features ….

Answer 6

Most common type
Blood vessel within the brain bursts
Often caused by hypertension and bleeding in small perforating arteries
Sometimes caused by Arteriovenous malformations (AVMs), typically a congenital jumbled mess of arteries

Question 7

What are the two types of ischemic stroke?

Answer 7

Embolic: clot that has broken off from somewhere and travelled
Thrombotic: Clot forms in the area of atherosclerosis
Both involve clots but one is stationary while the other is not

Question 8

What is a transient ischemic attack?

Answer 8

Blood flow to part of the brain stops for a short period of time
Appears suddenly and lasts less than 24 hours (Clot resolves on its own)
Generally no permanent damage

Question 9

What are some important stats about transient ischemic attacks?

Answer 9

40% of people who have a TIA will have a stroke
Nearly 1/2 of all strokes occur within the first few days after a TIA
Symptoms for TIA are similar to a stroke

Question 10

Which type of stroke is more common?

Answer 10

Ischemic

Question 11

Which type of stroke causes more deaths?

Answer 11

Ischemic

Question 12

Which type of stroke are you more likely to die from?

Answer 12

Hemmorhagic

Question 13

What are the signs and symptoms of a stroke?

Answer 13

Numbness/weakness
Confusion
Trouble speaking
Vision loss
Dizziness/poor balance
Severe headache

Question 14

What does the FAST acronym for strokes stand for?

Answer 14

Face drooping
Arm weakness
Speech difficulty
Time to call 911

Question 15

What are lifestyle factors that can reduce the risk for stroke?

Answer 15

Healthy diet
Physical activity
Eliminate smoking
Minimize alcohol consumption

Question 16

What medical factors increase the risk for stroke?

Answer 16

Hypertension
Afib (irregular and often fast heart movement)
Hypercholesterolemia
Diabetes
Circulation problems
Carotid artery diseases

Question 17

What are some uncontrollable factors that increase the risk for stroke?

Answer 17

Age > or equal to 55
Gender
Race (African American)
Family history
Previous stroke
Fibromuscular dysplasia
Patent foramen ovale

Question 18

What is acute stroke treatment for hemorrhagic stroke?

Answer 18

Stop the bleeding

Question 19

What is acute stroke treatment for ischemic stroke?

Answer 19

Remove the clot
Dissolve the clot

Question 20

What is small vessel disease?

Answer 20

Usually relates to ischemia in areas of the basal ganglia, thalamus, and internal capsule

Question 21

What is TIA (transient ischemic attack)?

Answer 21

“Mini-stroke” caused by a temporary deficiency of blood supply to the brain

Question 22

What is a stroke?

Answer 22

Disruption of blood flow to the brain that results in cell death

Question 23

What is r-TPA?

Answer 23

Protein that breaks down blood clots

Question 24

What is an intracerebral hemmorhage?

Answer 24

Hemorrhage in the brain, usually caused by a rupture of an artery

Question 25

What is a subarachnoid hemorrhage?

Answer 25

Hemorrhage within the meninges

Question 26

What is cerebral thrombosis?

Answer 26

A stationary blood clot along the wall of the blood vessel

Question 27

What is cerebral embolism?

Answer 27

All or part of a foreign material (usually blood clot) that travels through the bloodstream to a smaller vessel and gets stuck causing obstruction

Question 28

What are the three large arteries that supply the cerebral cortex?

Answer 28

ACA MCA PCA

Question 29

The ACA supplies the

Answer 29

Medial frontal and pariteal

Question 30

The MCA supplies the

Answer 30

Lateral cerebral hemispheres

Question 31

The PCA supplies the

Answer 31

Medial temporal and occipital lobes

Question 32

A PCA stroke typically leads to

Answer 32

Contralateral homonymous hemianopia Cut in the visual field, reading deficits

Question 33

What is MCA stroke?

Answer 33

Most common Occlusion of main branch leads to contralateral hemiplegia, hemianesthesia of arm, face, lower extremity Contralateral homonimous hemianopia If damage to left, global aphasia If damage to right, left neglect common

Question 34

MCA stroke in the left superior division causes....

Answer 34

Non fluent aphasia, deficits in language production

Question 35

MCA stroke in the left inferior division causes ....

Answer 35

Wernicke's aphasia, deficits in language comprehension

Question 36

MCA stroke in the deep division causes .....

Answer 36

Damage to the deep structures like the thalamus and basal ganglia

Question 37

ACA stroke causes ...

Answer 37

Motor and sensory issues on the contralateral side because it catches the motor strip Flat affect: no expression (catches the limbic system) Lack of motivation

Question 38

What are watershed strokes?

Answer 38

Strokes that occur in borders between cerebrovascular territories that are further from arterial supply

Question 39

What are the two types of watershed strokes and where do they occur?

Answer 39

ACA-MCA watershed stroke (between these two areas) MCA-PCA watershed stroke (between these two areas)

Question 40

What presentations do the two watershed strokes cause?

Answer 40

ACA-MCA: proximal arm and leg weakness, on the left > transcortical aphasia MCA-PCA: higher order visual processing deficits

Question 41

What are the 3 stages of recovery for stroke?

Answer 41

Acute: first hours to day or two after the stroke Subacute: few days or 1-2 weeks after stroke (typically inpatient rehab) Chronic: months to years after the stroke, typically 6 months after

Question 42

What is seen during the acute stage of stroke recovery?

Answer 42

Edema: swelling of brain tissue Excitotoxicity causing neuronal cell death (chem spill that messes up structure) Transneuronal degeneration: healthy neurons derived of input from damaged neurons Diaschisis: shock to areas, temporary loss of function from event Hypoperfusion in penumbral region: not getting bloodflow to surrounding areas

Question 43

What is seen during the subacute stage of stroke recovery?

Answer 43

Spontaneous recovery Edema resolves which contributes to recovery

Question 44

Why does spontaneous recovery occur during the subacute phase of stroke recovery?

Answer 44

Neuroplasticity Synaptogenesis: new connections made Regeneration of dendrites and axons Increased excitation of contralesional perilesional tissue: other side of brain helps take up functions of damaged areas that they previously worked together with

Question 45

What is seen during the chronic stage of stroke recovery?

Answer 45

Influence of intrinsic and extrinsic factors

Question 46

During the chronic phase of recovery, what are intrinsic factors that impact recovery?

Answer 46

Age at time of the stroke (younger = better prognosis) Lesion volume and location (larger lesion = poorer recovery) Vascular physiology (perfusion, blood flow returns to areas of stroke) White matter integrity (more connections = better recovery) Personality/other cognitive abilities

Question 47

During the chronic phase of recovery, what are some extrinsic factors that impact recovery?

Answer 47

1. Use, improve, or lose it (constraint-induced therapy, forced to use impacted side) 2. Specificity rebuilds targeted networks (work on what you want to see change in) 3. Salience is essential (increase attention to what you are working on) 4. Repetition and intensity influence learning and consolidation 5. Promote generalization, avoid interference