Stroke Flashcards
1
Q
What is a stroke?
A
- Cerebral vascular accident
- Sudden vascular event leading to disruption of blood flow to part of the brain and destruction of surrounding brain tissue
2
Q
T/F: After a stroke there is a rapid onset of neurological deficit
A
True
- Leading cause of serious long term disability
3
Q
What is a Transient Ischemic Attack?
A
Focal neurological symptoms, similar to stroke, but with resolution of neurological symptoms within 24 hours
4
Q
The etiology for Transient Ischemic Attack is same as what disorder? And what may it be confused with?
A
- Etiology is the same as stroke
- May be confused with minor ischemic stroke
5
Q
15% of all stroke are preceded by what?
A
Transient Ischemic Attack
6
Q
What is the early management of Transient Ischemic Attack?
A
- Imaging
- Close observation
- Blood thinners
7
Q
What are some potentially modifiable risk factors of stroke?
A
- HTN
- Cardiovascular disease
- Atrial Fibrillation
- DM (Type II)
- Smoking
- Alcohol / Cocaine use
- Medication
- Physical inactivity
- Obesity
- Diet
8
Q
What is the greatest non-modifiable risk factor for stroke?
A
-Age
- Risk double each decade after 55 yr
9
Q
What are some non-modifiable risk factor for stroke?
A
- Race
- Gender
- Family history (stroke, sickle cell disease, genetic predisposition)
10
Q
What are the early warning signs for stroke?
A
- BE FAST
- Loss of BALANCE, headache, dizziness
- EYES: blurred vision
- one side of the FACE is drooping
- ARM or leg weakness
- SPEECH difficulty
- TIME to call for ambulance immediately
11
Q
In regards to pathogenesis of Ischemic Stroke there is a loss of blood supply so what happens as a result of:
- No blood flow?
- Reduced blood flow?
A
- No blood flow can lead to neuronal cell death (core/infarct)
- Reduced blood flow can lead to ischemic penumbra
12
Q
What is an ischemic penumbra?
A
An area of damaged tissue surrounding the area of infarct
13
Q
Inflammatory processes in the penumbra can expand what?
A
initial lesion
14
Q
T/F: Even if blood flow is restored to ischemic area the damaged tissue can not recover
A
False
- If blood flow is restored to the ischemic area before irreversible damage occurs the tissue may recover
15
Q
What are the inflammatory processes that occur in the penumbra?
A
- Change to blood brain barrier causes leukocyte infiltration
- Activated glial and endothelial cells cause free radicals to be released, cytokines, chemokine & enzymes
16
Q
Inflammatory processes that occur in the penumbra lead to what?
A
Neuronal cell death within the ischemic penumbra
17
Q
Pathogenesis: Ischemic Stroke
What is Atherosclerotic Cerebrovascular Disease?
A
- Major Artery Occlusion
- Plaque forms in vessel walls
18
Q
What happens physiologically due Atherosclerotic Cerebrovascular Disease?
A
- Carotid & Vertebrobasilar system involved
- Decreased compliance & flow
- May form thrombus –> occlusion or embolism
19
Q
What is the most common source of embolism?
A
heart
20
Q
Pathogenesis: Ischemic Stroke
Atrial fibrillation can lead to what?
A
Clot formation
21
Q
Embolism form from what type of arteries?
A
- Atherosclerotic
(Carotid & Vertebrobasilar)
22
Q
(BLANK) and (BLANK) can promote thickening of small vessel walls leading to Lacunar infarcts.
A
HTN and DM
23
Q
Small vessel infarct can be due to what?
A
- Ischemic necrosis
- Cysts
- Gliosis
24
Q
What areas can Lacunar infarcts affect?
A
- Basal Ganglia
- Internal Capsule
- Pons
25
Lacunar infarcts is also known as?
Small vessel disease
26
What are the two type of hemorrhagic stroke?
1. Intracerebral hemorrhage
2. Subarachnoid hemorrhage
27
What is an intracerebral hemorrhage?
Bleeding from artery into brain parenchyma
28
What is a subarachnoid hemorrhage?
Bleeding from artery into sub arachnoid space
29
In regards to Intracerebral hemorrhage how does HTN lead to microvascular disease?
- Weaken arterial vessel walls
- Forms small aneurysms (micro aneurysms)
- Prone to leakage or rupture
30
What vessels are affected by intracerebral hemorrhage?
- Distal (small) vessels
- Arteriole branches
- Penetrating arteries of circle of Willis
31
What event precipitates intracerebral hemorrhage?
Acute increase in BP or blood flow
32
What type of hemorrhage can a Berry aneurysm cause?
Subarachnoid hemorrhage
33
What is a Berry aneurysm? And where can they occur?
- Congenital distention at bifurcation
- Occur at Circle of Willis
34
Venous or Cavernous Malformation can cause what type of hemorrhage?
Subarachnoid hemorrhage
35
What is an A-V Malformation? What type of hemorrhage can this cause?
- Direct artery to vein without capillary bed
- Subarachnoid hemorrhage
36
What are three risk factors/causes of chronic subdural hemorrhage?
- Elderly
- Cerebral atrophy (increase movement between brain & skull)
- Minor fall (trauma)
37
Tearing of (BLANK) can cause subdural hemorrhage
Bridging veins
38
Torn meningeal artery in periosteal layer of dura leads to what?
Epidural hematoma
39
What does an epidural hematoma typically occur with?
Traumatic skull fracture
40
In an epidural hematoma what does pooling of blood cause?
Compression of the brain
41
What is the onset of ischemic stroke?
What vasculature is involved?
- Sudden, evolving
- Blocked artery
42
What is the onset of intracerebral hemorrhage? What vasculature is involved?
- Gradual or sudden
- Mircorvasculature
43
What is the onset of subarachnoid hemorrhage? What vasculature is involved?
- Gradual if leak precedes rupture
- Or sudden
- Arterial
44
What is the onset of subdural hemorrhage? What vasculature is involved?
- Gradual
- Venous (bridging)
45
What is the onset of epidural hemorrhage? What vasculature is involved?
- Sudden/ trauma
- Arterial (meningeal)
46
What are the symptoms and prognosis of ischemic stroke?
- Sym: Sudden, progressive focal deficits
- Prog: Survival better than hemorrhage
47
What are the symptoms and prognosis of intracerebral hemorrhage?
- Sym: Focal deficits, headache, increased ICP
- Prog: High mortality; good recovery among survivors
48
What are the symptoms and prognosis of subarachnoid hemorrhage?
- Sym: Generalized symptoms, headache, increased ICP
- Prog: Variable with size, high mortality/ poor recovery in the elderly
49
What are the symptoms and prognosis of subdural hemorrhage?
- Sym: Headache, changes in mental status
- Prog: Acute worse than chronic
50
What are the symptoms and prognosis of epidural hemorrhage?
- Sym: Compression of brain causes symptoms
- Prog: Medical emergency, risk of death
51
T/F: The more distal the stroke = more hypoxic tissue
False
- More proximal the stroke = hypoxic tissue
52
Usually the more proximal the stroke = more hypoxic tissue except where?
Circle of Willis
53
In a middle cerebral artery syndrome what are the symptoms on the contralateral side?
- UE > LE
- Hemiparesis/hemiplegia
- Hemianesthesia
54
Which hemisphere is affected with middle cerebral artery syndrome and what does this cause?
- Dominant hemisphere
- Global aphasia
55
What are the symptoms of a superior division middle cerebral artery syndrome?
- UE/ Face weakness
- Broca's aphasia
- +/- sensory loss
56
What are symptoms of an inferior division middle cerebral artery syndrome?
- Wernicke's aphasia
- +/- sensory loss
57
What are the symptoms of an anterior cerebral artery syndrome?
- Contralateral (LE > UE)
- Hemiparesis
- Hemianesthesia
58
Occlusion proximal to the anterior communicating artery leads to what?
Minimal dysfunction due to collateral flow
59
What symptoms are seen with an internal carotid artery syndrome?
MCA + ACA symptoms
60
Why may symptoms be minimal in an internal carotid artery syndrome?
Collateral flow
61
In a posterior cerebral artery syndrome, injury to the thalamic branches cause?
- Abnormal sensation
- Exaggerated: light touch = pain
62
In a posterior cerebral artery syndrome, injury to the occipital branches cause?
- Visual changes
- Homonymous hemianopia, visual agnosia
63
In a posterior cerebral artery syndrome, injury to the temporal branches causes?
Memory loss
64
In a posterior cerebral artery syndrome, injury to proximal occlusion before cerebral peduncle causes?
Contralateral hemiparesis/ hemiplegia
65
In a posterior cerebral artery syndrome, injury to proximal occlusion before red nucleus causes?
Contralateral ataxia
66
A lacunar syndrome to the internal capsule (posterior limb) cause what symptom?
Pure motor
67
A lacunar syndrome to the internal capsule (genu) cause what symptom?
- Weak face
- Dysarthria
68
A lacunar syndrome to the posterolateral thalamus causes what symptom?
Pure sensory
69
A lacunar syndrome to the basal ganglia causes what?
Movement disorder
70
*Vertebral & Posterior Inferior Cerebellar Artery Syndrome*
What are the symptoms of the Lateral medullary (Wallenberg's) Syndrome on the whole body?
- Vertigo
- Nausea
- Hoarseness
- Dysphagia
71
*Vertebral & Posterior Inferior Cerebellar Artery Syndrome*
What are the symptoms of the Lateral medullary (Wallenberg's) Syndrome on the ipsilateral side?
- Ataxia
- Ptosis
- Fascial sensory loss
72
*Vertebral & Posterior Inferior Cerebellar Artery Syndrome*
What are the symptoms of the Lateral medullary (Wallenberg's) Syndrome on the contralateral side?
Torso and limb sensory loss
73
*Vertebral & Posterior Inferior Cerebellar Artery Syndrome*
What are the symptoms of Medial medullary Syndrome on the contralateral side?
- Hemiparesis (arm, leg)
- Loss of proprioception
74
*Vertebral & Posterior Inferior Cerebellar Artery Syndrome*
What are the symptoms of Medial medullary Syndrome on the ipsilateral side?
Ipsilateral tongue weakness
75
What are the symptoms of the anterior inferior cerebellar?
- Ipsilateral hearing loss
- Vertigo/nystagmus
- Ipsilateral face / contralateral body pain & temp
- Fascial weakness
- Ataxia
76
What are the symptoms of the superior cerebellar syndrome?
- Ipsilateral ataxia
- Contralateral pain / temp loss (body, limbs, face)
77
Complete basilar artery syndrome causes?
locked in syndrome
78
What are the symptoms of complete basilar artery syndrome?
- Quadriplegia
- Lower bulbar palsy
- Mutism
79
What is spared in a complete basilar artery syndrome?
- Cognition
- Sensation
- Vertical eye movement
80
What are the symptoms of a partial basilar artery syndrome?
- Ataxia
- Clumsiness
- Weakness
81
What are some ways to diagnosis strokes?
- History
- CT
- MRI
- PET
- Doppler Ultrasound
82
What are the pros and cons of using a CT for diagnosing stroke?
- Pro: Fast & Convenient, can detect hemorrhage
- Con: Decreased detection of acute ischemic stroke
83
An MRI can detect (BLANK) within 2-6 hours
ischemic
84
An MRI can monitor what?
Ischemia / Evolution of stroke
85
T/F: A PET scan has higher sensitivity and earlier detection
True
86
What areas can be seen with a PET scan?
Areas of hypo metabolism or decreased blood flow
87
What is a doppler ultrasound used for in diagnosing stroke?
Carotid and vertebral arteries blood flow and identify plaque accumulation
88
How is a cerebral angiography performed?
- Invasive procedure
- Inject radiopaque contrast agent or dye in a vein or artery
- Series of x - rays are taken
89
What can a cerebral angiography help to diagnosis?
- Obstruction
- Stenosis
- Malformation
90
Which type of stroke can a thrombolytic agent be used?
Ischemic Stroke
91
When using a thrombolytic agent there is significantly more recovery if within (BLANK)
4.5 hours
92
There is a risk of what when using a thrombolytic agent?
Risk of hemorrhage
93
What thrombolytic agent is used in acute medical management of ischemic stroke?
Tissue plasminogen activator (t-PA)
94
T/F: a way to manage an acute ischemic is intracranial clot retrieval
True
95
What are some medical prophylaxis (preventive) treatment option of ischemic stroke?
- Anticoagulation therapy
- Control HTN
- Lipid lowering agents
- Neuroprotection
- Surgery (manage stenotic vessels)
96
When is carotid endarterectomy or stenting warranted?
If stenosis in carotid is > 70% (asymptomatic) or > 50% (symptomatic) in internal carotid then surgery is warranted
97
T/F: Loss of consciousness is a good prognostic indicator
False - Poor prognostic indicator
98
T/F: Once a patient has a stroke they are at risk for a recurrent stroke
True
99
90% of recovery of stroke occurs in 1st (BLANK) months
3 month
100
After a stroke functional recovery of movement patterns can occur for (BLANK) years
5 years
101
What is the medical management of other hemorrhage?
Neurosurgery
- Evacuate
- Repair aneurysm / malformation/ rupture
102
What are the medical management option of intracerebral hemorrhage?
- Control HTN
- Control ICP
- Manage Edema
- Surgical drainage
103
When should you treat HTN and what can be used when managing intracerebral hemorrhage?
- Treat sBP > 160 - 180 mmHG, dBP > 105 mmHG
- Rapid acting antihypertensive meds
104
When is surgical drainage performed when managing intracerebal hemorrhage?
- Large size
- Neurological deterioration
- Often performed with cerebellar hemorrhage due to risk of rapid deterioration
105
What are some symptoms of left (dominant) hemisphere stroke?
- Right hemiparesis
- Aphasia (receptive - Wernicke's or Expressive - Broca's or Global)
- Possible dysphagia
106
A patient with a left (dominant) hemisphere stroke tends to be (BLANK), (BLANK) & (BLANK) when approaching unfamiliar tasks
Slow, cautious & disorganized
107
- A patient with a left (dominant) hemisphere stroke may be easily (BLANK) & (BLANK) with communication difficulties
- Also individuals aware of problems often responds with (BLANK)
- Frustrated & angered
- Anxiety
108
A patient with a left (dominant) hemisphere stroke has problems with recognition of what?
objects, use of objects or word recall
109
T/F: A patient with a left hemisphere stroke is able to process information quickly in order to respond verbally or with gestures
- False
- Needs time to process information and time to respond either verbally or with gestures
110
T/F: A patient with a left hemisphere stroke can profit from gestures and non verbal instructions
True
111
Why is repetition necessary for patients with a left hemisphere stroke?
They have an impaired ability to retain info
112
What are some symptoms of right hemisphere stroke?
- Left hemiparesis
- Difficulty with spatial perceptual task
- Left sided neglect
- Thinking is disjoined
- Safety awareness is diminished
- Tends to move impulsively and not follow directions or cues
- Overestimates own abilities to perform task
- Judgment and integration of information is impaired
- May not be aware of error
113
T/F: A patient with a right hemisphere stroke profits more from gestures than verbal instruction
False
Profits more from verbal instructions than gestures
114
T/F: For a patient with a right hemisphere stroke repetition and consistency are very important and they need cues to take things one step at at time
True
115
Does a patient with a right hemisphere stroke have increased distractibility?
Yes
116
When managing an acute ischemic stroke at what BP should you intervene if the patient has not taken t-PA?
220/120
117
When managing an acute ischemic stroke, at what BP should you intervene if the patient has taken t-PA?
180/105
