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Clinical Neuro and Rehab > Stroke > Flashcards

Stroke Flashcards

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1
Q

What is the definition of a stroke?

A

a neurological deficit attributed to an acute focal injury of the CNA by a vascular cause

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2
Q

How much of the total energy generated in the body does the brain consume?

A

20%

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3
Q

How much of the cardiac output is directed to the brain?

A

15-20%

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4
Q

What are the brains tough protective layers?

A

-dura

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5
Q

What % of deaths in the UK are caused by strokes?

A

10%

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6
Q

What is a stroke caused by?

A

Inadequate tissue perfusion - ischaemia

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7
Q

Why is the brain particularly sensitive to ischaemia?

A

because neurons in the brain have a high metabolic rate + can only survive a few minutes without oxygen

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8
Q

What is tissue death as a result of ischaemia called?

A

infarction

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9
Q

What occurs during a stroke in the brain?

A

an area of the brain tissue loses its blood supply and consequently stops functioning

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10
Q

What is a hallmark of a stroke?

A

Sudden onset of focal neurological deficits

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11
Q

What happens during a stroke to an individual physically?

A

F-lop-sided or numb on one side
A-one arm is week or numb
S-speech is slurred
T-Time-rapid treatment is important

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12
Q

What are the two major types of stroke?

A

Ischemic (85% of stokes)
Haemorrhagic (15%)

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13
Q

What is the cause of a ischemic stroke?

A

reduced blood flow to a particular part of the brain usually following occlusion (blockage of a cerebral artery)

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14
Q

What is the cause of a haemorrhagic stroke?

A

ruptured blood vessel commonly associated with high blood pressure and diseases that weaken the arterial wall

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15
Q

What are the different types of Ischemic stroke?

A

-Ischemic large vessel
-Ischemic small vessel
-Transient Ischemic Attack

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16
Q

What is the cause of a ischemic large vessel stroke?

A

-cerebral blood vessel blocked by an embolus often a small piece of coagulated blood that originates from the heart (cardioembolic stroke)

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17
Q

Why does a blockage of a bigger blood vessel cause more damage?

A

-big vessels supply smaller vessels = larger the area that the blood supplies too
-size of stroke= size of vessel that is blocked

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18
Q

What is the ischaemic penumbra?

A

The area of brain tissue that lies around the core of the stroke

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19
Q

What happens an hour after the stroke onset after a ischemic large vessel stroke?

A

a core lesion is established in which the blood flow is below 20%
-the ischaemic penumbra has a marginally better blood flow (20-40%)

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20
Q

what causes the lesion to expand?

A

if blood flow is not restored to the core lesion

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21
Q

What is the cause of an ischemic small vessel stroke?

A

Hardening of the arteries meaning the vessels cannot respond to blood flow leading to lacunar infracts (holes/gaps)

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22
Q

What are ischemic small vessel strokes associated with?

A

arterial hypertension
diabetes
smoking
increased cholesterol

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23
Q

Where are small vessel strokes usually located?

A

in the basal ganglia or internal capsule

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24
Q

What is a transient Ischemic attack?

A

A brief period of cerebral ischemia but neurologically reversible

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25
How long does it take for symptoms to reverse during a transient ischemic attack?
minutes (by definition it never lasts longer than 24hrs)
26
What does neuroimaging evidence suggest regarding transient ischemic attacks?
permanent damage occurs in 10-20% of cases
27
What are transient ischemic attacks associated with?
increased risk of stroke and heart attack
28
What are the different types of haemorrhagic strokes?
-Spontaneous intracerebral haemorrhage -Burst aneurysm -Subarachnoid Haemorrhage
29
What is a burst aneurysm caused by?
a weakening of an artery wall causing bulge/balloon of the vessel, making the vessel walls weak and potentially bursting
30
How many haemorrhagic strokes are caused by a burst aneurysm?
A third
31
What is the most common cause of a subarachnoid haemorrhage?
A ruptured berry aneurysm- a small vascular swelling which develop at congenital weak spots in the arterial wall usually found where blood vessels branch especially in the Circle of Willis
32
How does a subarachnoid haemorrhage present itself?
As a severe headache
33
what is 1st degree damage of haemorrhagic due to?
compression by the hematoma and an increase in the intracranial pressure
34
What is the second degree damage of haemorrhagic due to?
inflammation, disruption of the blood-brain barrier, edema, over production of free radicals such as reactive oxygen species, glutamate-induced excitotoxicity and release of haemoglobin + iron from the clot
35
What are the two major arteries that carry blood to the brain?
Carotid artery vertebral/basilar activity (meet at the base of the skull and form the circle of willis)
36
What does the circle of willis do?
Creates circulation territory where you find the consequences of stroke
37
What does the internal carotid artery divide into?
middle cerebral artery anterior cerebral artery
38
What are the properties of the middle cerebral artery?
Larger and receives 80% of internal carotid artery blood flow -therefore, cardiogenic emboli are much more likely to enter the middle cerebral artery than anterior
39
Where does the middle cerebral artery supply too?
most the motor and sensory cortex -where controls the contralateral arm and face -Wernicke's area -Broca's area -internal capsule -optic radiation
40
Where does the anterior cerebral artery supply too?
motor cortex controlling the leg frontal lobe corpus collosum anterior circulation territory
41
Where does the basilar artery ascend along?
Along the basal pons to reach the midbrain where it splits into two posterior cerebral arteries (Posterior cerebral arteries)
42
Where does the basal ganglia blood supply originate from?
the middle cerebral artery
43
How are ischemic strokes classified into 1 of 4 major clinical categories?
related to the areas that the anterior and posterior circulation system supply, based on the maximal deficit following a single stroke
44
Where does the basilar artery supply too?
occipital lobe brain stem midbrain thalamus cerebellum
45
What are the conditions of total anterior circulation syndrome? (TACS)
stroke affecting the whole ACS -new higher cortical dysfunction -homonymous visual field defect -sensorimotor deficit (must effect 2 out of the 3: face, arm leg)
46
What are the conditions of partial anterior circulation syndrome? (PACS)
infarction in the territory of one of the branches of the ACS -two out of the 3 elements of TACS -or higher cortical dysfunction alone -or limited sensorimotor deficit (affecting fewer than 2 of: face, arm, leg)
47
What are the 4 clinical categories ischemic strokes can be categorised into?
TACS - total anterior circulation syndrome PACS - partial anterior circulation syndrome POCS - posterior circulation syndrome LACS - lacunar syndrome
48
What are the conditions of posterior circulation syndrome? (POCS)
stroke affecting part of the posterior circulation -Cranial nerve + crossed sensorimotor deficit -or bilateral sensory/motor deficit -or a disorder of conjugate eye movement -or isolated cerebellar dysfunction/field defect
49
What are the conditions of lacunar syndrome?
resulting from the infarcts of small penetrating arteries that provides blood to the brains deep structures i.e. basal ganglia and thalamus -pure motor deficit -or pure sensory deficit -or sensorimotor deficit -or ataxic hemiparesis
50
What are all stroke syndromes likely to impact?
Motor system
51
What is the most important tract in humans for precise control of limbs?
Lateral corticospinal tract
52
Where does the lateral corticospinal tract originate from?
Primary motor cortex promotor cortex somatosensory area
53
What do neurons in the corticospinal tract make direct contact with that makes the muscles contract?
alpha motor neurons in the spine
54
54
What are the treatments of stroke?
Clot busting drugs- thrombolysis (need to be delivered very rapidly, within 4-5hrs) medical treatment = thrombectomy (only effective in treating ischemic strokes caused by a clot in a large artery in the brain)
55
What does the functional localisation theory suggest?
different areas in the brain are specialised for different functions
56
What is meant by lateralisation?
localisation specific to one hemisphere
57
What is speech?
an intricate orchestration of multiple effectors (articulators) coordinated in time and space to produce sound sequences
58
What were the events of Paul Broca study that lead to the development of the Broca's area?
51 year old patient had lost their speech and could only say 'Tan' following brain damage
59
What is Broca's aphasia?
-a type of aphasia (language disorder after stroke) with effortful speech e.g. understanding is good but finding the word is difficult, intelligence remains intact
60
What is the cause of aphasia in the Wernicke's area?
A type of aphasia (language disorder after stroke) with poor communication -speech is effortless but the meaning is impaired - speech doesn't make sense
61
What is transcranial magnetic stimulation be used for?
interrupt brain function in the targeted areas for the duration of stimulation
62
What is the problem with speech and language understanding being lateralised and produced in separate areas?
Small lesions can have big consequences
63
Where is language lateralised?
On the left -areas that produce and understand speech are in different areas of the left hemipshere
64

Clinical Neuro and Rehab (7 decks)

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