Stroke Flashcards
(145 cards)
1
Q
what is the scientific term for a stroke
A
cerebral vascular accident
2
Q
what is a stroke/CVA
A
sudden vascular event leading to disruption of blood flow to part of the brain and destruction of surrounding brain tissue
3
Q
when are neurological deficits present in a stroke patient
A
rapid onset
4
Q
what is the leading cause of serious long-term disability
A
stroke
5
Q
how many stroke per year
A
700,000
6
Q
what percentage of people (out of the stroke population) have their first stroke each year
A
75%
7
Q
what percentage of people (in the stroke population) have recurrent strokes
A
25%
8
Q
what is the leading cause of death
A
heart disease
9
Q
what is the second leading cause of death
A
cancer
10
Q
what is the third leading cause of death
A
chronic lover respiratory disease
11
Q
what is the fourth leading cause of death
A
stroke
12
Q
what are early warning signs of strokes (5)
A
- sudden weakness or numbness
- sudden vision change (in one eye)
- sudden difficulty speaking or understanding speech
- sudden severe headache
- unexplained dizziness, unsteadiness, falls
13
Q
what is the most common presentation for strokes
A
hemiplegic
14
Q
what does TIA stand for
A
transient ischemic attack
15
Q
what is a TIA
A
similar to a stroke, but with resolution of neurological symptoms within 24 hours
16
Q
is the etiology for a TIA the same as a stroke
A
yes
17
Q
___% of all strokes are preceded by a TIA
A
15%
18
Q
what are two methods of early managements for TIAs
A
imaging
blood thinners
19
Q
what are potentially modifiable risk factors for strokes
A
HTN (greater than 140/90) CV disease DM (Type 2) High cholesterol smoking alcohol/cocaine use physical inactivity obesity diet
20
Q
what are non-modifiable risk factors for stroke
A
age
race
gender
family history
21
Q
what is the greatest risk of stroke
A
age
22
Q
when is the significance of age 55 regarding strokes
A
risk doubles each decade after 55
23
Q
what races are more prone to strokes
A
Mexican and African American
24
Q
what gender is more prone to strokes
A
males
25
what family history should be noted for someone with a stroke
stroke
sickle cell disease
genetic predisposition
26
Two main types of stroke
ischemic and hemmoragic
27
the most common type of stroke is...
ischemic (85%)
28
what does an ischemic stroke involve
loss of blood supply
29
in ischemic strokes, what does loss of blood supply lead to
- no or reduced blood flow
| - secondary vascular changes (swelling)
30
what does no blood flow in an ischemic stroke result in
neuronal cell death
31
what does reduced blood flow in an ischemic stroke result in
ischmic penumbra
32
what happens to the content of the cells in cell death
content of cells spills out
33
what happens to neurotransmitter release in cell death
increased NT release
34
what results from increased NT release in cell death
excitotoxicity and free radicals
35
what does cell death as a whole lead to
damage beyond area of vascular supply
36
what are the two pathogenesis of an ischemic stroke
major artery occlusion
| penetrating artery disease
37
what is the disease associated with ischemic strokes
Atherosclerotic Cerebrovascular Disease and Penetrating Artery Disease
38
what kind of disease is Atherosclerotic Cerebrovascular Disease
large vessel disease
39
what is the cause of Atherosclerotic Cerebrovascular Disease (Major artery occlusion)
plaque forms in vessel walls
40
what systems are affected in an atherosclerotic cerebrovascular disease when plaque forms in vessel walls
carotid and vertebrobasilar systems
41
what ultimately results when plaque forms in vessel walls
decreased compliance and flow
42
what are other two results of Major Artery Occlusion
Thrombosis and embolism
43
what is the most common source of an embolism
heart
44
what is atrial fibrilation in a embolism of the heart
clot formation
45
where are the primary locations for embolisms
heart and atherosclerotic arteries
46
where are embolims for atherosclerotic arteries
carotid and vertebrobasilar
47
what type of disease is Penetrating Artery Disease
small vessel disease
48
in Penetrating Artery Disease, HTN and DM can promote
lipohyalinosis
49
what is lipohyalinosis
thickening of small vessel walls and narrowing of lumen
50
what areas of the brain are affected by Penetrating Artery Disease
basal ganglia, internal capsule, pons
51
for Penetrating Artery Disease, what is involved with a small vessel infarct
ischemic necrosis, cysts, gilosis
52
what type of stroke is worse: ischemic or hemmorhagic
hemmorhagic
53
what are the main types of hemmorhagic strokes
intracerebral, subarachnoid, subdural
54
for intracerebral hemorrhage, what does HTN lead to
microvascular disease
55
what does HTN --> microvascular disease lead to (3)
1. ) weaken vessel walls
2. ) prone to leakage or rupture
3. ) Charcot-Bouchard aneurysms
56
what is another term for microaneurysms
Charcot-Bouchard
57
what vessels are effected in intracerebral hemorrhages (3)
1. ) Distal (small vessels)
2. ) arteriole branches
3. ) penetrating arteries of Circle of Willis
58
what is noted in blood pressure or blood flow with intracerebral hemorrhages
acute increase in BP or blood flow precipitate event
59
does a hemorrhage spread in a hemorrhagic stroke?
hemorrhage spreads into surrounding brain structures
60
what are the two types of subarachnoid hemorrhage
1. ) Berry aneurysm
| 2. ) A-V Malformation
61
what is a Berry aneurysm
congenital distention at bifurcation
62
what vessels are effected in a Berry aneurysm
Circle of Willis
63
what is effected in AV Malformations
direct artery to vein without capillary bed
64
what occurs with a subdural hemorrhage
tearing of bridging veins
65
who is most effected by chronic subdural hemorrhages
elderly
66
what can occur with chronic subdural hemorrhages
cerebral atrophy
67
what happens with cerebral atrophy
increase movement between brain and skull
68
what can cause a chronic subdural hemmorhage
minor trauma (falls)
69
two types of stroke syndromes (general)
partial or complete
70
what kind of tissue is effected by more proximal strokes
more hypoxic tissue
71
what is the exception to more hypoxic tissue being affected by more proximal strokes
Circle of Willis
72
is middle cerebral artery syndrome ipsilateral or contralateral
contralateral
73
are UEs or LEs more effected in middle cerebral artery syndrome
UEs > LEs
74
what comes with contralateral middle cerebral artery syndrome
hemiplegia and hemianesthesia
75
what happens if a middle cerebral artery type stroke occurs in a dominant hemisphere
global aphasia
76
for Brachial Syndrome (of partial syndromes of middle cerebral artery syndrome), what is weak
UE weakness
77
for Frontal Opercular Syndrome, (of partial syndromes of middle cerebral artery syndrome), what occurs
facial weakness and Broca's apashia
78
for inferior division, (of partial syndromes of middle cerebral artery syndrome), what occurs
Wernicke's apashia
79
what is Broca's apashia
can't produce speech
80
what is Wernircke's apashia
can't understand speech
81
is Anterior Cerebral Artery Syndrome ipisilateral or contralateral
contralateral
82
are UEs or LEs more affected in Anterior Cerebral Artery Syndrome
LEs > UEs
83
what is experiencing with Anterior Cerebral Artery Syndrome
Hemiplegia and Hemianesthesia
84
in anterior cerebral artery syndrome, what does occlusion proximal to the anterior communicating artery lead to
minimal dysfunction due to contralateral flow
85
what symptoms are experienced with Internal Carotid Artery Syndrome
MCA and ACA symptoms
86
what does ACA stand for
Anterior Cerebral Artery Syndrome
87
what does MCA stand for
Middle Cerebral Artery Syndrome
88
in internal carotid artery syndrome, what symptoms may be minimal, and why
ACA minimal due to contralateral flow
89
in a Posterior Cerebral Artery occlusion, what is experienced with thalamic branches
abnormal sensation (exaggerated light touch = pain)
90
in a Posterior Cerebral Artery occlusion, what is experienced with occipital branches
visual changes (homonymous hemianopsia, visual agnosia)
91
in a Posterior Cerebral Artery occlusion, what is experienced with temporal branches
memory loss
92
for posterior cerebral artery issues, when might contralateral hemiplegia result
if the cerebral peduncle is involved
93
What structure is involved with Lacunar Syndrome
Internal Capsule
94
for Lacunar Syndrome, what happens if the posterior limb of the internal capsule is affected
pure motor effects
95
for Lacunar Syndrome, what happens if the anterior limb of the internal capsule is affected
weak face and dysarthria
96
in Lacunar Syndrome, what happens if the posterolateral thalamus is affected
pure sensory problems
97
What are the two Vertebral and Posterior inferior Cerebellar Artery Syndromes
lateral medullary syndrome and medial medullary syndrome
98
what symptoms are experienced with lateral medullary syndrome
vertigo, hoarseness, dysphagia
99
what ipsilateral symptoms are experienced with lateral medullary syndrome
ataxia, ptosis, facial sensory loss
100
what contralateral symptoms are experienced with lateral medullary syndrome
torso and limb sensory loss
101
what contralateral symptoms are experienced with medial medullary syndrome
hemiparesis (arm and leg), loss of proprioception
102
what ipsilateral symptoms are experienced medial medullary syndrome
tongue weakness
103
what is another phrase for basilar artery syndrome
locked in syndrome
104
what symptoms are experienced in basilar artery syndrome
quadriplegia, lower bulbar palsy, mutism
105
what is spared in basilar artery syndrome
cognition, sensation, vertical eye movement
106
what are the three cerebellar sydromes
1. ) posterior inferior cerebellar
2. ) superior cerebellar
3. ) anterior inferior cerebellar
107
what side is a "dominant" hemisphere stroke
left
108
what type of hemisphere stroke is right hemiparesis experienced in
left (dominant)
109
what type of hemisphere stroke is "easily frustrated and angered with communication difficulties" experienced in
left (dominant)
110
what type of hemisphere stroke involves "problems with recognition of objects, use of objects, or word recall"
left (dominant)
111
what type of hemisphere stroke involves "may not be aware of errors"
right (non-dom)
112
what type of hemisphere stroke involves possible dysphagia
left (dom)
113
what type of hemisphere stroke involves repetition and consistency being very important
right (non-dom)
114
what type of hemisphere stroke is thinking disjointed
right (non-dom)
115
what type of hemisphere stroke is safety awareness diminished
right (non-dom)
116
what type of hemisphere stroke profits from gestures and non-verbal instructions
left (dom)
117
what type of hemisphere stroke involves needing cues to take things one step at a time
right (non-dom)
118
what type of hemisphere stroke involves left hemiparessis
right (non-dom)
119
what type of hemisphere stroke involves difficulty with spatial perceptual tasks
right (non-dom)
120
what type of hemisphere stroke involves the individual being aware of problems often responds with anxiety
left (dom)
121
what type of hemisphere stroke involves dysphagia
left (dom)
122
what part of the brain is receptive aphasia
Wernicke's
123
what part of the brain is expressive aphasia
Broca's
124
what part of the brain is global apashia
wernicke's and broca's
125
4 ways to diagnose a stroke
1. ) CT
2. ) MRI
3. ) PET
4. ) Doppler Ultrasound
126
what type of stroke has decreased detection in a CT
acute ischemic stroke
127
why will an acute ischemic stroke be less detectable on a CT
hemorrhage will be seen
128
what type of a stroke can an MRI detect
ischmic
129
when can an MRI detect an ischemic stroke
2-6 hours
130
benefits of a PET for detecting stroke
higher sensitivity, earlier detection
131
what is an alternative diagnostic test for stroke
cerebral angiography
132
is cerebral angiography invasive
YAAAAAAS
133
how does cerebral angiography work
inject radiopaque contrast agent or dye in a vein or artery
134
what can cerebral angiography help diagnose
obstruction or stenosis in vessels
135
what fruit does an epidural stroke resemble
lemon
136
what fruit does a subdural stroke resemble
banana
137
what does cerebral perfusion do for people with ischemic strokes
decrease BP if dangerously high (greater than 230/120)
138
what can cerebral perfusion do to BP if it is too low in the acute stage
increase it
139
what agent is involved in "Thrombolytic agent"
Tissue Plasminogen Activator (TPA)
140
for thrombolytic agents (TPA), when is the optimum adminsitration
30% more recovery if they get it within 3 hours
141
what are 5 methods of treating ischemic stroke
1. anticoagulation therapy
2. control HTN
3. lipid lowering agents
4. neuroprotection
5. surgery (manage stenotic vessels)
142
when is carotid enarterectomy warranted
if stenosis in carotid is 70% in internal carotid
143
for stroke patients, what is a poor prognostic indicator
loss of consciousness
144
when does 90% of the recovery after a stroke take plave
first three months
145
how long can functional recovery of movement patterns occur for
5 years
