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Cardiorespiratory CC > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke

A

Consequence of cerebrovascular disease that interrupts blood flow to part of the brain, causing ischemia and hypoxia

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2
Q

Haemorrhagic stroke

A

Parenchymal- into brain tissue

Subarachnoid- into subarachnoid space

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3
Q

Stroke death

A

3rd most common cause of death

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4
Q

Stroke symptoms

A

Numbness/weakness of face, arm or leg, especially on one side
Confusion, trouble understanding or speaking
Trouble seeing in one or both eyes
Dizziness, loss of balance or coordination
Severe headache

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5
Q

Symptoms Pneumonic

A 
FAST
Face
Arms
Speech 
Time
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6
Q

Types of stroke

A

TIA
Thrombotic
Embolic
Haemorrhagic

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7
Q

Ischaemic stroke forms

A

Thrombotic + Embolic

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8
Q

TIA

A

Confined to area of brain of eye perfused by a specific artery
Release of small emboli from thrombus –> temporarily block downstream vessel then quickly dissolve

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9
Q

TIA Time

A

Most last seconds to 10 mins
Symptoms more than 1 hour 25%
Resolved within 24 hours

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10
Q

Stroke Diagnosis

A

Physical exam
Blood test- cholesterol, C reactive protein
CT scan- shows haemorrhage, stroke etc
MRI- shows brain tissue damage

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11
Q

Cerebral thrombosis

A

Formation of blood clot in cerebral artery, normally at site of atherosclerotic plaque
If surface of plaque breaks open, collagen + TF exposed –> thrombus produced –> blocks blood supply

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12
Q

Thrombotic stroke formation

A

60% form during sleep

20% form over hours/few days

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13
Q

Arteriosclerosis

A

Thickening, hardening + loss of elasticity of the walls of arteries

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14
Q

Atherosclerosis

A

When inside of artery narrows due to build up of plaque

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15
Q

Thrombotic stroke occurrence

A

Most not due to emboli occur at site of atherosclerosis or arteriosclerosis in brain

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16
Q

Cerebral embolism

A

Usually occurs during activity
Consciousness usually preserved
Neurological signs develop rapidly

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17
Q

Embolic Stroke

A

Source of embolism almost always LEFT SIDE OF HEART

AF, MI, defective/ artificial heart valves (especially MV)

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18
Q

Myocardial Infarction

A

Causes Akinetic region in heart wall

Thrombus can form in immobile region of ventricle

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19
Q

Thrombotic + embolic strokes

A

85% of all strokes

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20
Q

Haemorrhagic Stroke

A

Intracerebral haemorrhage- sudden onset of neurological symptoms
Severe headache
Stupor or coma that progress with time
Usually hypertensive

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21
Q

Lacunar stroke

A

Occlusion of one of arteries that provides blood to the brain’s deep structures instead of cerebral cortex
E.g. basal ganglia, thalamus, pons, cerebellum
Cortical infarct signs (aphasia, neglect, visual field defects) always absent

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22
Q

Lacunar Strokes

A

15-20% of ischaemic strokes

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23
Q

Motor hemiparesis with dysarthria

A

Most common lacunar syndrome
33-50%
Infarct in posterior limb of internal capsule

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24
Q

Ataxia + hemiparesis

A

2nd most common form lacunar stroke

Infarct in posterior limb of internal capsule

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25
Q

Dysarthria + clumsy hand

A

Infarct in anterior limb of internal capsule

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26
Q

Stroke Risk Factors

A 
Hypertension
Atrial Fibrillation
Smoking
Diabetes
Hyperlipidaemia
27
Q

Hypertension RF

A

35-50% stroke risk
BP reduction 10mmHg systolic or 5mmHg diastolic reduces risk by 40%
Lowering BP prevents both ischaemic + haemorrhagic strokes
Major RF for athero + arteriosclerosis

28
Q

Atrial Fibrillation RF

A

5% a year risk of stroke

Risk higher in those with valvular AF

29
Q

Diabetes RF

A

Increases risk by 2 to 3 times

30
Q

Hypercholesterolaemia (hyperlipidaemia)

A

Statins reduce stroke risk by 15-20% in those with high LDL cholesterol

31
Q

Smoking RF

A

General inflammation of blood vessels
Increased atheroma formation
Hypertension

32
Q

Obstructive sleep apnoea

A

Increases risk by up to 3 times

Especially in men

33
Q

Low diet potassium + hypokalaemia RF

A

Increase risk

Foods high in K- nuts, potatoes, choc, bananas

34
Q

Thiazides + loop diuretics RF

A

Block reabsorption of Na + water upstream from distal tubule
Promotes increased distal tubular K secretion
–> hypokalaemia

35
Q

MCA

A

Prone to aneurysms + stroke

Lots of twists

36
Q

Sodium Pump

A

Maintains nerve cell size + shape
Removes Na from nerve cells –> water follows
If doesn’t work, brain nerve cells SWELL

37
Q

Nerve cells

A

High SA/V ratio

Large SA- more sodium leakage into cells

38
Q

Swollen brain cells

A

Brain is contained in rigid box = cranial cavity
Decrease extracellular space
Compresses capillaries + venules–> oedema + swelling
Rise in ICP

39
Q

Raised ICP

A

Sign of cerebral hypoxia
Compresses cerebral veins
Loss of blood flow
Worsening hypoxia

40
Q

Normal Extracellular space in brain cells

A

20%

41
Q

Extracellular space in brain cells when swollen

A

5%

42
Q

Tonsillar herniation

A

Rise in ICP
Cerebellar tonsils extrudes through foramen magnum
–> compression of lower brainstem + upper cervical spinal cord

43
Q

Tonsillar herniation sign

A 
Intractable headache
head tilt
neck stiffness
Decreased consciousness
Flaccid paralysis
44
Q

Glial cells

A

Maintain homeostasis in brain environment

Remove potassium released into extracellular space by APs

45
Q

Hypoxic brain- K

A

Potassium not removed from ECS by glial cells
Increased extracellular K depolarises adjacent cells –> excess neurotransmitter release
ATP levels low, so neurotransmitters not taken up –> remain in synaptic cleft or ECS

46
Q

Excitotoxicity

A

Effects of excess release of excitatory neurotransmitter due to increased extracellular K

47
Q

Glutamate

A

Main excitatory transmitter

Acts on NMDA + AMPA receptors

48
Q

Excess NMDA stimulation

A

After 3-5 mins leads to excess influx of Ca into nerve cells –> fast excitotoxicity

49
Q

Excess AMPA stimulation

A

Over several hours

Leads to slow (delayed) excitotoxicity

50
Q

Excitotoxic Loop

A

In Hypoxia ATP levels drop + glutamate reuptake fails
Post-synaptic glutamate receptors (especially NMDA) are overstimulated
–> influx of calcium
–> increase in metabolic demand on cell + uses more O2
–> higher demand in absence of O2 leads to free radical formation
–> trigger cell death or apoptosis

51
Q

Stroke focus

A

Three regions of brain around it
Internal layer- cells face death
Middle layer- Penumbra region, neurones are hypoxic and/or damaged but survival possible
Outer layer- cells will survive

52
Q

Penumbra region

A

Neurones hypoxic and/or damaged
Survival possible
Stroke focus

53
Q

Stroke treatment strategies

A

Restore blood flow
Combat excitotoxicity
Combat free radical damage

54
Q

Stroke treatment goal

A

Survival of neurones in penumbra region

55
Q

Restore blood flow

A

Tissue plasminogen activators (thrombolysis)

Within 3-4 hours for most significant benefit

56
Q

Intravenous fibrinolytic therapy at cerebral circulation dose

A

Within first 3 hours of ischemic stroke- substantial benefits
Within 3.5-4.5 hours- Moderate net benefits

57
Q

Intra-arterial fibrinolytic therapy

A

In 3-6 hour window offers moderate net benefits

58
Q

Combat excitotoxicity

A

NMDA antagonists
AMP antagonists
Delay triggering of apoptotic pathways

59
Q

NMDA agonists

A

Cerestat

Block NMDA receptors + fast excitotoxicity

60
Q

AMP agonists

A

NBQX

Reduce slow excitotoxicity

61
Q

Lithium

A

delay apoptosis

62
Q

Reduce Free radical damaging

A

Antioxidants- Vit C + E
Free radical scavenging enzymes- superoxide dismutase
Cool down brain –> reduces O2 demand

63
Q

Reduce Primary risk

A

Treat hypertension- ACE inhibitors, AR antagonists
Treat AF- Aspirin <65yo, Warfarin >65yo
Vascular disease- Statins

Cardiorespiratory CC (34 decks)

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