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Biomed > Stroke and TBI > Flashcards

Stroke and TBI Flashcards

1
Q

Define stroke

A

A clinical syndrome of presumed vascular origin characterised by rapidly developing signs of focal or global disturbance of cerebral functions which lasts longer than 24 hours or leads to death

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2
Q

A stroke happens when what?

A
  1. blood supply to brain is cut off (ischaemia)
    OR
  2. there is bleeding around the brain (haemorrhage)
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3
Q

What is ischaemia?

A

a physical interruption of blood flow in a vessel

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4
Q

What is an infarct?

A

the area of ischaemia

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5
Q

What are the different types of stroke and their commonness?

A
  1. ischaemic (85%)
  2. haemorrhagic stroke (15%)
  3. transient ischaemic attack (TIA)
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6
Q

What is an ischaemic stroke?

A

an artery supplying blood to the brain is blocked by a clot

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7
Q

What is a haemorrhagic stroke?

A

a blood vessel ruptures in the brain, causing bleeding in the brain

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8
Q

What is a transient ischaemic attack?

A
  1. temporary interruption of blood flow due to a clot
  2. resolves quickly
  3. stroke symptoms occur but usually last less than 24 hours
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9
Q

What are the subtypes of ischaemic strokes?

A
  1. large vessel disease
  2. small vessel disease
  3. embolic
  4. cryptogenic
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10
Q

What is large vessel disease?

A

An ischaemic stroke due to plaque and thrombus that forms in the blood vessel

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11
Q

What is small vessel disease?

A

An ischaemic stroke due to hypertension, ageing, genetics

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12
Q

What is an embolic stroke?

A

An ischaemic stroke due to a clot travelling to the brain - common after heart surgery

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13
Q

What is a cryptogenic stroke

A

Cause not determined

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14
Q

What are the subtypes of haemorrhagic stroke?

A
  1. intracerebral haemorrhage
  2. subarachnoid haemorrhage
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15
Q

What is an intracerebral haemorrhage?

A

bleeding into the brain tissue

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15
Q

What is a subarachnoid haemorrhage?

A

Bleeding into the space under the arachnoid mater

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16
Q

What is the effect of an ischaemic stroke on the brain?

A
  1. neurons are starved of oxygen
  2. infarct sizes vary depending on which blood vessel is blocked
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17
Q

What is the effect of a haemorrhagic stroke on the brain?

A
  1. neurons are disrupted by direct contact with blood
  2. their extracellular balance is disturbed and they become dehydrated
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18
Q

What us a lesion?

A

an area of damaged tissue

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19
Q

What does TACI stand for?

A

total anterior circulation infarct

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20
Q

What is a TACI?

A

the worst type if ischaemic stroke affecting the entire anterior circulation of one side of the brain

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20
Q

How common is a TACI?

A

most common - 70%

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21
Q

Which arteries are usually affected by a TACI?

A
  1. middle cerebral artery (90%)
  2. anterior cerebral artery (2%)
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22
Q

What lobes are affected by a TACI?

A

frontal, parietal, one side temporal

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23
Q

What cortices are affected by a TACI?

A

motor, somatosensory, language

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24
Q

What are the symptoms of a TACI?

A

combination of:
1. unilateral and contralateral motor and/or sensory deficit of at least 2 out of arm leg and face
2. new higher order dysfunction
3. homonymous visual field deficit

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25
Q

What does PACI stand for?

A

Partial anterior circulation infarct

26
Q

What is a PACI?

A

ischaemic stroke affecting part of the anterior circulation supplying one side of the brain

27
Q

What artery is usually affected by PACI?

A
  1. middle cerebral artery (90%)
  2. anterior cerebral artery (2%)
28
Q

What lobes are affected by PACI?

A

frontal, parietal, one side temporal

29
Q

What cortices are affected by PACI?

A

motor, somatosensory, language centres

30
Q

What are the symptoms of a PACI?

A

At least 2 of:
1. unilateral and contralateral motor and/or sensory deficit of at least 2 out of arm leg and face
2. new higher order dysfunction
3. homonymous visual field deficit

31
Q

What does POCI stand for?

A

posterior circulation infarct

32
Q

What is a POCI?

A

an ischaemic stroke affecting the posterior circulation supply to one side of the brain, accounting for 20-25% of strokes

33
Q

What arteries are affected by a POCI?

A

vertebral, posterior cerebral, basilar, cerebellar

34
Q

What areas are affected by a POCI?

A

brainstem, cerebellum, occipital cortex

35
Q

What are the symptoms of a POCI?

A

Combination of:
1. ipsilateral cranial nerve palsy with contralateral motor/sensory deficit
2. cerebellar dysfunction
3. disorder of conjugate eye movement
4. isolated homonymous visual field defect

36
Q

What does LACI stand for?

A

Lacunar infarct

37
Q

What is a LACI?

A

occlusion of a single small deep penetrating artery which affects circulation to deeper brain structures

38
Q

Where are the lesions from a LACI?

A

mostly in internal capsule, but may also be in basal ganglia, putamen, thalamus, caudate nucleus, pons

39
Q

What can a LACI result in?

A
  1. pure motor stroke
  2. pure sensory stroke
  3. sensori-motor stroke
40
Q

Define TBI

A

injury to brain function or indication of brain pathology caused by an external force

41
Q

How is the severity of a TBI measured?

A

on the Glasgow Coma scale

42
Q

What are the subtypes of TBI?

A
  1. diffuse
  2. focal
43
Q

What is a diffuse TBI?

A

caused by force or event affecting all or most of brain

44
Q

What is diffuse axonal injury?

A

A type of diffuse TBI where there is shearing of the brain’s axons as it shifts and rotates inside the skull during rapid acceleration/deceleration

45
Q

What is a focal TBI?

A

caused by an external force at a local site and can be penetrating or non penetrating

46
Q

What are the ways a TBI can present?

A
  1. concussion
  2. contusion
  3. diffuse axonal injury
  4. haemorrhages
47
Q

What are the different kinds of TBI haemorrhage?

A
  1. epidural
  2. subdural
  3. intracerebral
48
Q

What is an epidural haemorrhage TBI?

A
  1. directly under skull bone
  2. can be from blunt trauma to head, typically temporal region
  3. can be penetrating injury often with skull fracture leading to bleeding
49
Q

What is a subdural haemorrhage TBI?

A
  1. blood enters subdural space due to damage to blood vessels near dura being stretched/torn/broken
  2. usually blunt force injury but can come from penetrating injury
50
Q

What is an intracerebral haemorrhage TBI?

A
  1. bleeding from brain tissue deeper in the brain
  2. blunt force, penetrating, or shearing
51
Q

What are the different stages of injury TBI?

A
  1. primary injury
  2. secondary injury
52
Q

What is primary injury in TBI?

A

Immediate tissue damage due to direct impact of the injury

53
Q

What is secondary injury TBI?

A
  1. hypoxia in minutes post injury
  2. brain bruising, swelling, bleeding, and development of blood clots leading to raied intracranial pressure over 24-48 hours
54
Q

What is intracranial pressure?

A

pressure in the cranial vault - usually <20mmHg

55
Q

How does haemorrhagic bleeding affect ICP?

A
  1. causes rise in ICP
  2. can lead to compression of medulla in foramen magnum
  3. damage may occur to vital centres controlling bleeding, blood pressure, and heart rate
56
Q

What are the major effects of stroke and TBI?

A
  1. effects on language and cognitive functions if temporal and frontal lobes
  2. hemiplegia - contralateral to lesion site
  3. sensory impairment if in somatosensory cortex
  4. vision impairment if in visual cortex
57
Q

What language disorders can arise from stroke and TBI?

A
  1. aphasia
  2. asprodia
  3. alexia
  4. agrapgia
  5. anomia
  6. apraxia of speech
  7. dysarthria
58
Q

What motor problems can arise from stroke and TBI?

A
  1. apraxia
  2. hemiplegia
  3. paresis
  4. spastic paralysis
  5. flaccid paralysis
59
Q

What is apraxia?

A

difficulty acting out willed movement

60
Q

What is paresis?

A

weakness

61
Q

What is spastic paralysis?

A
  1. upper motor neuron lesion
  2. voluntary movemetn on contralateral side lost
  3. reflex actions remain
  4. will have increased muscle tone and exaggerated reflexes
62
Q

What is flaccid paralysis?

A
  1. damage to lower motor neuron
  2. muscle receives no innervation from motor or sensory input
63
Q

What disorders of behaviour can arise from stroke and TBI?

A
  1. hemispatial neglect
  2. changes in higher order behaviours due to damage to frontal lobe
64
Q

What is hemispatial neglect?

A

deficit in attention and awareness towards side contralateral to brain damage

Biomed (30 decks)

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