Stroke Mechanisms (Rybinnik) Flashcards Preview

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Flashcards in Stroke Mechanisms (Rybinnik) Deck (11):
1

Define cerebral infarct.

type of ischemic stroke resulting from a blockage in the blood vessels supplying blood to the brain

2

Distinguish between the mechanisms underlying ischemic and hemorrhagic stroke.

What are the differentiating clinical features.

Ischemic: clot within vessel stops blood flow to an area of the brain -> deprive neurons of oxygen and nutrients

Hemorrhagic: blood begins to fill brain space (mass effect)

Differentiating clinical features:
*Headache
*Lethargy
*Confusion

3

Explain the contraindications of tPA in treatment of acute stroke.

tPA = tissue plasminogen activator (for blood clots)

- active internal bleeding
- acute intracranial hemorrhage
- recent intracranial or spinal surgery or serious head trauma

4

Distinguish between the mechanisms and symptoms of lacunar and large-vessel strokes (both ischemic thrombotic stroke subtypes)

Lacunar (not cortex): Small-vessel subcortical lesions - body able to adjust so takes decades for clot to make an impact (circle of willis)

Large-vessel (cortex): atherosclerosis (intracranial or extra cranial i.e. middle cerebral artery)

5

List the risk factors for embolic stroke.

Cardiac, artery to artery

VERY SEVERE/SUDDEN

Clinical features: maximal deficit at onset

risk factors:
- atrial fib (when this happens, there's a stasis of blood in the LA -> when blood goes back to normal rhythm, that clot gets pushed up to the brain)
- cardiac tumors
- valvular disease

6

Describe (generally) the most common sites for hemorrhagic strokes.

Basal ganglia / Thalamus (arterioles off MCA and PCA) - 50% - HTN

Lobar (penetrating branches of ACA, MCA, PCA) - 33%

Brainstem Cerebellum (Branches of basilar, PICA

7

Describe the major risk factors for hemorrhagic stroke.

Hypertension

8

Describe the features of A-V malformation.

Arteries and thin walled veins connected

Lack of capillaries -> therefore, no oxygen exchange

9

List the signs of subarachnoid hemorrhage.

Severe headache (97%) - worst headache of life
Lethargy
Nausea
Vomiting

10

Describe the mechanisms of venous stroke.

Impaired drainage causing brain swelling and damage

- Thrombosis of cerebral veins

11

What is a TIA

Transcient ischemic attack - 10-60 min / unilateral weakness or speech disturbance w/o weakness / history of diabetes / age > 60 years

Beyond 60 min = stroke