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neurodegenerative diseases > Strokes > Flashcards

Strokes Flashcards

1
Q

what is a stroke?

A

A brain attack caused by the disturbance of blood supply to the brain. (with rapidly developing clinical symptoms, focal or global, leading to a loss of cerebral function that can only be attributed to vascular origin).

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2
Q

where does stroke rank in the ‘leading cause of death globally’?

A

second

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3
Q

name as many stroke statistics as you can

A
  • average stay in hospital 28 days but highly variable
  • 1 in 5 acute hospital beds occupied by stroke patients
  • 25% of strokes occur in people under 65
  • In England, 1/6 people will have a stroke in their lifetime
  • 20-33% die within 1-3 months
  • Single largest cause of adult disability. (300,000 people in England with moderdate to severe disability)
  • In the UK almost two thirds of stroke survivors leave hospital with a disability
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4
Q

what does F.A.S.T stand for?

A

Face (face falls)
Arms (can’t lift there arms up and keep them there)
Speech (is there speech slurred)
Time ( call 999 if any of these occur)

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5
Q

what are the four major types of strokes?

A
  • ischemic
  • haemorrhagic
  • intracerebral haemorrhage
  • subarachnoid haemorrhage
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6
Q

what does TIA stand for?

A

Transient Ischemia Attack

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7
Q

what is a TIA?

A

Small clot that is resolved itself within 24 hours (no tissue death) however, have a high risk of a proper stroke thereafter

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8
Q

what is an intracebral haemorrhage ?

A
  • accounts for 10%
  • a rupture occurs causing blood to invade the brain tissue going between neurones and glial cells
  • this causes extracellular haemoglobin which is highly oxidative inducing cell death via oxidation causing local inflammation.
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9
Q

how common are subarachnoid haemorrhages?

A

make up 5% of strokes

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10
Q

How does a subarachnoid haemorrhage work?

A
  • blood leaks out into the brain tissue at high pressure
  • subarachnoid blood distributes rapidly over the entire brain and penetrates easily into the deeper layers of the cortex within a few hours
  • blood released into the subarachnoid space clots almost immediately and disappears ~ 3 days via clot lysis, which starts early after SAH
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11
Q

what does SAH stand for?

A

Subarachnoid Haemorrhage

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12
Q

What is the SAH mechanism?

A
  • blood leaks out into the brain tissue at high pressure
  • subarachnoid blood distributes rapidly over the entire brain and penetrates easily into the deeper layers of the cortex within a few hours
  • blood released into the subarachnoid space clots almost immediately and disappears ~ 3 days via clot lysis, which starts early after SAH
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13
Q

What small proportion does the brain make up in body weight?

A

2.5%

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14
Q

what amount of energy and cardiac output does the brain use?

A

20% - energy
15% - Cardiac Output

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15
Q

what are typical MCA stroke symptoms?

A
  • arms and facial weaknesses
  • speech affected
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16
Q

what is the most common form of stroke?

A

Lacunar Stroke

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17
Q

what arteries are affected in a lancunar stroke?

A

Lenticulostriate arteries

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18
Q

name the next three steps through which the blood flows to perfuse the brain starting from the arch of the aorta?

A

Next,
- common cartoid artery
- vertebral artery
- middle cerebral artery

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19
Q

what is the most common form of stroke?

A

Lancunar stroke

20
Q

what does a brain stem stroke affect?

A
  • fibre tracts (eg. spinothalamic tract)
  • nuclei (of cranial nerves)
  • physiological functions (conciousness and arousal)
21
Q

what is the brain stem made up of?

A
  • midbrain
  • pons
  • medulla
22
Q

what is the stroke syndromes called when 1,2,3 are affected:
1) Medulla
2) Midbrain
3) Pons

A

1) Wallenbergi syndrome
2) Weber’s syndrome
3) Locked-in syndrome

23
Q

definition of occlusion

A

the blockage or closing of a blood vessel or hollow organ

24
Q

how does a brain stem stroke occur?

A

an occlusion of a vessel in the posterior circulartion

25
Q

stroke revolution happens with three major steps which are?

A
  • rapid
  • secondary
  • delayed
26
Q

what happens in the rapid stage in stroke evolution?

A
  • O2 depletion
  • energy failure
  • terminal depolarisation
  • ion homeostasis failure
27
Q

what happens in the secondary stage in stroke evolution?

A
  • excitotoxicity
  • SD-like depolarisations
  • disturbance of ion homeostasis
28
Q

what happens in the delayed stage in stroke evolution?

A
  • inflammation
  • apoptosis
29
Q

current treatments for strokes?

A
  • thrombolysis
  • antiplatelets
  • anticoagulants
  • cartoid endarterectomy
  • statins
  • antihypertensives
  • neurosurgery
30
Q

What does the treatment cartoid endarterectomy entails?

A

removal of fatty deposits from artery

31
Q

what does neurosurgery treatment entail?

A

Remove the blood and repair the burst blood vessels

32
Q

what is thrombolysis also known as?

A

‘cloud busting’

33
Q

how is the clinical outcome measured?

A

NIHSS (National Institutes of Heaalth Stroke Scale)

34
Q

what are some modifiable risk factors that can aid/ lead to stroke?

A
  • hypertension
  • cholesterol level
  • smoking
  • physical inactivity
  • obesity
  • asymptomatic cartoid stenosis
  • alcohol consumption
  • atrial fibrilation
35
Q

Name some non-modifiable risk factors

A
  • Older age
  • Race (Hispanic, Black)
  • Maternal history of stroke
  • Sex (males)
  • Diabetes
36
Q

Risk factors increase the propensity to stroke via?

A
  • a change in the structure and function of blood vessels
  • a change with the interface with circulating blood (a reduction/ alteration of CBF (cerebral blow flow))
37
Q

what three changes in structure and function of blood vessels can increase the risk of stroke?

A
  • artherosclerosis
  • stiffening of arteries
  • narrowing thickening and tortuosity of arterioles and capillaries
38
Q

what is atheroma ?

A

An accumulation of intracellular and extracellular lipid in the inner layer of large and medium sized arteries

39
Q

what is atherosclerosis?

A
  • its a subtype of arteriosclerosis
  • other types include the thickening of the walls of arteries and arterioles usually eg. as a result of hypertension or diabetes
40
Q

what is an aneurysm?

A

A bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it brances

41
Q

From the outside in describe an artery cross-section?

A
  • thick outer wall
  • thick inner layer of muscle and elastic fibres
  • endothelium
  • narrow central lumen through with blood flows
42
Q

name the two types of cells and give examples that atheromas contain that can critically influence atherogenesis?

A
  • intrinsic vascular wall cells
    eg. endothelium smooth muscle cells
  • inflammatory cells
    eg. macrophages, T Lymphocytes, Mast Cells, Cascade -lesion development.
43
Q

Give some examples of stroke triggers?

A
  • neck trauma
  • pregnancy/ postpartum
  • systemic infection
  • use of drugs
  • mental stress
44
Q

what happens in a stroke trigger?

A
  • exacerbation of vascular inflammation
  • activation of the coagulation cascade
45
Q

name cells and components involved in a stroke

A
  • glia
  • neurons
  • vascular cells
  • matrix components
  • blood vessels
46
Q

what does inflammation fo to an ischemic lesion early on?

A

it amplifies it

neurodegenerative diseases (11 decks)

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