Neurology: stroke

Question 1

What is a neurological disease?

Answer 1

• Disease affecting health, function, structure of nervous system (brain, spinal cord, nerves)

Question 2

Time scale of neurological events:

• Immediate symptoms: usually A or B in origin
• Rapidly progressive symptoms (over days) may present C or D disease
• Slowly progressive symptoms tend to be caused by diseases

Answer 2

A: vascular (ischaemia/haemorrhage)
B: elecrtical (epilepsy)
C: infective (meningitis)
D: inflammatory

Question 3

The neuron: A + B terminate in the C

Answer 3

Cell body
Axon
Synapse

Question 4

Some neurons have an axonal length of more than A and can innervate between several B and C muscle fibres in one leg (= D)

Answer 4

A 1 m
B 100
C 2000
D motor unit

Question 5

Other neurons have axons <A , terminating on B neuronal cell body(s)

Answer 5

A 100 microm
B one

Question 6

What symptoms occur when the myelin sheath in destroyed as a function of auto-immune diseases?

Answer 6

(problems movement, coordination, sensation, such as in MS: multiple sclerosis)

Question 7

What are 7 possible causes for neurological disorders?

Answer 7

• Atherosclerosis -> ischaemia
• Drugs, toxins, and poisons.
• Autoimmune diseases (e.g. MS)
• Injury
• Infection: (e.g. meningitis)
• Inborn errors

Question 8

What are six common neurological disorders?

Answer 8

1. Dementia
2. Epilepsy (neurological disorder where the electrical activity of the brain is abnormal,
   resulting in recurrent seizures. Common cause = stroke)
3. Stroke
4. Pathogens (encephalitis: inflammation brain, meningitis)
5. MS
6. Parkinson’s

Question 9

What are symptoms of a stroke?

Answer 9

• Severe headache
• Weakness
• Numbness
• Vision problems
• Confusion
• Trouble walking/talking
• Dizziness
• Slurred speech

Question 10

Stroke is the ….. cause of severe disability, ….. people have a stroke each year

Answer 10

Leading
>15 million

Question 11

What stroke is most common: ischaemic vs haemorrhagic ?

Answer 11

ischaemic

Question 12

What are causes for ischaemic stroke?

Answer 12

• Blood vessel supplying blood to the brain gets blocked by a blood clot
• Atherosclerosis is responsible for this
• Other causes: atrial fibrillation, heart attack, blood clotting problem
• Damages brain cells

Question 13

Haemorrhagic strokes account for …% of strokes. The most common cause is… Other causes are….

Answer 13

13%
High blood pressure

• Aneurysms (weakening blood vessel wall that swells)
• AVMs (blood vessel abnormalities)

Question 14

What are the two types of haemorrhagic strokes + explain

Answer 14

1. Subarachnoid haemorrhage: happens between brain and membrane that surrounds it (=subarachnoid space)
2. Intracerebral haemorrhage: bleeding inside the brain

Question 15

Risk factors of stroke?

Answer 15

• Over 60 yo
• Had stroke/TIA before
• Smoke and/or have inactive lifestyle
• High blood pressure, heart disease, high cholesterol, diabetes, obesity
• Family history of strokes

Question 16

Diagnosis of stroke?

Answer 16

• Check alertness, immobility of one side of the face, trouble with coordination and balance, vision or speech
• Check numbness or weakness in any part of the body
• Physical exam; blood pressure, and listen to the heart
• Blood tests and imaging tests (CT, MRI or ultrasound) to figure out which type of stroke the patient might have had (CT scan to see if there’s bleeding in your brain)
• EKG (checks heart’s electrical activity) and EEG (checks brain’s electrical activity)

Question 17

What blood tests can be done to check for a stroke?

Answer 17

• Complete blood count
   Check level of platelets (cells that help clot blood)
   Check electrolyte levels (see how well kidneys work)
• Clotting time
   PT and PTT check how quickly blood clots. Too long = sign of bleeding problems

Question 18

Treatment stroke?

Answer 18

After a stroke, brain may need to relearn old skills.
 brain’s grey matter has an amazing ability to repair and rewire itself.
 Several types of therapy are there to improve physical and mental status

Question 19

The brain is roughly divided into three regions:

Answer 19

Cerebrum, cerebellum, brain stem

Question 20

Cerebrum exists of..

Answer 20

2 hemispheres: each has a cortex, each cortex has four lobes:

• frontal
• parietal
• temporal
• occipital

Question 21

What does the frontal lobe control?

Answer 21

• movement
• executive function

Question 22

What does the parietal lobe control?

Answer 22

• sensory information (3d)

Question 23

What does the temporal lobe control?

Answer 23

• hearing
• memory
• smelling
• facial recognition
• language

Question 24

What does the occipital lobe control?

Answer 24

• vision

Question 25

What does the cerebellum control?

Answer 25

- muscle coordination - balance

Question 26

What does the brain stem control?

Answer 26

- breathing - heart rate - blood pressure - GI function - conciousness

Question 27

How does an embolism lead to ischaemic stroke?

Answer 27

- Embolism: blood clot breaks off from one location, gets lodged in another (from atherosclerosis or from the heart: stagnant blood in the heart can clot: route to the brain of lung)

Question 28

How can shock lead to an ischaemic stroke?

Answer 28

- When the body is in shock, there can be reduction in blood flow throughout the entire body: tissues furthest downstream affected most (e.g. border of two different blood supplies in the brain: watershed infarct)

Question 29

describe how smoking increases the risk of stroke

Answer 29

- One classic irritant of the endothelium is a toxin found in tobacco - Damage becomes a site for atherosclerosis - Plaque forms

Question 30

explain how braincells can swell (cytotoxic edema) when blood flow is blocked

Answer 30

- No glucose & oxygen: cells run out of energy. High build-up of sodium and calcium levels -> draws water into the cells making them swell.

Question 31

explain the three typical features of a stroke

Answer 31

- Facial drooping - Arm weakness - Speech difficulties

Question 32

describe how strokes are generally treated and secondary strokes are prevented

Answer 32

- Treatment: Re-establish blood flow as quickly as possible  Thrombolytic enzymes (TPA): to activate the bloods natural clot busting mechanism (time limit)  Aspirin (prevents more clots)  Surgery: physically remove clot - Prevention:  Quit smoking, healthy blood pressure, normal LDL cholesterol, control diabetes - Surgery: help clean arteries, stent