Biomed > Stroke and TBI > Flashcards

Stroke and TBI Flashcards

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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
What cortices are affected by a TACI?
motor, somatosensory, language
24
What are the symptoms of a TACI?
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
25
What does PACI stand for?
Partial anterior circulation infarct
26
What is a PACI?
ischaemic stroke affecting part of the anterior circulation supplying one side of the brain
27
What artery is usually affected by PACI?
1. middle cerebral artery (90%) 2. anterior cerebral artery (2%)
28
What lobes are affected by PACI?
frontal, parietal, one side temporal
29
What cortices are affected by PACI?
motor, somatosensory, language centres
30
What are the symptoms of a PACI?
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
What does POCI stand for?
posterior circulation infarct
32
What is a POCI?
an ischaemic stroke affecting the posterior circulation supply to one side of the brain, accounting for 20-25% of strokes
33
What arteries are affected by a POCI?
vertebral, posterior cerebral, basilar, cerebellar
34
What areas are affected by a POCI?
brainstem, cerebellum, occipital cortex
35
What are the symptoms of a POCI?
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
What does LACI stand for?
Lacunar infarct
37
What is a LACI?
occlusion of a single small deep penetrating artery which affects circulation to deeper brain structures
38
Where are the lesions from a LACI?
mostly in internal capsule, but may also be in basal ganglia, putamen, thalamus, caudate nucleus, pons
39
What can a LACI result in?
1. pure motor stroke 2. pure sensory stroke 3. sensori-motor stroke
40
Define TBI
injury to brain function or indication of brain pathology caused by an external force
41
How is the severity of a TBI measured?
on the Glasgow Coma scale
42
What are the subtypes of TBI?
1. diffuse 2. focal
43
What is a diffuse TBI?
caused by force or event affecting all or most of brain
44
What is diffuse axonal injury?
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
What is a focal TBI?
caused by an external force at a local site and can be penetrating or non penetrating
46
What are the ways a TBI can present?
1. concussion 2. contusion 3. diffuse axonal injury 4. haemorrhages
47
What are the different kinds of TBI haemorrhage?
1. epidural 2. subdural 3. intracerebral
48
What is an epidural haemorrhage TBI?
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
What is a subdural haemorrhage TBI?
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
What is an intracerebral haemorrhage TBI?
1. bleeding from brain tissue deeper in the brain 2. blunt force, penetrating, or shearing
51
What are the different stages of injury TBI?
1. primary injury 2. secondary injury
52
What is primary injury in TBI?
Immediate tissue damage due to direct impact of the injury
53
What is secondary injury TBI?
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
What is intracranial pressure?
pressure in the cranial vault - usually <20mmHg
55
How does haemorrhagic bleeding affect ICP?
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
What are the major effects of stroke and TBI?
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
What language disorders can arise from stroke and TBI?
1. aphasia 2. asprodia 3. alexia 4. agrapgia 5. anomia 6. apraxia of speech 7. dysarthria
58
What motor problems can arise from stroke and TBI?
1. apraxia 2. hemiplegia 3. paresis 4. spastic paralysis 5. flaccid paralysis
59
What is apraxia?
difficulty acting out willed movement
60
What is paresis?
weakness
61
What is spastic paralysis?
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
What is flaccid paralysis?
1. damage to lower motor neuron 2. muscle receives no innervation from motor or sensory input
63
What disorders of behaviour can arise from stroke and TBI?
1. hemispatial neglect 2. changes in higher order behaviours due to damage to frontal lobe
64
What is hemispatial neglect?
deficit in attention and awareness towards side contralateral to brain damage
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