Sem 3 > stroke/case 5 > Flashcards

stroke/case 5 Flashcards

(39 cards)

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1
Q

What does the brain use for respiration? what type of respiration?

A

O2 and glucose

aerobic respiration: no lactate build up

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2
Q

What happens with occlusion of the anterior cerebral artery?

A
  • contralateral hemiparesis

- sensory loss of contralateral leg and perineum

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3
Q

What parts of the brain does the middle cerebral artery supply?

A
  • lateral sulcus and travels along lateral surface of frontal, temporal and parietal lobes
  • subcortical areas including internal capsule and neostratium
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4
Q

What happens with occlusion of the middle cerebral artery?

A
  • contralateral hemiparesis
  • sensory loss of contralateral upper limb
  • contralateral homonymous hemianopia
  • aphasia
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5
Q

What happens with occlusion of the posterior cerebral artery?

A

-contralateral homonymous hemianopia with macular sparing
-visual agnosia
(-Weber’s syndrome: branches of the PCA that supply midbrain: ipsilateral CN3 palsy + contralateral weakness of upper and lower extremity)

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6
Q

What parts of the brain does the posterior cerebral artery supply?

A

curves around midbrain to reach medial surface of cerebral hemisphere
–> inferior surface of temporal lobe + occipital lobe

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7
Q

What happens with occlusion of the basilar artery?

A
  • ‘locked-in’ syndrome

- respiratory failure: death

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8
Q

What is a lacunar stroke?

A

type of ischemic stroke that occurs when blood flow to one of the small arteries deep within the brain

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9
Q

What are symptoms of lacunar strokes?
What are the risk factors?
Common sites?

A
  • isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
  • strong association with hypertension
  • common sites: basal ganglia, thalamus and internal capsule
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10
Q

What are functional consequences of damage to motor cortex?

A

movement

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11
Q

What are functional consequences of damage to frontal lobe?

A

-Broca’s aphasia
-disinhibition
-perseveration
-anosmia
-inability to generate a list
(judgement, foresight, voluntary movement, smell)

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12
Q

What are functional consequences of damage to temporal lobe?

A
  • Wernicke’s aphasia
  • superior homonymous quadrantonopia
  • auditory agnosia
  • prosopagnosia
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13
Q

What are functional consequences of damage to brainstem?

A

swallowing, breathing, heartbeat, wakefulness centre (+other involuntary functions)

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14
Q

What are functional consequences of damage to cerebellum?

A
  • midline lesions: gait and truncal ataxia

- hemisphere lesions: intention tremor, past pointing, dysdiadokinesis, nystagmus

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15
Q

What are functional consequences of damage to parietal lobe?

A
  • sensory inattention
  • apraxias
  • astereognosis (tactile agnosia)
  • inferior homonymous quadrantanopia
  • Gerstmann’s syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and rich/left disorientation)
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16
Q

What are functional consequences of damage to occipital lobe?

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A
  • homonymous hemianopia (with macular sparing)
  • cortical blindness
  • visual agnosia
17
Q

What brain areas do the anterior cerebral artery supply?

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A

superior and medial surfaces of frontal and parietal lobes

18
Q

What is the WHO definition of stroke?

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A

-sudden onset of acute focal ‘occasionally global) neurological deficit probably due to a pathological process in blood vessels

19
Q

What are stroke risk factors?

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A
  • BP (especially in haemorrhage strokes)
  • cholesterol
  • blood sugar/diabetes
  • atrial fibrillation
  • obesity
  • smoking
20
Q

What is the FAST test?

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A

Face
Arms
Speech
Time

21
Q

What is the percentage of ischemic strokes compared to haemorrhage strokes

22
Q

What are causes of ischemic strokes?

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A
  • blood clot causing occlusion: carotid atherosclerosis (carotid bifurcation), embolism of plate rich clot further i cerebral vessel
  • atrial fibrillation
23
Q

What must be looked at in terms of blood diffusion:perfusion for treatment via thrombolysis?

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A

it mismatch (perfusion loss but not much diffusion loss) then brain tissue can be salvaged

24
Q

What is the neurovascular unit and what does it consist of?

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A
  • close interaction of brain cells with the brain endothelium and the extracellular matrix contributes to the maintenance of brain homeostasis and functions
  • consists of :
  • ->astrocytes, microglia, neurones
  • -> endothelial cells and pericytes
  • -> extracellular matrix
25
What are the different post stroke complications?
- paralysis/motor control - sensory disturbances - dysphagia - language problems - memory impairments - depression/anxiety - fatigue
26
What is the initial damage in stroke? When does it take place?
energy failure, excitatoxicity, depolarisation, necrosis, oxidative stress (causing mitochondrial damage) -within minutes to hours
27
What happens in secondary damage in stroke? When does it happen?
inflammation, programmed cell death | hours to days
28
What is excitotoxicity?
over activation of NMDA receptors by glutamate allowing excess calcium into cell causing it to swell and rupture (inhibitory cells die quite quickly)
29
How would you describe progression of injury between the tissue and the MRI scan?
- upon presentation: no perfusion of tissue (doesn't show in brain tissue but it shows in MRI scan) - one day after presentation: loss of brain tissue - 6 days after presentation: not much difference n MRI but more tissue loss
30
What do you measure stroke severity with?
-National Institute of stroke scale | the higher the scale, the more severe the stroke
31
What is the initial treatment of ischemic stroke? What are the complications
1. -thrombolysis: tissue plasminogen activator (alteplase) by IV bolus (10%) plus 1 hour infusion (90%) with 4.5h - complications: haemorrhage, anaphylaxis 2. endovascular thrombectomy: removal of clot BUT time dependent benefit: within 6 hours of onset
32
What treatment do you give if the patient presents with haemorrhagic stroke?
- PCC (prothrombin complex concentrates) to reverse bleeding - management of BP - lower blood pressure: beta blockers and GTN - sometimes minimally invasive surgery
33
What is secondary treatment for stroke?
- blood pressure - aspirin 300 mg 14days then clopidogrel 75mg - exclude AF (if have AF: anticoagulants) - statins - exclude DM - exclude carotid stenosis (if have stenosis more than 50% can get carotid endarterectomy) - speech and language therapy (dysarthria + swallowing) - physiotherapy - occupational therapy - pschomotor
34
How do you diagnose stroke?
MRI CT signs (ROSIER and National Institute of Stroke scale, FAST)
35
What are the different types of aphasia?
- Wernicke's (receptive) aphasia - Broca's (expressive) aphasia - conductive aphasia - global aphasia
36
What happens in Wernicke's (receptive) aphasia?
- due to lesion of superior temporal gyrus - comprehension is impaired - sentences that make no sense, word substitution and neologisms but speech remains fluent
37
What happens in Broca's (expressive) aphasia?
- due to lesion of the inferior frontal gyrus - speech is non-fluent, laboured, and halting - comprehension is normal
38
What happens in conductive aphasia?
- ususally due to stroke affecting arcuate fasciculus (connection between Wernicke's and Broca's area) - speech fluent but repetition is poor - aware of errors they are making - comprehension is normal
39
What happens in global aphasia?
large lesion affecting all 3 of the areas (Wernicke's, Broca's and arcuate fascicles) --> severe expressive and receptive aphasia
Sem 3
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