Term
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Definition
| brain injury caused by interruption of the brain's blood supply |
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Term
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Definition
| brain injury caused by bleeding into or around the brain |
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Term
| Transient Ischemic Attack (TIA) |
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Definition
abrupt onset of focal neurological deficits cause by loss of blood supply
Reversible within <1 hour |
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Term
| Resolving Ischemic Neurologic Deficits (RINDs) |
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Definition
| Acute focal neurologic symptoms that resolve completely but take longer then an hour |
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Term
| What are an important warning sign of future stroke? |
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Definition
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Term
| What are the causes of Ischemic Stroke? |
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Definition
Atherosclerotic CV disease
Embolism
Lacunar Infarcts
Cryptogenic |
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Term
| What are the 2 types of Hemorrhagic Stroke? |
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Definition
Intracerebral
Subarachnoid |
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Term
| What are the non-modifiable risk factors for ischemic stroke? |
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Definition
Age (doubles each decade >55y)
Gender (male 1.5 x risk of female)
Race (AA 2 x risk of EA)
Family History |
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Term
| What are the modifiable risk factors for Stroke? |
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Definition
Hypertension
Diabetes
Hyperlipidemia
Smoking
Carotid artery stenosis
A. Fib
Obesity
Physical inactivity |
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Term
| What is the #1 risk factor for Stroke? Why? |
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Definition
Hypertension
Relative risk is low (3-5fold) but its prevalence is very high in the population |
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Term
| What is the a goal for acute stroke intervention? |
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Definition
Normalize elevated body temperature
Treat Hyperglycemia |
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Term
| What 2 factors can accelerate Ischemic brain injury? |
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Definition
elevated temperatures
elevated circulating glucose |
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Term
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Definition
| The central area with sever blod flow reduction |
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Term
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Definition
| the peripheral areas with less severe ischemia |
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Term
| How long until the ischemic core sufferes irreversible injury? Penumbra? |
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Definition
Core - <1hr
Penumbra - ~4-6hrs |
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Term
| What is the therapeutic window for acute stroke? |
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Definition
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Term
| What is the normal CBF? What range of MAP is the CBF constant? |
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Definition
55ml/100gmbrain/min
55 - 155mmHg |
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Term
| In Chronic Hypertension how does the CBF curve shift? |
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Definition
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Term
| At what BP is it recommended to lower the BP for acute stroke? |
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Definition
Systolic >220 or diastolic >120
Only lower 10-15% in 24hrs |
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Term
| What are the Neurologic signs and symptoms commonly caused by a stroke? |
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Definition
Weakness or paralysis
Loss of sensation
Loss of vision
Difficulty talking or understanding
Difficulty with organization or perception
Clumsiness/lack of balance |
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Term
| What are the 2 categories of ischemic stroke? |
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Definition
Blood vessel location
Blood vessel Size |
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Term
| What arteries are included in an Anterior Circulation stroke? |
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Definition
Internal Carotic
Middle cerebral
anterior cerebral
Any of their branches |
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Term
| Arteries of Posterior Circulation? |
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Definition
Posterior cerebral
vertebral
superior cerebellar
anterior inferior cerebellar
posterior inferior cerebellar
Any Branches |
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Term
| What Functional brain areas does the Middle cerebral artery supply? |
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Definition
Dorsal to Rostral
Hip
Trunk
Shoulder
Arm
Hand
Fingers
Thumb
Face
Lips
Tongue
Larynx |
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Term
| What areas of the brain do the Lenticulostriate arteries supply? |
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Definition
| Internal capsule and Basal Ganglia |
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Term
| What artery supplies blood to the Visual Radiations? |
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Definition
| Posterior cerebral a., Branches to the Occipital lobe |
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Term
| What artery supplies blood to the motor sensory area that controls the Hip, Leg, Foot? |
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Definition
Anterior cerebral A.
Branches to corpus callosum |
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Term
| Medial Medullary Syndrome |
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Definition
Paramedian branches of vertebral and anterior spinal arteries
Contralateral
--arm and leg weakness
--decreased position and vibration sense
Ipsilateral
--Tongue weakness |
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Term
Wallenberg's Syndrome
(Lateral medullary syndrome) |
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Definition
Vertebral artery
Contralateral:
--decreased pain and temperature sense
Ipsilateral
--ataxia, vertigo, nystagmus, nausea
--facial decreased pain and temperature
--Horner's syndrome
--Decreased Taste
Hoarseness, dysphagia |
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Term
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Definition
Paramedian Branches of Basilar artery, ventral territory
Contralateral face, arm, and leg weakness, Dysarthria |
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Term
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Definition
Paramedian branches or basilar artery, ventral territory
Contralateral face, arm, and leg weakness, dyarthria, ataxia |
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Term
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Definition
Paramedian branches of basilar artery, ventral and dorsal territories
Contralateral face, arm, and leg weakness, dysarthria
Ipsilateral face weakness, horizontal gaze palsy |
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Term
|
Definition
Paramedian branches of basilar arter, ventral and dorsal territories
Conralatera face, arm, and leg weakness, dysarthria
Ipsilateral face weakness |
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Term
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Definition
Branches of PCA and top of basilar artery
Ipsilateral third-nerve palsy
Contralateral hemiparesis |
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Term
|
Definition
Branches of PCA and top of basilar artery
Ipsilateral third-nerve palsy
Contralateral ataxia |
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Term
|
Definition
Branches of PCA and top of basilar artery
Ipsilateral third-nerve palsy
Contralateral hemiparesis, ataxia, tremor, and involuntary movements |
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Term
| Anterior Circulation Stroke |
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Definition
Ipsilateral blindness or contralateral inferior quadrantanopsia
Ipsilateral gaze paresis
Contralateral mono/hemiparesis and/or mono/hemisensory deficit
Aphasia in the dominant hemisphere or neglect in the nondominant hemisphere |
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Term
| Posterior Circulation Stroke |
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Definition
Unilateral, Bilateral, or crossed (face/body) weakness or sensory deficits
Contralateral homonymous hemianopsia or superior quadrantanopsia
Vertigo, N/V, gait ataxia, diplopia, dysphagia, Horner's syndrome
Altered consciousness and amnesia |
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Term
| What will cause a right sided inferior quadrantanopsia? |
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Definition
| occlusion of the parietal-temporal branches of the Left MCA |
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Term
| What will cause a homonymous hemianopsia of the Right visual field? |
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Definition
| Left Posterior Cerebral Artery occlusion |
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Term
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Definition
| small areas of ischemic necrosis caused by occlusion of small, penetrating arteris |
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Term
| What are the 4 Lacunar syndromes? |
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Definition
1. Pure hemiparesis
2. Pure hemisensory deficit
3. Ataxia Hemiparesis
4. Dysarthria-clumsy hand syndrome |
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Term
| What are the common sites for Atherothrombosis/Atheroemboli? |
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Definition
-Origins of carotid & vertebral a.
-Bifurcations of common carotid a.
Internal carotid a at carotid siphon & branch points of middle and anterior cerebral a.
-M1 segment of middle cerebral a.
-Basilar artery |
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Term
| What are the causes of Lacunar Stroke? |
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Definition
Microatheroma
Microemboli
Lipohyalinosis
Fibrinoid Necrosis |
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Term
| What is the most common cause of cardiogenic emboli affecting the brain? |
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Definition
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Term
| What are the causes of Cardiogenic Emboli? |
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Definition
Arrhythmia
Valvular Heart Disease
-mitral stenosis
-bacterial endocarditis
-prosthetic heart valves
Mural Thrombus - MI |
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Term
| What is a paradoxical embolus? |
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Definition
| arises from the deep venous circulation and goes through patent foramen ovale or ventricular septal wall defect |
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Term
| What are some uncommon causes of Cardiogenic emboli? |
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Definition
Atrial Myxoma
Mitral valve prolapse
nonbacterial endocarditis
Mural Thrombus
Paradoxical embolus |
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Term
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Definition
Inflammation of CNS vessels producing segmental narrowing and multifocal occlusions
Mulifocal presentation |
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Term
| What are some Hyperviscosity syndromes that can cause ischemic stroke? |
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Definition
Polycythemia
Multiple Myeloma |
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Term
| What are some Hypercoagulable conditions that can cause ischemic stroke? |
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Definition
Antiphospholipid Syndrome
Protein C & S deficiency
Cancer
Pregnancy
Leiden factor V deficiency
Thrombocytosis |
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Term
| What is a hemoglobinopathy that can cause ischemic stroke? |
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Definition
|
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Term
| What are some drugs that can cause stroke? |
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Definition
Street Drugs: Cocaine
Ethanol
Oral Contraceptives |
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Term
| What type of Hemorrhage showes up as blood filling in the sulci? |
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Definition
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Term
| What type of hemorrhage presents with blood in the basal ganglia? |
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Definition
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Term
| What type of hemmorrhage presents with blood between the inner plate of skull bone and the dura? |
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Definition
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Term
| What is the most common cause of subarachnoid hemorrhage? |
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Definition
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Term
| What are the risk factors for Subarachnoid Hemorrhage? |
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Definition
Tobacco
Ethanol abuse
Hypertension
OCPs
Stimulant drugs
Low Cholesterol
Genetics (Polycystic kidneys, Marfans) |
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Term
Symptoms of Subarachnoid Hemorrhage
(Ruptured berry aneurysm) |
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Definition
"Worst Headache of my life" - sudden
Rapid loss of consciousness in some
Neck stiffness/pain, photophobia, phonophobia
Nausea/vomiting
Focal Neurologic signs minimal or absent |
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Term
| What causes neck stiffness and pain in a SAH? |
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Definition
| irritation and inflammation of the meninges secondary to the breakdown products of red blood cell lysis |
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Term
| Signs of Subarachnoid Hemmorrhage |
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Definition
Elevated BP, arrhythmias
Meningeal signs - subtle of delayed
Retinal hemorrhages
Focal signs ubtle or absent |
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Term
| Where would an aneurysm be if the patient had Nerve III paresis? |
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Definition
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Term
| Where would an aneurysm be if the patient had Paraparesis? |
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Definition
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Term
| Where would an aneurysm be if a patient had Hemiparesis? |
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Definition
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Term
| What is the most helpful noninvasive diagnostic test to identify a subarachnoid hemorrhage? |
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Definition
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Term
| What is the only way to rule out a subarachnoid bleed? |
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Definition
| Lumbar puncture - 3-4 hours after onset of headache |
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Term
| Why is it necessary to wait 3-4 hours to do a lumbar puncture on a possible SAH? |
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Definition
| to distinguish the breakdown products of hemaglobin in the fluid from the presence of blood that occurred from nicking a vein while preforming spinal tap |
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Term
| What does a spianl tap with xanthochromia show? |
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Definition
| hemoglobin is dissolved in the spinal fluid from RBC that have been in the spinal fluid for several hours - from a ruputurd aneurysm |
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Term
| What is the Gold Standard for neuroradiology of an SAH? |
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Definition
| 4 vessel digital subtraction arteriography |
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Term
| What are the most common causes of parenchymal brain hemorrhage from greatest to least? |
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Definition
| Trauma > Hypertension > Arteriovenous malformations |
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Term
| What are Charcot Bouchard aneurysms? |
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Definition
microaneurysms to small cerebral blood vessels
Caused by Hypertension |
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Term
| Where do Charcot Bouchard aneurysms develop? |
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Definition
| basal ganglia, thalamus, pons, cerebellum |
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Term
| Is a cortical, polar hemorrhage usually related to hypertension? |
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Definition
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Term
Treatment for Parenchymal Hemorrhage
Hypertensive/Traumatic |
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Definition
Correct any bleed problem
Reduce BP to <160/100 or MAP <130mmHg
Monitor and treat elevated intracranial pressure CPP - 60-80mmHg |
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Term
Treatment for Parenchymal Hemorrhage
AVM hemorrhage |
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Definition
Intravascular occlusion of AVM with coils
Surgical removal or gamma knife obliteration of AVM |
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Term
| What are the Routine Labs for possible stroke? |
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Definition
EKG with Rhythm strip
CXR
CBC with diff and platelet count
glucose, BUN, electrolytes (chemistry)
Lipid profile
Clotting times
Head CT without contrast |
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Term
| When is a head CT useful? |
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Definition
Highly sensitive to hemorrhage - used to rule out hemorrhagic stroke
Infarcts from ischemic stroke not detected 6-12 hours |
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Term
| What's the acute treatment for stroke if <4.5hrs from onset? |
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Definition
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Term
| What's the acute treatment for stroke <6 hr from onset? |
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Definition
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Term
| What is the acute treatment of Stroke if <8 hr from symptom onset? |
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Definition
| Retrieve clot with intra-arterial retrieving device |
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