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Pathology F10

Stroke

QuestionAnswer
What is the number 1 cause of disability in adults? Stroke
What is a TIA and how long does it last? Transient Ischemic Attack: transient appearance of focal neurologic symptoms -Etiology same as stroke seen in 50-80% of ppl who experience an occlusion -treated w/ anti-coagulants
Symptoms from a TIA resolve in ____ hrs. -24 hours -Symptoms include temporary blindness and weakness
What disease leads to a higher risk of stroke in AA? •Large artery occlusive disease
Name modifiable and non-modifiable risk factors for stroke. •Modifable: hypertension (160/95), obesity, smoking, diabetes •Non-modifiable: age, race, sex, increased fibrin deposition (associated with RH disease, polycythemia, thrombocytosis, endocarditis), various cardiac diseases
What % of people who have a stroke are over age 65? •Incidence of stroke doubles with every year after 55. •5% of men between the ages of 65-69 compared with 10% of men between the ages of 80-84
What are the two major types of stroke? Ischemic Hemorrhagic
What are the most common causes of ischemic stroke? Thrombosis and embolic occlusion of the a major vessel
What is a penumbra? •area around where an acute infarct has occurred receives sufficient blood from collateral circulation to maintain viability but not to sustain function •known as an ischemic penumbra
What is the most common source of embolic material? The heart as a result of damage to its tissues.
Are lacunar strokes ischemic or hemorrhagic? ischemic
WHere do lacunar strokes usually occur? small arteries supplying the basal ganglia and internal capsule are occluded
What neurotransmitter is involved in producing excitotoxicity? glutamate
Middle Cerebral Artery Syndrome: Dominant contralateral hemiplegia and hemisensory of UE/ face, loss of conjugate gaze on right side, homonymous hemianopsia on right side, aphasia (Broca, Wernwicke, Global)
Middle Cerebral Artery Syndrome: Non-Dominant contralateral hemiplegia and hemisensory of UE/ face, loss of conjugate gaze on left side, homonymous hemianopsia on left side, parietal syndrome (anosognosia, left side neglect, somatopognosia, visual-spatial perceptual defecits, preservation)
Anterior Cerebral Artery Syndrome contralateral hemiplegia and sensation of LE, incontinence, personality changes, reappearance of grasping and sucking
Posterior Cerebral Artery Syndrome fleeting contralateral hemiparesis, impairment of superficial touch and loss of deep sensation, visual agnosia, homonymous hemianopsia, thalamic syndrome
Vertebral and Posterior Inferior Cerebellar Artery Syndrome vertigo, nausea, hoarseness, dysphagia, nystagmus, ipsilateral ataxia, ipsilateral facial analgesia, ipsilateral Horner’s syndrome, ipsilateral weakness of vocal cords, contralateral hemianalgesia
Basilar Artery Syndrome sensory and motor aspects of the cranial nerves are affected: bilaterally if the basilar artery is occluded, unilaterally if when a branch of the basilar artery is occluded
Superior Cerebellar Artery Syndrome severe ipsilateral ataxia, nausea and vomiting, dysarthria, dysmetria, los of pain and temperature control in the contralateral extremity, torso, and face
Anterior Inferior Cerebellar Artery Syndrome ipsilateral hearing loss, facial weakness, vertigo, nausea and vomiting, nystagmus, ataxia, horner’s syndrome (ptosis, miosis, loss of sweating)
Why is the middle cerebral artery the most frequently involved when a person has a stroke? Because it is a direct continuation of the internal carotid artery
Which of the cerebral arteries is least likely to be involved in a stroke? Anterior Cerebral Artery
Which cerebral artery is occluded when a person has thalamic syndrome? Posterior Cerebral Artery
What occurs in Claude's syndrome? palsy of cranial nerve III (occulomotor) occurs with contralateral hemiataxia
What occurs in Weber's syndrome? Palsy of R CN III with L contralateral hemiplegia
What visual deficit commonly occurs when the posterior cerebral artery is occluded? •HH may occur if occipital lobe affected •Cortical blindness – inability for brain to record an image although optic nerve is intact **
What blood flow is occluded in a stroke when there is contralateral hemiplegia with greater involvement of the leg than the arm? Anterior cerebral artery
Contralteral hemiplegia with greater involvement of the arm than the leg is indicative of a stroke involving which artery? Middle Cerebral Artery
What arteries supply blood to the brainstem, medulla and cerebellum? branches of basilar and vertebral arteries – superior cerebellar artery, anterior inferior cerebellar artery, posterior inferior cerebellar artery
What structures are damaged in Wallenberg's syndrome? lateral medulla and cerebellum
What structure is damaged when a person with MCA infarct presents with homonymous hemianopia? •Posterior cerebral stem is damaged •visual field defect is on the opposite side of the lesion
What the signs and symptoms of Wallenberg syndrome? •Vertigo •nausea •hoarseness •dyschagia (difficulty swallowing)
What type of speech pattern is indicative of cerebellar involvement? •Scanning speech – a drawn-out and monotone speech pattern that reflects damage to the cerebellum •dysarthria – slurring of speech (seen with an occlusion of the superior cerebellar artery)
A pure sensory stroke indicates a lesion in the __________. posterolateral thalamus
A pure motor stroke indicates a lesion in the ____________. posterior limb of the internal capsule
lacunar syndrome •Both the pure motor and pure sensory strokes are lacunar syndrome – lacunar infarcts are small infarcts of the end arteries found in the basal ganglia, internal capsule, and pons
Ipsilateral ataxia (arm or leg) with leg weakness indicates a lesion in the _________. cerebellum
What imaging technique is used to distinguish between a hemorrhagic and an ischemic stroke? • A CT scan can quickly determine between an ischemic stroke or a hemorrhagic stroke, it will show a hemorrhage immediately but may take a long time before the changes (white areas) from an ischemic/embolic stroke are seen
What can detect an ischemic stroke in 2-6 hours? MRI
What medication is given to "bust" a clot? within what kind of time frame must it be administered? •The medication commonly given to bust a clot is Tissue Plasminogen Activator (TPA) •The window of opportunity to administer this drug is 3 hours after it occurs •There is a risk of them having a hemorrhage that must be ruled out
What prophylactic medications are used to decrease the risk of stroke? •Anticoagulants – prevent coagulation oHeparin – may be given in a bolus oWarfarin (Coumadin) – long term (2x more effective than aspirin oAspirin – an antiplatlet
What surgical intervention is indicated in an individual who has had a low flow or embolic TIA? •A carotid endarterectomy – surgery is done if there is a 70% occlusion of the origin of the internal carotid artery oThis procedure cleans the plaque off of the artery walls •Stents are also sometimes used to keep the vessel open
When does most of the neurologic recovery occur after a stroke? •Recovery is fastest in the first few weeks after onset •The most measurable neurologic recovery (90%) is in the frist 3 months •Can still see improvements in some individuals up to 5 or more years after stroke
What is the single most modifiable risk factor for an intracerebral hemorrhage? hypertension
What are the age and cultural differences in incidence of ICH (Intercerebral hemorrhage)? •Low under age of 45 •Increases dramatically over age of 65 •Occurs more frequently in men •In US, African Americans are more likely than whites •Worldwide rates are higher in Asians than any other
Where do the largest percentage of hemorrhages occur? •Putamen – 40% •Lobar – 22% •Thalamus – 15%
Subarachnoid hemorrhage blood between the arachnoid layer and pia layer (arterial)
Etiology of a Subarachnoid Hemorrhage oAneurysm & vascular malform responsible for most oCan be result of trauma, developmental defects, neoplasm, infection oHypertension seen in 32% oHighest incidence= women over 70
Risk Factors of a Subarachnoid Hemorrhage oRisk factors: smoking, excessive alcohol, hypertension, family history
Signs of a Subarachnoid Hemorrhage o Sudden headache (sentinel headache), brief loss of consciousness (due to rising intracranial pressure), nausea and vomiting
Treatment of a Subarachnoid Hemorrhage oTreatment prevents secondary problems: rebleeding, vasospasm, hydrocephalus, hyponatremia, and seizures oLots of fluids, avoid antihypertensive drugs, administer calcium antagonist nimodipine
Outcome of a Subarachnoid Hemorrhage o High mortality in elderly oEarly aggressive surgical treatment lead to better outcomes oIf hematoma is less than 3cm, prognosis is good oPrompt removal of aneurysm leads to better improvement
Subdural hemorrhage blood below the dura, (of the cortical bridging veins)
Etiology of a Subdural hemorrhage o80% occur in elderly men oSymptoms are slow, “walk, talk, and die” syndrome, confusion is prominent sign, complain of headache oAnticoagulant therapy is a risk factor oCauses a midline shift of brain (squishes it over) – space occupying lesion
Treatment of a Subdural hemorrhage take to hospital immediately
Prognosis of a Subdural hemorrhage most important predictor of mortality is hemorrhage size
How do you differentiate between an upper motor and lower motor neuron lesion involving the face? •UMN lesion of the face: lower part of face on the contralateral side will be affected (due to bilateral control, of upper facial mm are not affected) •LMN lesion of face: both upper & lower facial symptoms on same side of lesion
Discuss the movement problems associated with stroke. •Decreased force production •Sensory impairments •Synergistic organization of movement oFlexion in UE oExtension in LE •Altered temporal sequencing of muscle activation oCan be very slow oCan get “stuck” at end ranges
Created by: CWestrick