Term
| What percentage of americans >20 years old have had a stroke? |
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Definition
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Term
| Roughly how many people suffer a new or recurrent stroke? |
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Definition
800,000 people
New=75%
Recurrent=25%
averages to 1 stroke every 40 seconds |
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Term
| Ischemic (DRY) stroke accounts for what percentage of all strokes? |
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Definition
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Term
| What is the mortality rate at 30 days for ischemic stroke? |
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Definition
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Term
| What percentage of ischemic strokes are lacunar? |
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Definition
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Term
| Hemorrhagic strokes account for what percentage of all strokes? |
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Definition
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Term
| What is the mortality rate at 30 days for Hemorrhagic stroke? |
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Definition
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Term
| How many hemorrhagic strokes are intracerebral and how many are subarachnoid? |
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Definition
Intracerebral=3/4
Subarachnoid-1/4 |
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Term
| What are some modifiable risk factors for stroke? |
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Definition
Hypertension
Cardiac Disease (atrial fibrillation)
Smoking
Diabetes
birth control
elevated lipids and cholesterol
physical inactivity |
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Term
| What are some non-modifiable risk factors for stroke? |
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Definition
Heredity
Gender (Women)
Ethnicity (African American)
Geographical Location |
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Term
| What is the normal cerebral blood flow? |
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Definition
| 50-55 mL/100g of brain mass peer minute. |
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Term
| when cerebral blood flow is below _____ neuronal function will be impaired. |
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Definition
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Term
| irreversible change occurs when CBF drops below ____ ? |
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Definition
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Term
| When CBF is _____ it can be tolerated for 2 weeks. |
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Definition
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Term
| When CBF is _______ it will result in an infarct within 1 - 3 hours. |
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Definition
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Term
| What diseases can cause Dry Stroke? |
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Definition
Cerebrovascular occlusive disease
Embolization
Hematologic Disease
Inherited Hypercoagulability
Vasculitis
Collagen Vascular Disease
Dissection
Moyamoya |
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Term
| When blocked by more than ____ reduction of blood flow to the brain occurs. |
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Definition
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Term
| When occluded, the clinical outcome depends on...? |
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Definition
Speed of the occlusion
collateral circulation |
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Term
| when the plaque is ulcerated it may result in...? |
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Definition
| Cholesterol or platelet emboli |
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Term
| ____ have a complete circle of willis |
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Definition
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Term
| in ___ - ___ atleast one vessel is hypoplastic. |
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Definition
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Term
| What are some symptoms used to diagnose a stroke? |
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Definition
Sudden numbness or weakness of face, arm, or leg
sudden confusion, trouble speaking or understanding
sudden trouble seeing in one or both eyes
sudden trouble walking, dizziness, loss of balance or coordination
sudden severe headaches with no known cause |
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Term
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Definition
A small stroke (1cm)
Usually deep
higher cortical function preserved
Causes: Hypertension (Arteriosclerosis, lipohyalinosis)
Treatment:
Control B.P.
Anti-platelet (aspirin) |
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Term
| A Lacunar Stroke in the Lenticulostriate A. could result in: |
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Definition
Pure Motor Hemiplegia
Weakness of contralateral face arm and leg
dysarthria |
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Term
| A Lacunar Stroke in the Thalamogeniculate A. could result in: |
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Definition
artery is located in the VPL nucleus of thalamus
Pure sensory stroke
numbness and tingling of contralateral face and limbs
sensory examination may be normal |
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Term
| A Lacunar Stroke in the Perforrating branch of the Basilar A. could result in: |
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Definition
This is in the dorsal pons.
Dysarthria (clumsy hand) due to weakness of ipsilateral face and tongue associated with clumsy
STRONG CONTRALATERAL ARM |
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Term
| A Lacunar Stroke in the Perforrating branch of the Basilar A. could result in |
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Definition
This is a lesion in the ventral pons (interruption of ponto-cerebellar fibers)
Ataxic Hemiparesis
Mild hemiparesis
ipsilateral limb ataxia
Also can be from Anterior capsular lesions |
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Term
| A Lacunar Stroke in the Lenticulostriate A. could result in: |
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Definition
Lesion in the anterior limb of the internal capsule
Dysarthria
Dysphagia
Mutism
mild facial weakness
no limb weakness or clumsiness |
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Term
| What is luxury perfusion? |
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Definition
| When areas of reduced CBF are bordered by areas of increased CBF |
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Term
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Definition
Treated within 3 hours of onset
usually no benefit at 24 hours
after 3 months 39% increase in people returning to normal activities |
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Term
| Etiology of Intracerebral Hemorrhages |
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Definition
Hypertension is the most common cause (40-50%)
usually deep near thalamus and basal ganglia
Amyloid Angiopathy (10-15%) (amyloid deposits that weaken vessel walls, patients usually much older and several hemorrhages occur at the same time)
Aneurysm
Ateriovenous malformations
Neoplasms
coagulopathy (hemophilia & blood thinners)
Vasculitis
Infarction w/ hemorrhage |
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Term
| What are the 5 P's in hypertensive patients. and what % of hemorrhages occur there? |
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Definition
Putamen - 60%
Pulvinar - 20% (Thalamus)
Pons - 10%
Posterior Fossa - 5% (Cerebellum)
Poles - 5% (Lobar white matter) |
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Term
| What is a benign perimesencephalic hemorrhage? |
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Definition
A diagnosis of exclusion:
someone has a vein in CSF space that eventually obliterates itself and we cannot find anything through testing. |
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Term
| Almost all of the aneurysms are located in: |
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Definition
Bigger blood vessels
if in smaller vessels it is usually in one of the smaller arteries. |
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Term
| Aneurysm ruptures responsible for ____ of strokes. |
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Definition
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Term
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Definition
Arterioles w/ in brain substance is replaced by skeins of amyloid microfilaments.
(Have an affinity for congo red w/ light microscopy and yellow/green w/ polarized light)
Association w/ Alzheimer's (rarely Familial)
Hemorrhage likely to be in subarachnoid space
Multiple hemorrhages occur simultaneously
(especially seen in older patients) |
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Term
| Cavernous Malformation (Angioma) |
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Definition
Tightly packed collection of hyalinized vessels w/ no intervening brain parenchyma
1% risk of rupture annually
clinical relevance depends on location |
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Term
| Signs of Carotid-Cavernous Fistulas |
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Definition
Chemosis
proptosis
EOM weakness
Decreased visual acuity
(if retrograde cortical venous drainage present)
venous hypertension w/ infarct
rarely steal phenomena |
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Term
| You should seek urgent treatment for carotid-cavernous fistulas if you have: |
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Definition
Increased ICP (Cerebral Cortical Venous Hypertension)
Deterioration in vision
increased intraocular pressure
Worsening of proptosis |
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Term
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Definition
causes 1% of all strokes
Caused by:
Trauma
infection
dehydration
pregnancy
birth control pills
hyper-coagulable states |
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Term
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Definition
Following subarachnoid hemorrhage, blood on outside of vessels promotes inflammation irritating vessel walls causing them to clamp down.
Treatment:
right now we give Nimodopine
in small percentage they have another stroke. |
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Term
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Definition
"Gamma Knife"
(focused beams of radiation on one point)
80% cured at 2 years |
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Term
| Onyx (ethylene-vinyl alcohol copolomer) |
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Definition
Non-adhesive
Long working timepause injection to perform control angiography
Permanent agent - no recanalization at 20 months |
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