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30 Cards in this Set

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What is a stroke
It is referred to as sudden death of brain cells or neurons due to lack of oxygen. This is either due to blockage of blood flow to the brain or due to a rupture of an artery
What are the leading cause of strokes
A stroke could be caused by 2 methods, by a hemorrhagic event (20%) or by a ischemic event (80%)
What is an ischemic event
Loss of blood to the brain long enough to cause the neuronal cells to die
What are some of the common risks involved with stroke
Smoking, heart disease, genetics, hypercholesterolemia
What are the vessels that are normally involved with stroke
Mainly large surface vessels like the MCA, they usually get an emboli and that’s how the problems happen
Are there any other vessels involved with stroke
Yes, some times it deep penetrating vessels, these can be in the brainstem, and that refers to “lacunar infarct”, mainly seen with hypertension
How does a stroke present
As the worst headache of my life, this is usually sudden and with maximal deficit,
What are the five signs of strokes*
1)sudden numbness in the hands, feet, arm, or legs
How are strokes or brain attacks treated now a days
Just like heart attacks, you do a CT scan or MRI,CT SCAN IS MUCH FASTER, thrombosis is usually hard to see but the hemorrhagic stroke can be seen very quickly,
What’s the treatment for a thrombotic stroke, and what the limitation and side effects
Treat with plasminogen activator TPA, if with in 3 hours, and may lead to severe to intracranial bleeding, also Heparin can do the same thing with the same sideeffects
A 65 year old woman present with transient blindness in her right eye (amurosis fugax) stuttering and loss of strength in her left side, what vessel is occluded
Well we know that loss of vision is due to ophthalmic artery, and the weakness of the left side means that the vessel was contralteral, and loss of vision is ipsilateral, the most likely candidate would be right internal carotid
48 year old man presents with sudden right handed weakness and numbness and global phagia
Right handed weakness means the left vessel is occluded, alos broca’s area is on the left side and that’s also messed up, left MCA’s superior and inferior divisions
80 years old female, right face, arm and leg messed up
Mainly the supply to the internal capsule is messed up, stroke on left side, lenticulside arteries
What technique is good to test for hemorrhagic strokes
CT scans
What is good for ischemic events
MRI, it is based on H2O
What is an irreversible infarct
ishemia→ necrosis, this will be the death of the tissue and there is nothing that we can do about it
What is penumbra
Penumbra is the area around the necrotic cells, we can protects further damage by containing the penumbra and containing the injury
What is apoptosis
Apoptosis is programmed death of the cells, it can be pathological and non
What is the difference between necrosis and apoptosis
1)necrosis is cell death, ischemic, irreversible but apoptosis is penumbra and reversible
What is the major muscle causing cell death in ischemia and neuropathological conditions
Glutamate excitotoxicity
What is the name of the receptor that plays a deadly role in an ischemic event
It is called NMDA receptor
What is the role of the glutamate and NMDA in neuro probs
Glu is an extremely potent excitatory molecule, it is used by all the glial cells in the brain therefore it is cleared up very quickly, but during brain injury or trauma, the homeostatic mechanism of the brain are severely compromised, cells make a lot more GLu and clear it even less, and the ECF concentration of the Glu is builtup, this will lead to depol. Of many cells via use of death receptors like NMDA
What is unique about NMDA and what does It do in an ischemic event
It is both a ligand gated and voltage gated channels. When there is too much glutamate, it bind NMDA receptors , this will lead to Mg+ ion that usually block the Ca2+ channel to move out of the way and this will cause a huge influx of Ca= seen in an ischemic event, since the cells are dying, even more glutamate is released and that will bind more NMDA and the cycles continues
What are the cells that are responsible for picking up all the extra GLu, and what happens to them during necrosis
EATT expressed by Astrocytes and they die during ischemia and the synaptic clefts are leaky
What are the signs and the symptoms of hypertensive hemorrhage
It is usually acute, mass effect, immediate collapse, and decreased function depending on the location, bleeding is usually self limiting and never occurs at the same site, if the patient survives the initial bleed and mass effect, prognosis is better than infarct where tissue is dead
What is subarachnoid hemorrhage
Usually “worst headache of my life”, sudden onset, also called the thunder clap headache, shows focal hemiplegia, drowsiness upon wakening, nuchal rigidity, from blood irrtitating the meninges, focal cranial damage, like PCOM aneurysm affecting the occulomotor nerve,
What are diagnosis tools for SAH or hemorrhagic stroke
First and foremost, CT scan, and then conventional angiography
What are the common sites for hemorrhagic strokes
Berry aneurysm occurs at the bifurcation of the vessels, inside circle of willismost commonly at anterior communicating, P. communicating, at the junction of internal carotid, MCA bifurcation, and the Bifurcation of internal carotid into MCA and ACA
What are the five signs of strokes
1)sudden numbness in the hands, feet, arm, or legs
2)sudden confusion, loss of ability to speak, weakness in facial muscles leading to drool
3)sudden trouble seeing in both eyes
4)sudden trouble walking, seeing, dizziness and maintaining balance
5)sudden headaches with no known cause
What is the difference between necrosis and apoptosis
1)necrosis is cell death, ischemic, irreversible but apoptosis is penumbra and reversible
2)necrosis is swelling of the cells till they burst, but apoptosis is programmed death of the cells
3)necrosis is toxic to the surrounding tissue, but apoptosis is ↓toxic to the surrounding
Area
4)necrosis is highly toxic but apoptosis is less toxic
5)both use NMDA necrosis uses ↑ and apoptosis↓