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15 Cards in this Set

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Stroke (cerebrovascular accident CVA)
A rapidly developed clinical sign of focal disturbance of cerebral function of presumed vascular origin of more than 24 hours duration. Stroke stops blood from circulating through cerebral blood vessels, providing oxygen and removing toxic waste products.
2 main types of stroke.
1. Hemorrhagic stroke (bleeding from the blood vessels). 2. Occlusive (closure of a blood vessel).
Hemorrhagic stroke
- 20% of all strokes. - 60% die w/in 12months.
Occlusive stroke
80% OF ALL STROKES. Occlusion of a vessel causes ischaemia (loss of blood
supply) to the surrounding tissue • If ischaemia is sustained for long enough it causes infarction (death of neuronal tissue)
2types of Hemorrhagic stroke
1. Intrcerebral haemorrhage; 50% of all Hem strokes, blood escapes directly in2 brain n destroys localised brain tissue. cAUSES RELATIVELY LOCALISED NEURAL DAMGE. 2. Subarachnoid haemorrhage; 50% of all HSs. Blood BURSTS from blood vessel in2 the subarchnoid space, and has NO direct contact w/ neural tissue. Often causes hydrocephalus. Damage is GLOBAL throughout the brain.
Cognitive outcome after haemorrhage in;
ICH....
SAH...
ICH: localised neuronal damage. Nature of con impairments depends on region of brain affected.
SAH: Causes diffuse neuronal damage, cog impairment generalised w/DAMPENING of all systems incl intellect.
Mechanism
of Occlusion
Two primary types:
1. Cerebral Thrombosis: Local narrowing of blood vessel, most commonly due to Atherosclerosis, which cause atheromatous plaques which in turn reduce blood flow.
2.Cerebral Embolism: Fragments of atheromatous plaques (e.g. in heart) break off and become lodged in narrower arteries (e.g. in brain).
Extent of infarction
(tissue death) depends on location of occlusion/blockage & extent of collateral circulation (e.g.. infarction in a large vessel = greater affected area)
Vascular dementia (VAD)
2nd most common AD. - memory impairment common BOT NOT necessary feature. - due to dev of multiple strokes on other cerebrovascular lesion over time. Increasing cog impairment.
Memory function --> Ischaemic stroke
- severe amnestic syndrome --> occlusion of anterior choroidal arteries (MTL) or posterior cerebral arteries (thalamus). Milder mem changes --> occ of anterior cerebral arteries (med fr lobes, mam bods, fornix, ant cing) or middle cerebral artery (lat fr and temp lobes)
Effect of size of stroke. Small strokes result in circumscribed (r................) cognitive deficits, dependent on stroke location. Very large stokes --> widespread cog d...................and impairment in c................(patient usually D.......)
RESTRICTED, dysfunction, consciousness, DIE
Recovery of stroke. Most rapid (d......., w........ impovements. ....-... months post. 6-12 months ................ recovery (............... improvement). >12 very .................. if..........
days, weeks, 6, 12. slower, monthly. slow, any.
CASE STUDY: RW.
56yo man. dense R sided hem (neuro imaging) ischaemic stroke in LFL. rapid recovery of motor function, residual fine motor difficulties remained. APATHY MEMORY, mild CONFAB, poor PLANNING & ORG skills, impulsivity, primary mot sys (MTL & Thal) intact, FL diff- impairment in organising & encoding & retrieval of novel info, more impairment to delayed recall vs.. new learning.
Stroke; mem impairment can occur in ............... due to lesioning of structures in primary motor structure.
isolation
Affects of strokes on cog is dependent on ............. & .............. of lesion
location, size