Term
| What dz triples the risk for stroke or TIA? |
|
Definition
|
|
Term
| If C Reactive Protein is in the upper tertile range, what is the increased risk of stroke? |
|
Definition
| 2.1x greater risk for ischemic stroke |
|
|
Term
|
Definition
Anterior Cerebral Artery
Branches off of carotid artery |
|
|
Term
| What does the ACA supply? |
|
Definition
| parasagittal cerebral cortex |
|
|
Term
| What does the parasagittal area of the cerebral cortex control? |
|
Definition
portions of motor and sensory cortex related to contralateral leg
Also contains bladder inhibitory or micturation center |
|
|
Term
| Are ACA strokes common or uncommon? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What does the superior division of the MCA supply? |
|
Definition
Motor and sensory cortical representation of face, hand, and arm.
Broca's area (expressive language)
Stroke results in hemiparesis of contralateral and inability to speak well |
|
|
Term
| What does the inferior division of the MCA supply? |
|
Definition
Supplies optic radiations, visual cortex area related to macular vision
Supplies receptive language (Wernicke's)
Stroke results in impaired comprehension with fluent but nonsensical speech 'word salad' and failure to recognize the contralateral side of the body, neglect of other half of body |
|
|
Term
|
Definition
| Posterior Cerebral Artery |
|
|
Term
| What does the PCA supply? |
|
Definition
| occipital cortex, medial temporal lobes, thalamus, and rostral midbrain |
|
|
Term
| What does PCA occlusion cause? |
|
Definition
| contralateral homonoymous hemianopsia, though macula may be spared due to MCA supply |
|
|
Term
| What are secondary symptoms of PCA occlusion? |
|
Definition
| Disturbed MLF fxn, inability to name objects or read |
|
|
Term
|
Definition
|
|
Term
|
Definition
| artery that bifurcates off of common carotid artery in neck, supplies the ACA, MCA, and ophthalmic artery |
|
|
Term
| What does stroke of ICA cause? |
|
Definition
| Sx similar to MCA, preceded by ipsilateral transient monocular blindness 15% of the time. |
|
|
Term
|
Definition
ASA (anti-platelet therapy)
Aggrenox (ASA and dipyridamole)
Ticlopidine or clopidogrel if ASA can't be taken
Heparin for anti-coagulation (for limited time)
t-PA (tissue-type plasminogen activator), inhibits clotting
Vampire bat saliva?
Minocycline if out of TPA window but less than 24 hours since onset |
|
|
Term
| What fxn's are controlled by the thalamus? |
|
Definition
| Chooses what topic brain will focus on |
|
|
Term
|
Definition
| Aspirin: used for Antiplatelet therapy to treat strokes |
|
|
Term
|
Definition
| Aspirin with dipyridamole, strong vasodilator. Combo is very effective |
|
|
Term
|
Definition
| If pt cannot tolerate aspirin, used to tx stroke |
|
|
Term
|
Definition
| If pt cannot tolerate aspirin, used to tx stroke |
|
|
Term
|
Definition
Tissue-type plasminogen activator, also called alteplase
Derived from human melanoma cells, only breaks down fibrin --> breaks clots
Must be administered within 3 hrs of stroke |
|
|
Term
|
Definition
| Inhibits clots, but since it inhibits clotting, may exacerbate a hemorrhagic stroke. |
|
|
Term
| What are ultrasound-stimulated microspheres? |
|
Definition
| Used with t-PA to mechanically break down fibrin clot. The gas microspheres 'sandpaper' the clot away. Thrombosonolysis |
|
|
Term
| What is thrombosonolysis? |
|
Definition
| gas microspheres activated by ultrasound to break up clots in stroke tx |
|
|
Term
|
Definition
| caffeine and ethanol infusion equivalent to 7 cups of coffee and 2 shots of ethanol. Combo has been shown to be neuroprotective for stroke tx. |
|
|
Term
| What does ERIS stand for? |
|
Definition
| Early Recurrent Ischemic Stroke |
|
|
Term
| What is a possible complication of t-PA treatment? |
|
Definition
| May result in early recurrent ischemic stroke from thrombus breakdown byproducts |
|
|
Term
| What is the medical use of vampire bat saliva? |
|
Definition
| Stroke tx, may be effective up to 9 hrs after stroke to help break down clot and remove ischemia |
|
|
Term
|
Definition
| Neuroprotective effect, used outside of t-PA window for stroke pt's, i.e. more than 3 hrs but less than 24 hrs |
|
|
Term
| Why are acid sensing channels sometimes blocked? |
|
Definition
| They open up Ca++ channels, too much Ca++ will kill neurons. |
|
|
Term
| What can reduce the risk of second stroke? |
|
Definition
|
|
Term
|
Definition
| a diuretic that also has a neuroprotective ability, may reduce brain damage by 30% in stroke pt's |
|
|
Term
| What is spider venom used to tx? |
|
Definition
| Blocks acid sensing channels, which is neuroprotective. May reduce brain damage by 60% in stroke pt's. |
|
|
Term
|
Definition
| tarantula venom used to treat stroke |
|
|
Term
| What is a Concentric MERCI Retrieval System? |
|
Definition
| Surgical corkscrew used to remove thrombus from stroke pt's |
|
|
Term
| What is a penumbra stroke vacuum system? |
|
Definition
| Used to vacuum up thrombi in stroke pt's, used outside of t-PA window |
|
|
Term
| What is induced hypothermia used for? |
|
Definition
| To reduce the inflammatory process of the body after stroke. Brings body temperater down to 91*. Must be done within 5 hours of stroke, depressed temp is held for 24 hours, then increased. |
|
|
Term
| What are brain stents used for? |
|
Definition
| stroke tx, open up arteries again. So far disappointing results. |
|
|
Term
| What is intraparenchymal hemorrhage? |
|
Definition
| Sudden and dramatic, devastating brain bleed |
|
|
Term
| What are s/sx of intraparenchymal hemorrhage? |
|
Definition
| sudden and severe HA, vomiting, loss of consciousness |
|
|
Term
| What is the outlook for an intraparenchymal hemorrhage? |
|
Definition
| poor, high mortality rate |
|
|
Term
| What are the leading causes of intraparenchymal hemorrhage? |
|
Definition
|
|
Term
| What is the worst kind of stroke? |
|
Definition
| Intraparenchymal hemorrhage |
|
|
Term
| What is a subarachnoid hemorrhage? |
|
Definition
When a blood vessel in the head snaps open (often audibly) and often on the Circle of Willis
Caused by congenital aneurysm
|
|
|
Term
| What % of subarachnoid hemorrhage pt's will die from it? |
|
Definition
|
|
Term
| What is the most common cause of subarachnoid hemorrhage? |
|
Definition
| congenital aneurysm on the circle of Willis (75% of subarachnoid hemorrhages) |
|
|
Term
| What are s/sx of subarachnoid hemorrhage? |
|
Definition
| sudden, "popping bubblewrap" sensation --> severe HA, vomiting, rapid loss of consciousness and death |
|
|
Term
| What are the leading causes of CNS trauma? |
|
Definition
| automobile accidents and personal violence |
|
|
Term
| What are common long term CNS trauma side effects? |
|
Definition
Paresis or paralysis
Epilepsy
Distrubed mentation |
|
|
Term
|
Definition
| direct trauma that causes transient loss of consciousness without noticeable pathologic changes upon examination |
|
|
Term
| What is a grade 1 concussion? |
|
Definition
| No loss of consciousness, pt is dazed (90%) |
|
|
Term
| What is a grade 2 concussion? |
|
Definition
| no loss of consciousness, pt is dazed and has no memory of the event for >15 minutes |
|
|
Term
| What is a grade 3 concussion? |
|
Definition
| Loss of consciousness; post-trauma amnesia |
|
|
Term
| How long can s/sx present after a concussion? |
|
Definition
|
|
Term
| What are long term post traumatic symptoms from concussions? |
|
Definition
HA
Depression
Irritability
Personality changes
Insomnia
Unsteadiness |
|
|
Term
| When is a CT scan recommended for a concussion pt? |
|
Definition
suspected skull fracture
Two episodes of vomiting
amnesia of greater than 30 minutes prior to concussion
If the cause of the concussion is severe enough (MVA, >3ft fall or > 5 stairs) |
|
|
Term
| How long should concussion patients be observed? |
|
Definition
|
|
Term
| What is the Glascow Coma scale? |
|
Definition
| The lower the number, the lower the level of responsiveness. |
|
|
Term
| When does the Glascow Coma scale indicate a CT scan should be done? |
|
Definition
| If GCS is less than 15 after 2 hours |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What should a concussion pt be hospitalized? |
|
Definition
abnormal CT
seizures
If pt has a bleeding disorder |
|
|
Term
| When should a pt be seen again after concussion? |
|
Definition
|
|
Term
| What are SE of brain contusion? |
|
Definition
may form epileptic focus
edema that can lead to death |
|
|
Term
| Is there a loss of brain tissue continuity in brain contusion? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| trauma sheers axons from the gray-white matter jxn. |
|
|
Term
| Are DAI's seen well with diagnostic imaging? |
|
Definition
| No, s/sx will seem greater than apparent damage |
|
|
Term
| What is the prognosis for DAI pt's? |
|
Definition
| poor, often results in permanent vegetative state. If they will recover to somewhat normal fxn, they will do so in the first year |
|
|
Term
| What is an epidural hematoma? |
|
Definition
| bleeding between inner table of the skull and the dura mater |
|
|
Term
| What is a common cause of epidural hematoma? |
|
Definition
| lacerated middle meningeal artery or branch |
|
|
Term
| What is the onset of epidural hematoma s/sx? |
|
Definition
|
|
Term
| What is a subdural hematoma? |
|
Definition
| Bleeding between dura and pia-arachnoid tissue |
|
|
Term
| What is common cause of subdural hematoma? |
|
Definition
| tearing of venous arachnoid bridging vessels |
|
|
Term
| What is the onset of subdural hematoma s/sx? |
|
Definition
| Slower than epidural hematoma due to lower pressure in venous system |
|
|
Term
| What may subdura hematoma's be misdiagnosed as? |
|
Definition
|
|
Term
| What is seen in 2/3 of subdural hematoma pt's? |
|
Definition
| Contralateral hemiparesis and ipsilateral pupil dilation |
|
|
Term
| When do CNS infections occur? |
|
Definition
| When body resistance is low |
|
|
Term
| What are s/sx of CNS infection? |
|
Definition
Fever
HA
Altered mental status
seizures
Focal neurologic signs
stiff neck |
|
|
Term
| Who is most susceptible to acute bacterial meningitis? |
|
Definition
| 75% of cases occur before age 15 |
|
|
Term
| What are s/sx of acute bacterial meningitis? |
|
Definition
fever
HA
Lethargy
confusion
irritability and stiff neck |
|
|
Term
| What % of acute bacterial meningitis cases present abruptly? |
|
Definition
|
|
Term
| What is the tx for acute bacterial meningitis? |
|
Definition
|
|
Term
| What is important for preventing acute bacterial meningitis? |
|
Definition
| pneumococcal conjugate vaccination |
|
|
Term
| What is aseptic meningitis? |
|
Definition
|
|
Term
| What are s/sx of aseptic meningitis? |
|
Definition
severe HA exacerbated by position changes an coughing
Fever |
|
|
Term
| What are ocular SE of aseptic meningitis? |
|
Definition
|
|
Term
| What is the prognosis for aseptic meningitis? |
|
Definition
| usually benign; self limiting |
|
|
Term
| What is Multiple Sclerosis? |
|
Definition
| Damaged myelin sheaths due to autoimmune attack and resulting inflammation scar (plaque) |
|
|
Term
| Who are most prone to Multiple Sclerosis? |
|
Definition
Women 20-40 yo
More common in Caucasians, but more severe in pt's of african descent
Those who live in temperate climates and receive less sunlight |
|
|
Term
| What is a Multiple Sclerosis 'attack'? |
|
Definition
| rapid onset s/sx over a week or two |
|
|
Term
| How long will Multiple Sclerosis attacks last? |
|
Definition
1-3 mo average
up to 6 mo |
|
|
Term
| What are ocular SE of Multiple Sclerosis? |
|
Definition
Unilateral vision loss
Optic Neuritis
Diplopia
Nystagmus
Internuclear ophthalmoplegia |
|
|
Term
| What is a relapsing-remitting course? |
|
Definition
| When a dz flares up, then subsides repeatedly |
|
|
Term
| What % of optic neuritis pt's will develop MS? |
|
Definition
|
|
Term
| What is internuclear ophthalmoplegia? |
|
Definition
Often seen with MS
The eye cannot pass beyond the midline when trying to gaze contralaterally |
|
|
Term
| What is a bilateral internuclear ophthalmogplegia? |
|
Definition
|
|
Term
| What is a common GI SE of MS? |
|
Definition
| bladder and bowel dysfunction |
|
|
