ADVANCED PATHOPHYSIOLOGY: NEUROLOGY
QUESTIONS WITH DETAILED VERIFIED AND 100%
ACCURATE ANSWERS
Stroke: Cerebrovascular accident (CVA) Correct Answers Stroke
(CVA) is the 2nd leading cause of death globally. Stroke types include
ischemic (80-85%) and hemorrhagic (15-20%).
1) Ischemic stroke:
Due to:
Large artery thrombosis (20% related to atherosclerotic dx) OR
Small penetrating artery thrombosis (25%)- these are lacunar strokes
(white matter or deep in the brain)
Embolic/cardiogenic (20%)- ex. when someone has afib and throw a
clot to the brain
Cryptogenic (30%)- transient and of unknown etiology
2) Hemorrhagic stroke:
Subarachnoid (due to aneurisms in 80% of cases)
Intracerebral/intraparenchymal (20%, most fatal)
Stroke: Presentation Correct Answers Think about the presentation
related to where the occlusion is:
LEFT hemisphere is characterized by:
Language deficits:
-expressive aphasia --> inability to find words or communicate (Broca's)
,-receptive aphasia --> inability to process and receive verbal
communication (Wernicke's)
-global deficits
Intellectual/cognitive impairment
Slow, cautious behavior
Have R visual field deficits
RIGHT hemisphere is characterized by:
Spatial-perceptual deficits
Distractibility
Impulse behavior: unaware of deficits
Poor judgment
L visual field deficits
CVA: Secondary stroke prevention Correct Answers When we think
about CVA, the main focus is on early identification and secondary
stroke prevention.
CVA presentation:
Sudden focal neuro deficit:
hemiparesis (one-sided weakness), aphasia (inability to express speech),
hemianopia (blindness over half field of vision, hemispatial inattention
(reduced awareness of space)
,BE FAST:
Balance --> loss of balance/dizzy
Eyes --> blurred vision
Face --> unilateral drooping/sagging of face
Arms --> unilateral weakness in an arm or leg
Speech --> receptive or expressive difficulty
Time --> respond quickly!
Differential diagnoses:
Migraine/headache, seizure, vestibular disturbance
Dx and Tx:
CT (without contrast)
Thrombolytic therapy (within <4.5 hrs of symptom onset)
Endovascular thrombectomy- remove clot/re-perfuse brain (if longer but
<6 hours)
Secondary prevention:
-control BP!
-lifestyle (smoking, diet, salt, activity)
-antiplatelet tx
-high-dose statin tx (bc often underlying atherosclerotic dx)
, Ischemic stroke (80-85%) Correct Answers 1 in 4 adults --> ischemic
stroke (cause: thromboembolic arterial occlusion) in their lifetime...
>80M stroke survivors --> inc. risk, focus on secondary prevention
Cause:
Arterial occlusion (thromboembolic) occluding perfusion of the brain,
may result from:
-Large artery atherosclerosis and CVD (i.e. afib) --> resulting in
inflammation and ulceration of vasculature (aortic arch neck OR
intracranial vessels in brain)
-Small vessel disease (uncontrolled HTN, DM) --> may also result in
lacunar stroke- which are occlusion of small arteries penetrating deep
brain areas
-Arterial dissection (artery ruptures) --> initiated by trauma/sneeze,
vasculitis, patent foramen ovale (L-R aria), hematologic disorders
(thrombocytosis, polycythemia vera- overload of RBCs which can
occlude vessels in the brain), endocarditis
Modifiable risk factors:
BP (>160/90 mm/Hg particularly high risk)
CVD (a-fib, previous MI)
DM, dec. physical activity, high waist:hip ratio
Lifestyle such as smoking, ETOH, diet, psychosocial stress
Ischemic stroke: Mechanisms Correct Answers Ischemia is impaired
blood flow and decreased oxygenation of the tissues
QUESTIONS WITH DETAILED VERIFIED AND 100%
ACCURATE ANSWERS
Stroke: Cerebrovascular accident (CVA) Correct Answers Stroke
(CVA) is the 2nd leading cause of death globally. Stroke types include
ischemic (80-85%) and hemorrhagic (15-20%).
1) Ischemic stroke:
Due to:
Large artery thrombosis (20% related to atherosclerotic dx) OR
Small penetrating artery thrombosis (25%)- these are lacunar strokes
(white matter or deep in the brain)
Embolic/cardiogenic (20%)- ex. when someone has afib and throw a
clot to the brain
Cryptogenic (30%)- transient and of unknown etiology
2) Hemorrhagic stroke:
Subarachnoid (due to aneurisms in 80% of cases)
Intracerebral/intraparenchymal (20%, most fatal)
Stroke: Presentation Correct Answers Think about the presentation
related to where the occlusion is:
LEFT hemisphere is characterized by:
Language deficits:
-expressive aphasia --> inability to find words or communicate (Broca's)
,-receptive aphasia --> inability to process and receive verbal
communication (Wernicke's)
-global deficits
Intellectual/cognitive impairment
Slow, cautious behavior
Have R visual field deficits
RIGHT hemisphere is characterized by:
Spatial-perceptual deficits
Distractibility
Impulse behavior: unaware of deficits
Poor judgment
L visual field deficits
CVA: Secondary stroke prevention Correct Answers When we think
about CVA, the main focus is on early identification and secondary
stroke prevention.
CVA presentation:
Sudden focal neuro deficit:
hemiparesis (one-sided weakness), aphasia (inability to express speech),
hemianopia (blindness over half field of vision, hemispatial inattention
(reduced awareness of space)
,BE FAST:
Balance --> loss of balance/dizzy
Eyes --> blurred vision
Face --> unilateral drooping/sagging of face
Arms --> unilateral weakness in an arm or leg
Speech --> receptive or expressive difficulty
Time --> respond quickly!
Differential diagnoses:
Migraine/headache, seizure, vestibular disturbance
Dx and Tx:
CT (without contrast)
Thrombolytic therapy (within <4.5 hrs of symptom onset)
Endovascular thrombectomy- remove clot/re-perfuse brain (if longer but
<6 hours)
Secondary prevention:
-control BP!
-lifestyle (smoking, diet, salt, activity)
-antiplatelet tx
-high-dose statin tx (bc often underlying atherosclerotic dx)
, Ischemic stroke (80-85%) Correct Answers 1 in 4 adults --> ischemic
stroke (cause: thromboembolic arterial occlusion) in their lifetime...
>80M stroke survivors --> inc. risk, focus on secondary prevention
Cause:
Arterial occlusion (thromboembolic) occluding perfusion of the brain,
may result from:
-Large artery atherosclerosis and CVD (i.e. afib) --> resulting in
inflammation and ulceration of vasculature (aortic arch neck OR
intracranial vessels in brain)
-Small vessel disease (uncontrolled HTN, DM) --> may also result in
lacunar stroke- which are occlusion of small arteries penetrating deep
brain areas
-Arterial dissection (artery ruptures) --> initiated by trauma/sneeze,
vasculitis, patent foramen ovale (L-R aria), hematologic disorders
(thrombocytosis, polycythemia vera- overload of RBCs which can
occlude vessels in the brain), endocarditis
Modifiable risk factors:
BP (>160/90 mm/Hg particularly high risk)
CVD (a-fib, previous MI)
DM, dec. physical activity, high waist:hip ratio
Lifestyle such as smoking, ETOH, diet, psychosocial stress
Ischemic stroke: Mechanisms Correct Answers Ischemia is impaired
blood flow and decreased oxygenation of the tissues
