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neurophysio course stroke unit

neurophysio course stroke unit

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neurophysio course stroke unit - flashcard style

Items (44)

  • autoregulation

    helps maintain constant supply of blood to brain tissues

  • why does the brain need so much energy

    to maintain resting potential, synthesize, remove and recycle NTs

  • stroke aka

    cerebrovascular accident or brain attack

  • __th leading cause of death in canada. _____die each year bc of it.Â

    4th - 16000 canadians die each year

  • Stroke - 2 major causes

    1. Ischemic Stroke -- clot -global -- ex. during cardiac arrest -focal -- ex. during occlusion of a cerebral blood vessel 2. Hemorrhagic Stroke -- burst - ex. following rupture of a cerebral blood vessel

  • Lacunar Infarcts

    * Caused by occlusion of a single deep penetrating artery * Occur most often in the basal ganglia, internal capsule, thalamus and brainstem * Symptoms:- Only motor OR only sensory

  • hemorrhagic stroke

    rupture of a blood vessel aneurysm or arteriovenous malformation

  • What does a watershed zone lesion cause?

    Between ACA and MCA, damage that happens in settings of severe hypotension , -> upper leg/upper arm weakness, defects in higher-order visual processing.

  • watershed zone

    the border zones between large arterial territories are called WATERSHED ZONES OR AREAS and are especially likely to suffer ischemic damage from DIFFUSE CEREBRAL HYPO-PERFUSION.

  • 2 areas divisions of ischemiaÂ

    umbra region - ischemic core of blood vessel Penumbra region - area still getting some blood flow around the plaque/ blockage

  • neural energy failure effects of ischemia

    energy failure due to hypoxia and decreased glucose availability Na+/K+ pump requires ATP to maintain resting potential extracellular glutamate increases by 8x

  • what causes glutamate to be in excess during ischema?

    energy failure results in neurons not being able to pump out enough Na and in enough K, so gradient that astrocytes use to remove glutamate is not there. glutamate accumulates at the cleft.

  • NMDA receptor in excitotoxicity

    A specialized ionotropic glutamate receptor that controls a calcium channel causes influx of Ca++ and Na+ when glutamate binds (if an Mg++) is not blocking channel) --> increase cell size, may lyse calcium activates proteases, lipases, may initiate apoptosis

  • stroke outcome depends onÂ

    regions effected

  • Acute Ischemic Stroke Treatment

    * reopen blocked vessels by "lysing" clots * tPA - thrombolytic drug which has been proven effective in acute ischemic stroke patients within 3 hours of onset; only FDA-approved drug * interventional/endovascular * "preserve the penumbra"

  • thrombolytics

    tPA - dissolve clots. 3 hr window. 33% more likely to recover from stroke with little or no disability risk: hemorrhage

  • neuroprotective strategies to treat acute stroke

    glutamate antagonists Ca++ and Na+ blockers antioxidants

  • what may be an unorthodox but potentially promising treatment of acute stroke?

    hypothermia - cool body by 1.3 degrees in acute phase of stroke-----> patients 2x more likely to survive 6 months post stroke

  • 3 processes associated with recovery

    resolution of diaschisis, inflamation etc. behavioural compensation neuroplasticity

  • Diaschisis

    -it spreads after an injury in the CNS. • depression of a specific region distantfrom the primary site of brain injury by reduced blood flow • Full functional recovery may occur overtime if addressed quickly

  • diaschisis initial improvement likely corresponds toÂ

    resolution of tissue inflammation

  • when do you see early stage inflammation after onset of ischemia? what cells are involved?

    few hours, microglia and leukocytes

  • behavioural compensation

    eg. use unaffected arm, or walk with cane

  • neuroplasticity mechanisms

    redundancy - alternate pathways take over lost function unmasking - activation of normally inhibited pathways long-term potentiation - increasing efficiency of synaptic connections and formation of a new synapse

  • unmasking

    - neighboring regions with intracortical connections.that are normally inhibited by a inhibitory cell to prevent inappropriate coactivation. - in stroke patients inhibitory/ gaba cells so alternate path opens up -

  • once lateral excitory connections are unmasked by decreased intracortical inhib, what happens?

    adjacent cortical regions expand

  • after focal ischemic lesion, what is seen to change throughout the cortex?

    reduction in GABA receptors throughout cortex

  • long-term potentiation


  • receptors and functions of them in LTP

    1) AMPA- sodium channel, activated by glutamate, depolarizes cell slightly 2) NMDA - once glutamate is bound and cell is slightly depolarized it opens, allowing in Na and Ca, causing rapid depolarization - the increase in Ca++ causes LTP via activation of calmodulin kinase II and protein kinase C --> modifies receptors or sends retrograde factor to increase transmission

  • LTP may arise from

    rapid insertion of AMPA receptors

  • LTP may increase

    size and number of synaptic contacts (synapse multiplication)

  • Long Term Depression


  • forced use/ constraint- induced training

    patients practice using affected limb while other limb is restrained. 6hrs/day for several weeks. representation of unconstrained limb increases

  • Hemiparesis

    Weakness; 1 side is more weak

  • induced lesion in one hand area of M1 causes what to occur in a person who does not undergo post-stroke rehab?

    digit representation in non lesioned regions also diminished.

  • induced lesion in one hand area of M1 causes what to occur in a person who does undergo post-stroke rehab?

    spared hand rep areas increase in size

  • how do you optimize plastic change?

    post-lesion training

  • observation therapy

    observe someone else moving with intent or imitate movements --> may involve mirror neurons

  • mirror box therapy

    therapy that tricks the brain into thinking a limb is present and moving, which relieves feelings of pain and paralysis makes the brain believe that the body is whole

  • drugs that may enhance stroke recovery

    amphetamine fluxetine

  • where can you find stem cells in an adults brain?

    lateral ventricular walls

  • Reperfusion

    reestablishment of interrupted blood supply

  • acute treatmentÂ

    reperfusion and neuroprotection time window: hours target: ischemic core and penumbra limits: time window, risks

  • recovery and rehabÂ

    time window: days, weeks, months, years target: rest of brain development of innovative rehabilitation techniques and "stroke recovery drugs"