A
stroke (to know) _____________________ as cerebrovascular accident (CVA). It (to be) _____ an acute neurologic injury in which the blood supply to a part of the brain (to interrupt) _______________. It (to be) ______ the third leading cause of death and adult disability in the US and industrialized European nations. Of every 5 deaths from stroke, 2 (to occur) _____________ in men and 3 in women.
Risk factors (to include) __________________ advanced age, hypertension (high blood pressure), diabetes mellitus, high cholesterol, and cigarette smoking. Cigarette smoking (to be) ______ the most important risk factor of stroke.
Strokes can (to classify) _____________________ into two major categories: ischemic and hemorrhagic. Ischemic stroke (to occur) _________________ in approximately 85-90% of strokes. In ischemic stroke, a blood vessel (to become) _______________ occluded and the blood supply to part of the brain ______ totally or partially (to block).
Embolic stroke refers to the blockage of arterial access to a part of the brain by an embolus -- a traveling particle or debris in the arterial bloodstream originating from elsewhere. An embolus is most frequently a blood clot, but it can also be a plaque broken off from an atherosclerotic blood vessel or a number of other substances including fat (e.g., from bone marrow in a broken bone), air, and even cancerous cells. Another cause is bacterial emboli released in infectious endocarditis.
A hemorrhagic stroke, or cerebral hemorrhage, (to be) ______ a form of stroke that (to occur) _________ when a blood vessel in the brain (to rupture) _________________or (to bleed) __________. Hemorrhagic strokes (to be) ________ more dangerous than ischemic strokes.
The symptoms of stroke (to depend) _________________ on the type of stroke and the area of the brain affected. Ischemic strokes usually only (to affect) __________ regional areas of the brain. Hemorrhagic strokes can (to affect) _________________ local areas, but often can also (to cause) ____________ more global symptoms due to bleeding and increased intracranial pressure.
Symptoms may (to include) ________________________: muscle weakness or numbness (hemiplegia),
reduction of pain or temperature sensation, reduction in sensory or vibratory sensation
In most cases, the symptoms (to affect) _____________ one side of the body, from the neck downwards, excluding the face. There may (to be) ____________:
• altered smell, taste, hearing, or vision (total or partial)
• drooping of eyelid (ptosis) and weakness of ocular muscles
• decreased reflexes
• decreased sensation and muscle weakness of the face
• balance problems
• altered breathing and heart rate
• inability to turn head to one side
• weakness in tongue (inability to protrude and/or move from side to side)
Strokes also can also (to produce) ____________________ the following symptoms:
• aphasia (inability to speak or understand)
• altered voluntary movements
• disorganized thinking, confusion
• altered vision
• memory deficits
If the cerebellum is involved, the patient may have the following: trouble walking, altered movement coordination, dizziness
Loss of consciousness, headache, and vomiting usually (to occur) ___________ more often in hemorrhagic stroke than in thrombosis.
If the symptoms (to resolve) ___________________ within an hour, or maximum 24 hours, the diagnosis (to be) ________ transient ischemic attack (TIA), and not a stroke. This syndrome may (to be) ______ a warning sign, and a large proportion of patients (to develop) ________________ strokes in the future.
Stroke (to diagnose) _________________ through several techniques: a neurological examination, blood tests, CT scans or MRI scans, Doppler ultrasound, and arteriography.
It (to be) ______ important to identify a stroke as early as possible because patients who (to treat) ________earlier (to have) ______________ better recoveries.
As ischemic stroke (to be) _____ due to a blood clot occluding a cerebral artery, a patient (to give) _______________ antiplatelet medication (aspirin, clopidogrel, dipyridamole), or anticoagulant medication (warfarin
Patients with bleeding into or around the brain (to require) _____________ neurosurgical evaluation to detect and treat the cause of the bleeding.
For most stroke patients, physical therapy (to be) ______ the cornerstone of the rehabilitation process. Often, assistive technology such as a wheelchair and standing frame may (to be) _______ beneficial. Another type of therapy (to be) ______ occupational therapy (OT). OT (to involve) ____________ exercise and training. Speech and language therapy (to be) _____ appropriate for patients with problems understanding speech or written words, or problems forming speech.
Stroke rehabilitation can (to last) ________________ anywhere from a few days to several months. Disability affects 75% of stroke survivors. Stroke can (to affect) _______________ patients physically, mentally, emotionally, or a combination of the three.
Some of the physical disabilities that can (to result) _________ from stroke (to include) ____________ paralysis, numbness, pressure sores, pneumonia, incontinence, difficulties carrying out daily activities, appetite loss, vision loss, and pain. If the stroke (to be) ______ severe enough, coma or death can (to result).
30 to 50% of stroke survivors (to suffer) __________ post stroke depression. Post stroke depression (to characterize) _______________ by lethargy, irritability, and sleep.
Cognitive deficits resulting from stroke (to include) _______________ perceptual disorders, speech problems, dementia, and problems with attention and memory. Up to 10% of all stroke patients (to develop) _______________________ seizures.
Brain tumors (to be) _____ any intracranial masses. Brain tumors (to create) _____________ by an abnormal and uncontrolled growth of cells. Brain tumors (to classify) _______________ into primary brain tumors and secondary brain tumors. Primary (true) brain tumors (to locate) ________________ commonly in the posterior cranial fossa [‘fose] in children. They can also (to locate) __________in the anterior two-thirds of the cerebral hemispheres in adults, although they can (to affect) ____________ any part of the brain. In the United States in the year 2000, it (to estimate) ___________ that there (to be) _________ 16,500 new cases of brain tumors, which (to account) __________for 1.4% of all cancers, 2.4% of all cancer deaths, and 20%–25% of pediatric cancers. Ultimately, it (to estimate) that there (to be) _____ 13,000 deaths/year as a result of brain tumors. Secondary or metastatic brain tumors (to originate) ____________ from malignant tumors (cancers) located primarily in other organs. Their incidence (to be) _______ higher than that of primary brain tumors. The most frequent types of metastatic brain tumors (to originate) _______ in the lung, skin (malignant melanoma), kidney (hypernephroma), breast (breast carcinoma), and colon (colon carcinoma). These tumor cells (to reach) ________ the brain via the blood-stream. The kind of symptoms (to depend) ___________ on two factors: tumor size (volume) and tumor location. Many low-grade (benign) tumors can (to remain) ________ asymptomatic (symptom-free) for years and they may accidentally (to discover) __________by imaging exams for unrelated reasons (such as a minor trauma). Large tumors (to lead) ___________ to elevated intracranial pressure (intracranial hypertension). Patients may (to have) ____________ headaches, vomiting (sometimes without nausea), altered state of consciousness, dilatation of the pupil. Brain tumors may (to cause) ____________ cognitive and behavioral impairment, personality changes, visual field impairment, facial paralysis, double vision, tremor etc. Imaging (to play) ________________ a central role in the diagnosis of brain tumors. Evaluation (to include) _____________ electroencephalography, computed tomography (CT) and especially magnetic resonance imaging (MRI). The definitive diagnosis of brain tumor can only (to confirm) _______________ by histological examination of tumor tissue samples. These samples (to obtain) ______________ either by means of brain biopsy or open surgery. Meningiomas can (to remove) _________ surgically. In more difficult cases, radiotherapy (to remain) ___________ an option. Most pituitary adenomas can (to remove) _____________ surgically. A minimally invasive approach through the nasal cavity and skull base may (to use) ___________. Large pituitary adenomas (to require) _____________ a craniotomy (opening of the skull) for their removal. Postoperative radiotherapy and chemotherapy (to be) ________integral parts of the therapeutic standard for malignant tumors. Survival rates in primary brain tumors (to depend) _______________ on the type of tumor, age, functional status of the patient, the extent of surgical tumor removal. Patients with benign gliomas may (to survive) _________________ for many years. The main treatment option for single metastatic tumors (to be) _______surgical removal. It (to follow) __________by radiotherapy and/or chemotherapy. Multiple metastatic tumors (to treat) _________ generally with radiotherapy and chemotherapy.
Epilepsy (to refer) ____________ to as a seizure disorder. Epilepsy (to be) _____ a chronic neurological condition. Epilepsy (to characterize) ________________________ by recurrent unprovoked seizures. The condition (to name) _____________ from the Greek epilepsis ("to take a firm grip on"). It is (to control) ______________________commonly with medication, although surgical methods (to use) _____________as well. The diagnosis of epilepsy (to require) ___________ the presence of recurrent, unprovoked seizures. It (to make) ___________usually based on the medical history. EEG and brain MRI. Magnetoencephalography may (to be) _______ useful to discover an etiology for epilepsy. Long-term video-EEG monitoring for epilepsy (to be) ______ the gold standard for diagnosis, but it (not to employ) ___________ routinely owing to its high cost and inconvenience. It is, however. Sometimes (to use) ______________ to distinguish psychogenic non-epileptic seizures from epilepsy. All the causes (or etiologies) of epilepsy (not to know) _______________, but many predisposing factors (to identify) ___________________, They (to include) _______________ brain damage. Brain damage (to result) _______________ from malformations of brain development, head trauma, neurosurgical operations, other penetrating wounds of the brain, brain tumor, high fever, bacterial or viral encephalitis, stroke, intoxication, or acute or inborn disturbances of metabolism. Hereditary or genetic factors also (to play) ________ a role. The most common ages of incidence (to be) ________ under the age of 18 and over the age of 65. Some people with epilepsy (to have) ________________ certain triggers or provocants. Examples of the “provocants" (to include) ____________ reading, hot water on the head, hyperventilation, and flashing lights. Epilepsy (to treat) ________________ usually with medication prescribed by a physician; primary caregivers, neurologists, and neurosurgeons. In some cases the implantation of a stimulator of the vagus nerve, or a special diet can (to be) ________ helpful. Neurosurgical operations for epilepsy can (to be) ____________ palliative [‘paelietiv]. Surgery (to reduce) ____________ the frequency or severity of seizures. In some patients, an operation can (to be) ______ curative [‘kjueretiv]. Some medications can (to take) ___________ daily in order to prevent seizures. They can (to reduce) ____________ the frequency of their occurrence. These (to term) __________ "anticonvulsant" or "antiepileptic" drugs (sometimes AEDs). All such drugs (to have) __________ side effects. Surgical treatment can (to be) ______ an option for epilepsy when an underlying brain abnormality, such as a benign tumor can (to identify) ________________. The abnormality must be removable by a neurosurgeon. The most common form of resective surgical treatment for epilepsy (to be) ______ to remove a portion of either the right or left temporal lobe, depending on where the seizures (to occur) ___________. Palliative surgery for epilepsy (to design) _______________to reduce the frequency or severity of seizures. Examples are callosotomy or commissurotomy. Ketogenic diets may (to be) ______ occasionally effective in controlling some types of epilepsy. Ketogenic diets (to be) ___high in fat and extremely low in carbohydrates. Intake of fluids (to limit) ___________________often. The ketogenic diet (to be) ________ not good for the heart or kidneys. Medical problems resulting from the diet (to report) _____________________. Vagus nerve stimulation (to use) ______________ an implanted electrical device. It (to be) _____ similar in size, shape and implant location to a heart pacemaker.
