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Neuro_week3 > 3-Ischemia > Flashcards

3-Ischemia Flashcards

1
Q

Define ischemic stroke

A

acute infarction ischemic injury to brain –> persistent focal neuro defect at 24 hrs

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2
Q

Define TIA

A

ischemic neurological (focal brain or retinal ischemic) deficits completely resolve within 1 hr

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3
Q

Large vessel ischemic stroke deficits correspond with

A

arterial region supplied by blocked artery

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4
Q

middle cerebral artery stroke causes what?

A

hemiparesis
hemisensory loss
hemianopsia

ALL CONTRALATERAL TO SIDE OF OCCLUSION

aphasia (dominant)
neglect (non-dominant)

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5
Q

small vessel strokes have what kind of deficits?

mechanism of why?

A

isolated on one side of body such as isolated motor or sensory loss

occlusion of small penetrating arteries that penetrate brain –> lacunar infarcts

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6
Q

ruptured intracranial aneurysm

most common nontrauamatic cause of ___

A

subarachnoid hemorrhage

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7
Q

ruptured intracranial aneurysm

presents with

A

1 o Cataclysmic onset, like a fire cracker

2 o Sudden onset neurological deficits

3 o Headache – “worst headache of my life”

4 o Nausea and vomiting

5 o Depressed level of consciousness

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8
Q

intracerebral (intraparenchymal) hemorrhage
often due to?

commonly occur where?

progresses over how long

A

hypertension and age

basal ganglia
thalamus
pons
cerebellum

also can have lobar hemorrhage near cortex
progress over few hrs

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9
Q

intracerebral (intraparenchymal) hemorrhage

presents with

A

1) begin with mild HA
2) some deficit/nausea
3) decr consciousness –> coma
4) hemiparesis –> hemiplegia

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10
Q

subdural hemorrhage
usu due to?

bleed btwn what 2 layers

typically arterial or venous bleed

appearance n imaging

more common at what age?

A

due to trauma but not always

btwn dura and arachnoid

venous from tearing of bridging veins = low pressure, slow

crescent shape

elderly due to atrophy

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11
Q

subdural hemorrhage

presents with

A

1) HA, n, v
2) decr eye, verbal, motor responses
3) confusion, LOC, localized weakness
4) speech/vision changes
5) seizures

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12
Q

Epidural hemorrhage
usu due to?

bleed btwn what 2 layers

typically arterial or venous

appearance on imaging

A

trauma

btwn dura and skull

arterial (fractures –> tear middle meningeal) = high pressure

lens shaped

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13
Q

Epidural hemorrhage

presents with

A

1) brief decr consciousness or LOC –> coma
2) then lucid interval –> LOC d/t incr ICP
3) N/V/HA
4) seizures

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14
Q

Non-atherosclerotic causes of stroke in young patients
Vasculopathy mechanism
types

A

Non-inflamm, non-athero hyperplasia of arteries –> weakening

1) fibromuscular dysplasia
2) moyamoya
3) arterial dissection

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15
Q

describe fibromuscular dysplasia
mechanism
assoc with

A

hypertrophy of arterial media –> segmental occlusion

assoc with saccular aneurysms and arterial dissection

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16
Q

describe moyamoya
mechanism
assoc with

A

hyperplasia of arterial intima, usu proximal middle cerebral artery and distal internal carotid artery

assoc with saccular aneurysms and arterial dissection

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17
Q

describe arterial dissection
mechanism
assoc with

blood dissect btwn what 2 layers

A

tear in endothelial lining of artery

assoc with CVD (FMD, marfans)

btwn endothelium and adventitia

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18
Q

Non-atherosclerotic causes of stroke in young patients

hematological = hypercoaglulable states

A

1) deficiency in prot C, S, antithrombin
2) factor V leiden and prothrombin gene 20210 (decr anticoag products)
3) malignancies
4) sickle cell
5) hyperviscosity (incr prot, HCT, thrombocytopenia)
6) OCT esp smokers
7) antiphospholipid antibodies

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19
Q

Non-atherosclerotic causes of stroke in young patients

inflamm

A

vasculitis secondary to CNS infections

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20
Q

Non-atherosclerotic causes of stroke in young patients

migraines

A

via vasospasm or incr platelet aggreg

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21
Q

Non-atherosclerotic causes of stroke in young patients

venous infarction

A

dehydration –> hypercoag state

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22
Q

Non-atherosclerotic causes of stroke in young patients

vasospasm

A

1) sympathomimetic drugs
2) severe HTN
3) vessel irritation

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23
Q

most strokes due to

A

atherosclerotic or thrombotic/embolic occlusion of vessels

24
Q

major risk factors for atheroscleortic strokes

A

1) age
2) HTN
3) lipid disorders
4) incr homocysteine
5) smoking
6) obesity
7) DM
8) physical inactivity
9) alcohol abuse
10) cocaine
11) congenital hearts 12) PFO/ASD/VSD
12) CHF, valvular, A-fib, myxoma

25
Q

how to prevent thrombus formation as way to decr stroke risk or after suffer thrombus ischemic stroke

what is used primarily for small vessel infarcts and also large vessel occlusion or embolization

A

antiplatelet agents

1) aspirin
2) ticlodipine/clopidogrel/prasugrel
3) ASA/dipyridamole
4) ASA/clopidogrel

anticoag used

26
Q

what is used for patients with afib or mech heart valve or short term thrombus in artery/dissection to decr risk of stroke

A

warfarin

27
Q

procedure to reduce risk in patients with stenosis

A

carotid endarectomy

28
Q

what happens in ED for ischemic strokes?

A

TPA
maintain fluids
maximize cardiac output
maintain BP

treat hypoglycemia

29
Q

what patients will benefit from tpa and which won’t

A

benefit = thrombus/embolus

not benefit = vasospastic, vasculopathic, inflamm

30
Q

basic principles of emergency treatment of ischemic stroke or hemorrhage

A

1) TPA
2) keep fluids up
3) maximize cardiac ouptut
4) resist temptation to lower BP

31
Q

how to treat diff factors of stroke
• hypertension -
• hyperlipidemia –
• high homocysteine levels –

  • Smoking –
  • Obesity –
  • Physical inactivity –
  • Alcohol abuse
A

1) HTN = many drugs
2) hyperlipidemia = statins
3) high homocysteine = folate B6, B12
4) smoking = stop
5) obesity = dietary/lifestyle
6) physical inactivity = lifestyle mod
7) alcohol abuse = stop

32
Q 
how to treat 
•	Lumen stenosis –
•	Cardiac issues –
•	Atrial septal defects -
•	Atrial Myxomas – cardiac tumors can increase risk of embolus –
A
  • Lumen stenosis – can be repaired surgically or via IV catheter
  • Cardiac issues – A-fib, CHF, valve disorders increase risk of embolus - treat with warfarin
  • Atrial septal defects – can be repaired or treated medically to prevent embolus
  • Atrial Myxomas – cardiac tumors can increase risk of embolus – remove
33
Q

do you take asa after a stroke

A

no because can’t tell if ischemic or hemorrhagic stroke

34
Q

deep vs lobar intracerebral hemorrhage

locations

A

deep = basal ganglia, thalamus, pons, cerebellar

lobar = frontal > parietal > occipital > temporal

35
Q

deep vs lobar intracerebral hemorrhage

major causes

A 
deep = HTN, age
lobar = amyloid angiopathy, age, dementia, coagulopathy (HTN 1/3)
36
Q

deep vs lobar intracerebral hemorrhage

outcomes

A 
deep = poor
lobar = well tolerated
37
Q

pontine intracerebral hemorrhage assoc with

A

locked in syndrome

cortex is preserved so cognition
but relay in pons destroyed —> quadriplegic
and no facial but still have vertical eye reflex

38
Q

most common cause of subarachnoid hemorrrhage

A

trauma

39
Q

describe brain aneurysm

difference btwn saccular and fusiform aneurysm

A

weak bulge in brain artery –> wall thinner and swells outward

saccular = branch points
fusiform = less likely to rupture
40
Q

most common sites of brain aneurysm

A

ACom

PCom

41
Q

subarachnoid hemorrhage

symptoms

A

sudden severe HA
sometimes focal deficit
altered LOC

–> arterial bleed = can dissect into brain tissue but usu no deficit

42
Q

risk factors for subarachnoid hemorrhage

A 
smoking
HTN --> risk for aneurysm formation
women
FHx aneurysm/SAH
ADPKD
Ehlers, danlos
marfan
fibromuscular dysplasia
43
Q

complications of SAH

A

1) rebleed
2) hydrocephalus
3) vasospasm 94-14 d)
4) cerebral salt wasting

44
Q

arteriovenous malformation
define

risk for what type hemorrhage

presentation

A

1) abnormal connection btwn artery and vein w/o capill bed
2) IVH, SAH
3) hemorrhage, incidental, seizure

45
Q

risk factors for AVM

A

1) age
2) prior hem
3) deep
4) exclusive deep drainage
5) size doesn’t predict

46
Q

causes of small vs large vessel stroke

A 
small = lipohyalinosis
large = embolic
47
Q

etiology of stroke
pipes
pump
passengers

A

vessels
heart
platelets

48
Q

young stroke patient think of what?

A

dissection of artery –> occlusion or creating embolus to brain

49
Q

legs (numbness, weakness); no pain; sudden onset

numbness and weakness (more in arms and face than legs usu symm); gaze preferences and aphasia

vision loss and Wernicke’s aphasia

high chance of causing coma

A

ACA

MCA

PCA

basilar

50
Q

Gerstmann’s syndrome features

A

acalculia
left-right disorientation
finger agnosia
agraphia

51
Q

CT negative neuro deficits

sudden onset, slow improve
sudden onset, rapid improve
minute onset, rapid improve
sudden onset, slow improve, LOC
slow onset,
A

sudden onset, slow improve = stroke

sudden onset, rapid improve = TIA

minute onset, rapid improve = migraine

sudden onset, slow improve, LOC = seizure

slow onset = MS

52
Q

symptoms of small vessel strokes

A

hemiparesis

hemisensory loss

53
Q

subcortical or lacunar stroke symptoms

A

1) pure motor hemiparesis
2) hemi sensory loss
3) mixed motor sensory
4) clumsy hand dysarthria
5) ataxia hemiparesis (should not have but cerebellar fibers cross twice)

face + arm + leg symm
acute onset

54
Q

common features of vasculopathies

A 
young age
female
lesion any portion of vessel 
pseudoaneurysm
saccular aneurysm
10% familial
55
Q

symptoms started 1 hr ago

A

tpa used in acute stroke for 3-4.5 hrs

intraarterial treatment
IA = tPA
or mech retrieval for PENUMBRA or Merci

56
Q

after given tPA NIHSS high what else to do

A 
MERCI or penumbra
or solitaire (stent retriever)

Neuro_week3 (23 decks)

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