Atherosclerotic Cerebrovascular Disease with CVA and TIA - Pales Flashcards by Matt Stanton

Q

3rd leading cause of death in US

A

stroke

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Q

CVA

A

stroke

abrupt onset of neuro eficit - attributable to focal vascular cause

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Q

types of strokes

A

hemorrhagic

ischemic (majority)

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Q

ischemic penumbra

A

brain tissue around necrosis that is reversible - with appropriate tx

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Q

large artery thrombosis

A

rupture of plaque with fibrous plaque

blood clot forms - occluding artery

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Q

emboli

A

from atherosclerotic plaque or thrombus

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Q

paradoxical emboli

A

from lower leg DVT

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Q

atrial cardiac emboli

A

A-fib
atrial septal aneurism
tumor - myxoma

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Q

A-fib

A

fast/ineffective atrial contraction

-stasis and thrombus formation

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Q

atrial septal aneurysm

A

weak and outpouch of septum - stasis and thrombus formation

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Q

atrial myxoma

A

piece of tumor tear off and embolize

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Q

ventricular emboli

A

cardiomyopathy
MI
ventricular aneurysm

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Q

cadiomyopathy

A

weak dilated ventricle - stasis and thrombi formation

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Q

libman sacks endocarditis

A

with SLE

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Q

marantic

A

non-bacterial thrombi from cardiac source

malignancy or hypercoag state

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Q

tighter the stenosis

A

higher risk of stroke

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Q

hole in heart

A

with paradoxical emboli

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Q

lacunar infarct

A

subcortical areas of brain
-asymptomatic/minor sx

large artery branch to small artery right away - get lipohyalinosis from high pressure

hyperplasia and hyalinosis of vessel walls - narrow and occluded

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Q

watershed infarct

A

with profound hypotension

sepsis, bleeding, dehydration

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Q

hemostasis

A

3 parts working other

coag system
anticoag system
thrombolytic system

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Q

hypercoagulable state

A

factor V - leiden mutation
protein C and protein S
antithrombin deficiency
plasminogen deficiency
prothrombin mutation

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Q

antiphospholipid Ab syndrome

A

arterial clotting

anticardiolipid Abs
lupus anticoagulantas

hyperhomocysteinemia

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Q

hyperhomocysteinemia

A

hypercoag

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Q

other hypercoag states

A

pregnancy
cancer
HRT
prolonged bed rest/immobile
myeloproliferative

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vasculitis

inflammed vessels | -cause of stroke

vasospasm

cocaine use | stroke

moyamoya disease

large intracranial artery occlusion

stroke presentation

depend on size of vessel | area of brain supplied by vessel

weakness of one side of body

hemiparesis

paralysis of one side of body

hemiplegia

loss vision same visual field both eyes

homonymous hemianopia

difficulty perform math

acalculia

difficulty recognize object, people, sounds, shapes, etc.

agnosia

inability to speak

aphasia

inability to read

alexia

inability to write

agraphia

difficulty swalowing

dysphagia

slurred speach

dysarthria

inability to attend to one side of body

hemispatial neglect

inability to perform specific task

apraxia

unawareness or denial of existance of disability

anosognosia

difficutly recall words or names

anomia

unsteady gait

ataxia

middle cerebral artery syndrome

C/L hemiplegia - face and upper extremities C/L homonymous hemianopia dominant - aphasia, alexia, agraphia, acalculia non-dominant - hemineglect, dressing apraxia, anosognosia

posterior cerebral artery syndrome

homonymous hemianopia, alexia without agraphia - can't read - can write** visual or color anomia

lateral pontine syndrome

marie foix syndrome anterior inferior cerebellar a ataxia - arm and leg weak upper and lower extremity hemisensory loss - pain and temp

lateral medullary syndrome

wallenberg syndrome posterior inferior cerebellar a ``` facial sense loss/pain ataxia nystagmus vertigo hoarse dysphagia horner syndrome** hemisensory loss hiccups ```

locked in syndrome

quadriplegia, B/L facial paralysis, dysarthria

ventral pontine syndrome

raymond syndrome - lateral gaze weakness - C/L hemiplegia

millard-gubler syndrome

ventral pontine syndrome - C/L upper/lower extremity weak - C/L hemiplegia

ataxic hemiparesis

C/L upper/lower extremity weakness and ataxia

anton syndrome

cortical blindness blindnes and denial

amaurosis fugax

temporary one eye blindness warning sign of stroke embolic - carotid artery also - hemodynamic, ocular, neuro, idiopathic

TIA

stroke lasts less than 24 hours 10% risk of CVA within first 3 months

diagnosis of stroke

neuro and mental status exam CT without contrast MRI - very sensitivte

CT and stroke

to rule out bleeding - so can give clot buster or not

lower face only affected

with central bells palsy - CN VII

tx of stroke

acute tx primary stroke prevention secondary stroke prevention

acute tx of stroke

rtPA and aspirin IV fluid - keep BP sufficient for saving penumbra swallowing eval early rehab

non-modifiable stroke risk fx

``` age fam hx race - AA and hispanics gender - men med hx ```

modifiable stroke risk fx

``` HTN A-fib smoking DM carotid stenosis hyperlipidemia obesity alcohol/drug use ```

stroke prevention

diet exercise control BP, blood sugar, cholesterol quit smoking

stroke prevent meds

aspirin clopidogril ASA, dipyridamole warfarin, heparin, LMWH