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Junior - Neuro 2 > 4 - Vascular Disease > Flashcards

4 - Vascular Disease Flashcards

1
Q

Abrutpt LOC can be?

A

Subarachnoid hemorrhage

Seizure

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2
Q

Gradual LOC can be?

A

Brain tumor

Abscess

Chronic subdural hematoma

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3
Q

Fluctuating LOC can be?

A

Recurrent seizures

Metabolic encephalopathy

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4
Q

Symptoms preceding the LOC?

A

Hemiparesis: structural lesion w mass effect

Visual symptoms: posterior circulation ischemia

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5
Q

What illnesses previous to LOC can indicate:

Fever
HA
Falls
Confusion/delirium

A

• Fever: suggests infection, sepsis, meningitis
• Increasing headache: suggests
intracranial mass lesion or infection
• Recent falls suggest possibility of subdural hematoma
• Recent confusion or delirium suggests metabolic or toxic cause

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6
Q

What is a circulatory system problem that can lead to LOC?

A

Vascular disease

- tons of types, look on slide 9 if you want

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7
Q

What does the anterior carotid supply?

A

Supplies The cerebral hemispheres

except median temporal and occipital lobe

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8
Q

What does the posterior (vertebro-basilar) circulation supply?

A 
Supplies the:
– Brainstem
– Thalami
– Cerebellum
– Posterior	portions of the cerebral	hemisphere
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9
Q

What arteries make up “posterior circulation”?

A 
• SCA 
• PICA 
• AICA 
• Basilar	
Artery
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10
Q

2nd MC cause of death in world?

A

Strokes

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11
Q

Prognosis for stroke?

A

20% die w/in 30 days
20% of survivors die each year after
90% of survivors have residual defects
30% are incapacitated

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12
Q

When you hear stroke you need to think?

A

Neuron death

Caused by bleeding or lack of blood flow

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13
Q

S/S of stroke?

A 
Sudden:	
– Muscle weakness
– Paralysis
– Abnormal or lost sensation	 on one	side of the body 
– Difficulty speaking 
– Confusion 
– Problems	with vision
– Dizziness 
– Loss of balance and coordination.
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14
Q

What are teh 3 most predictive examination findins for acute (ischemic) stroke

A

According to the national institute of health Stroke Scale:

  • asymmetric facial paresis
  • arm drift/weakness
  • abnormal speech (dysarthria)
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15
Q

What happens when the blood stops (stroke)?

A

Cells cant do aerobic metabolism

Cells die

Dead cells swell

Swelling = increased ICP

ICP decreases blood flow

progressively hypoxic causing more swelling

Cycle continues until brain wont fit in cranium

Brain herniates

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16
Q

Types of brain herniation

A
  1. Midline shift
  2. Downward displacement of cranium
  3. Uncus and hippocampus herniate into tentoral notch
  4. Cerebellar tonsils herniate through foramen (death)

Pic on slide 22

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17
Q

Brain hypoperfusion is aka?

A

Anoxic brain injury

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18
Q

Causes of a decrease in O2 supply to the brain?

A 
– Sepsis
– Shock
– Bleeding
– Cardiac Arrythmia
– MI
– Thrombus
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19
Q

Major risk factors for stroke?

A 
PRIMARY ARTERIAL HTN
A fib
Smoking
Medical hx (stroke)
Previous TIA
Age
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20
Q

1/3 of TIA patients get what?

A

A full stroke in 5 years

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21
Q

Differential diagnosis for stroke?

A
  • Seizures
  • Systemic infection
  • Syncope
  • Intracranial masses
  • Neuroses
  • Metabolic disorders
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22
Q

Causes of brain ischemia (stroke)

A

Thrombosis
Embolism
Systemic hypoperfusion

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23
Q

How does systemic hypoperfusion affect the brain? (Contrasted with thrombosis or embolus)

A

The lack of perfusion is more generalized and affects the brain diffusely and bilaterally

thrombosis and embolus are probably going to be in one area

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24
Q

Common ischemic syndromes?

A

Anterior circulation strokes

Posterior circulation strokes

Lacunar syndrome

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25
L cerebral hemisphere stroke shows symptoms predominantly ____?
On the R side
26
Real talk
There is a bunch of stuff that differentiates the different locations of stroke and their symptoms slides 31, 32 and 33 go look at it, or dont. I dont care
27
What are lucunar infarcts?
Aka small vessel disease Basically lipohyalinosis or atheroma formation in the small (0.5-1.5mm) arteries
28
Presentation of lacunar syndrome?
Initially silent Develop in a stepwise fashion
29
Types of lacunar stroke?
Pure motor: weakness Pure sensory: parethesias Dysarthria: clumsy hand syndrome Ataxic hemiparesis: weakness/ataxia on 1 side Dementia: dementia
30
Most important diagnostic test for strokes?
Noncontract CT Sensitivity: 16% Specificity: 96%
31
Differentiating ischemic stroke from hemorrhagic stroke on noncontrast CT?
Ischemic stroke: dark spots (may take 24hrs to show) Hemorrhagic stroke: bright white spots (shows up fast)
32
MRI’s diagnostic use in stroke?
Better for brainstem and cerebellar strokes (infarct shows up sooner) Sensitivity: 83% Specificity: 98%
33
Contraindications to thrombolysis?
Slide 40 (its a shit ton)
34
Preferred thrombolytic for strokes (that are not actively bleeding)
Tissue Plasminogen Activator (tPA) If cant get than then ASA
35
BP control in ischemic stroke?
Keep SBP <220 and DBP <120 Use B1 beta blocker (esmolol)
36
BP control in intracranial hemorrhage stroke?
Keep SBP <140 watch for signs of cerebral hypoperfusion Nicardipine (cardene) Esmolol
37
BP control for subarachnoid hemorrhage stroke?
Keep SBP <160 Labetalol Nicardipine Esmolol
38
DOC for SAH stroke?
Labetalol
39
Medical care concerns for stroke?
- liberal use of antipyretics (temp control) - decrease stress - monitor symptoms (edema-> H ICP)
40
Prevention of elevated ICP?
- Elevate head of bed - barbiturate coma - mannitol/hypertonic saline - hyperventilation - tracheal intubation - Neurosurgical consult
41
Post stroke therapy?
Prophylaxis for DVT/PE PT for the new problems Watch closely (remember many happen again)
42
Vascular screening for stroke?
Carotid doppler MRA X-ray angiography (gold standard)
43
Why does the x-ray angiography (gold standard) suck?
1% risk of stroke during the procedure
44
Why do TTE on stroke patients?
To detect cariogenic and aortic sources for cerebral embolism - done after the acute treatment phase
45
What are berry aneurysms?
Small aneurysms at the bas of the brain in the circle of willis - common in elderly - deadly
46
How do berry aneurysms present?
When they rupture they have sudden severe HA followed by LOC 35% fatality
47
What usually triggers a rupture of an aneurysm?
Increased ICP | - valsalva/cough/sneeze
48
Why are aneyrysm such a big deal? Its just a little blood
Blood is NOXIOUS to brain Spreads rapidly and elevates ICP
49
How long do most aneurysm last?
Short - arterial spasms stop the bleeding But relapse is common
50
What are sentinel bleeds and TIA?
Warning bleed You are going to get a real stroke soon (usually 6-20 days)
51
Sudden severe HA?
Subarachnoid hemorrhage until proven otherwise
52
Definition of TIA?
Brief episode of neurological dysfunction (decreased perfusion) that is <1hr Impending stroke...
53
TIA buys you?
Urgent eval - non-contrast CT - duplex US - transcranial Doppler - MRI/MRA - ECG - TTE You’re prob getting hospitalization for 24-48hrs
54
Tx for TIA?
- HTN tx - Thrombolytic therapy - Antiplatelet - Carotid endarterectomy - Angioplasty or stent
55
Ticlopidine?
Anti-platelet that is more effective than aspirin and clopidogrel but more expensive
56
3 goals for management of strokes?
ID cause of neurologic deficit Plan immediate plan of action Long term management (prevention)
57
Why do we give statins for stroke?
Money? But seriously studies have found that statins protect against all cause mortality and nonhemorrhagic strokes
58
Primary prevention methods for stroke and TIA?
HTN control Reduce cardiac risk factors Aspirin Anticoagulation (afib pts)
59
How effective is aspirin for non-fatal stroke reduction?
20% reduction of non-fatal strokes
60
Causes of intracranial hemorrhage?
``` Causes – Hypertension – Trauma – Illicit drug use (cocaine and/or methamph.) – Coagulopathy – Cerebral amyloid angiopathy ```
61
Symptoms of incracerebral hemorrhage?
- Evolve over minutes to hours - NOT ABRUPT - NOT MAXIMAL AT ONSET (progressive symptoms) - ICP symptoms
62
MC causes (MC and MC medical) of subarachnoid hemorrhage?
MC: Head trauma MC medical: ruptured cerebral aneurysm
63
How big of a deal is a subarachnoid hemorrhage?
25% are dead in the 1st 24hrs 20% die prehospital 25% die from bleeding 20% die from rebleeding
64
MC aneurysmal morpholic type?
Saccular
65
Subhyloid retinal hemorrhages?
Indication of subarachnoid hemorrhage
66
Clinical findings for subarachnoid hemorrhage?
``` Worst HA of my life LOC Confusion/stupor/coma Vomiting High BP Hyperthermia Nuchal rigidity Neurologic findings non-focal ```
67
Subarachnoid hemorrhage workup
- Non-contrast CT - MRI - cerebral angiography - electrolytes - CBC - ECG - blood culture
68
Tx for subarachnoid hemorrhage?
Surgical: - clipping neck of aneurysm - AVM removal
69
4 complications of subarachnoid hemorrhage?
Cerebral ischemia Acute hydrocephalus Bleeding Hydrocephalus
70
What type of hemorrhage is more common than SAH?
Intracerebral hemorrhage
71
An intracerebral hemorrhage may extend to?
The ventricular system | The subarachnoid space
72
S/S of intracerebral hemorrhage?
LOC Vomiting HA Focal S/S
73
Common sites from intracerebral hemorrhage?
``` Putamen Thalamus Cerebellum Pons Basal ganglia ```
74
Types of vascular malformations?
AVM: arteriovenous malformations DVM: developmental venous anomalies Cavernous angiomas Telangiectasia
75
What are AVM’s?
Arteriovenous malformations - arteries that empty directly into arterialized veins with no capillary bed - abnormal gliotic parenchyma
76
MC brain vascular malformation?
Developmental venous anomalies (DVM)
77
What are DVM?
Anomalous veins that are morphologically different from brain parenchyma - conspicuous central draining vein
78
What are cavernous angiomas?
Relatively compact mass of sinusoidal vessels with no intervening brain parenchyma - Basically its a big ball of veins where brain matter should be
79
What are telangiectasia’s
True capillary malformations that form extensive vascular networks through an otherwise normal brain. - Usually in the pons and deep cerebral white matter
80
Tx for telangiectasia’s?
No treatment options
81
General tx for vascular malformations?
- Medical seizure therapy - Surgery to prevent bleeding - Interventional obliteration - Radiotherapy

Junior - Neuro 2 (4 decks)

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