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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
Q

L cerebral hemisphere stroke shows symptoms predominantly ____?

A

On the R side

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26
Q

Real talk

A

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

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27
Q

What are lucunar infarcts?

A

Aka small vessel disease

Basically lipohyalinosis or atheroma formation in the small (0.5-1.5mm) arteries

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28
Q

Presentation of lacunar syndrome?

A

Initially silent

Develop in a stepwise fashion

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29
Q

Types of lacunar stroke?

A

Pure motor: weakness

Pure sensory: parethesias

Dysarthria: clumsy hand syndrome

Ataxic hemiparesis: weakness/ataxia on 1 side

Dementia: dementia

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30
Q

Most important diagnostic test for strokes?

A

Noncontract CT

Sensitivity: 16%
Specificity: 96%

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31
Q

Differentiating ischemic stroke from hemorrhagic stroke on noncontrast CT?

A

Ischemic stroke: dark spots (may take 24hrs to show)

Hemorrhagic stroke: bright white spots (shows up fast)

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32
Q

MRI’s diagnostic use in stroke?

A

Better for brainstem and cerebellar strokes (infarct shows up sooner)

Sensitivity: 83%
Specificity: 98%

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33
Q

Contraindications to thrombolysis?

A

Slide 40 (its a shit ton)

34
Q

Preferred thrombolytic for strokes (that are not actively bleeding)

A

Tissue Plasminogen Activator (tPA)

If cant get than then ASA

35
Q

BP control in ischemic stroke?

A

Keep SBP <220 and DBP <120

Use B1 beta blocker (esmolol)

36
Q

BP control in intracranial hemorrhage stroke?

A

Keep SBP <140

watch for signs of cerebral hypoperfusion

Nicardipine (cardene)
Esmolol

37
Q

BP control for subarachnoid hemorrhage stroke?

A

Keep SBP <160

Labetalol
Nicardipine
Esmolol

38
Q

DOC for SAH stroke?

A

Labetalol

39
Q

Medical care concerns for stroke?

A
  • liberal use of antipyretics (temp control)
  • decrease stress
  • monitor symptoms (edema-> H ICP)
40
Q

Prevention of elevated ICP?

A
  • Elevate head of bed
  • barbiturate coma
  • mannitol/hypertonic saline
  • hyperventilation
  • tracheal intubation
  • Neurosurgical consult
41
Q

Post stroke therapy?

A

Prophylaxis for DVT/PE

PT for the new problems

Watch closely (remember many happen again)

42
Q

Vascular screening for stroke?

A

Carotid doppler
MRA
X-ray angiography (gold standard)

43
Q

Why does the x-ray angiography (gold standard) suck?

A

1% risk of stroke during the procedure

44
Q

Why do TTE on stroke patients?

A

To detect cariogenic and aortic sources for cerebral embolism

  • done after the acute treatment phase
45
Q

What are berry aneurysms?

A

Small aneurysms at the bas of the brain in the circle of willis

  • common in elderly
  • deadly
46
Q

How do berry aneurysms present?

A

When they rupture they have sudden severe HA followed by LOC

35% fatality

47
Q

What usually triggers a rupture of an aneurysm?

A

Increased ICP

- valsalva/cough/sneeze

48
Q

Why are aneyrysm such a big deal? Its just a little blood

A

Blood is NOXIOUS to brain

Spreads rapidly and elevates ICP

49
Q

How long do most aneurysm last?

A

Short
- arterial spasms stop the bleeding

But relapse is common

50
Q

What are sentinel bleeds and TIA?

A

Warning bleed

You are going to get a real stroke soon (usually 6-20 days)

51
Q

Sudden severe HA?

A

Subarachnoid hemorrhage until proven otherwise

52
Q

Definition of TIA?

A

Brief episode of neurological dysfunction (decreased perfusion) that is <1hr

Impending stroke…

53
Q

TIA buys you?

A

Urgent eval

  • non-contrast CT
  • duplex US
  • transcranial Doppler
  • MRI/MRA
  • ECG
  • TTE

You’re prob getting hospitalization for 24-48hrs

54
Q

Tx for TIA?

A
  • HTN tx
  • Thrombolytic therapy
  • Antiplatelet
  • Carotid endarterectomy
  • Angioplasty or stent
55
Q

Ticlopidine?

A

Anti-platelet that is more effective than aspirin and clopidogrel but more expensive

56
Q

3 goals for management of strokes?

A

ID cause of neurologic deficit

Plan immediate plan of action

Long term management (prevention)

57
Q

Why do we give statins for stroke?

A

Money?

But seriously studies have found that statins protect against all cause mortality and nonhemorrhagic strokes

58
Q

Primary prevention methods for stroke and TIA?

A

HTN control
Reduce cardiac risk factors
Aspirin
Anticoagulation (afib pts)

59
Q

How effective is aspirin for non-fatal stroke reduction?

A

20% reduction of non-fatal strokes

60
Q

Causes of intracranial hemorrhage?

A 
Causes
– Hypertension
– Trauma
– Illicit drug use (cocaine	
and/or methamph.) 
– Coagulopathy 
– Cerebral amyloid angiopathy
61
Q

Symptoms of incracerebral hemorrhage?

A
  • Evolve over minutes to hours
  • NOT ABRUPT
  • NOT MAXIMAL AT ONSET (progressive symptoms)
  • ICP symptoms
62
Q

MC causes (MC and MC medical) of subarachnoid hemorrhage?

A

MC: Head trauma

MC medical: ruptured cerebral aneurysm

63
Q

How big of a deal is a subarachnoid hemorrhage?

A

25% are dead in the 1st 24hrs

20% die prehospital
25% die from bleeding
20% die from rebleeding

64
Q

MC aneurysmal morpholic type?

A

Saccular

65
Q

Subhyloid retinal hemorrhages?

A

Indication of subarachnoid hemorrhage

66
Q

Clinical findings for subarachnoid hemorrhage?

A 
Worst HA of my life
LOC
Confusion/stupor/coma
Vomiting
High BP
Hyperthermia
Nuchal rigidity
Neurologic findings non-focal
67
Q

Subarachnoid hemorrhage workup

A
  • Non-contrast CT
  • MRI
  • cerebral angiography
  • electrolytes
  • CBC
  • ECG
  • blood culture
68
Q

Tx for subarachnoid hemorrhage?

A

Surgical:

  • clipping neck of aneurysm
  • AVM removal
69
Q

4 complications of subarachnoid hemorrhage?

A

Cerebral ischemia
Acute hydrocephalus
Bleeding
Hydrocephalus

70
Q

What type of hemorrhage is more common than SAH?

A

Intracerebral hemorrhage

71
Q

An intracerebral hemorrhage may extend to?

A

The ventricular system

The subarachnoid space

72
Q

S/S of intracerebral hemorrhage?

A

LOC
Vomiting
HA
Focal S/S

73
Q

Common sites from intracerebral hemorrhage?

A 
Putamen
Thalamus
Cerebellum
Pons
Basal ganglia
74
Q

Types of vascular malformations?

A

AVM: arteriovenous malformations
DVM: developmental venous anomalies
Cavernous angiomas
Telangiectasia

75
Q

What are AVM’s?

A

Arteriovenous malformations

  • arteries that empty directly into arterialized veins with no capillary bed
  • abnormal gliotic parenchyma
76
Q

MC brain vascular malformation?

A

Developmental venous anomalies (DVM)

77
Q

What are DVM?

A

Anomalous veins that are morphologically different from brain parenchyma

  • conspicuous central draining vein
78
Q

What are cavernous angiomas?

A

Relatively compact mass of sinusoidal vessels with no intervening brain parenchyma

  • Basically its a big ball of veins where brain matter should be
79
Q

What are telangiectasia’s

A

True capillary malformations that form extensive vascular networks through an otherwise normal brain.
- Usually in the pons and deep cerebral white matter

80
Q

Tx for telangiectasia’s?

A

No treatment options

81
Q

General tx for vascular malformations?

A
  • Medical seizure therapy
  • Surgery to prevent bleeding
  • Interventional obliteration
  • Radiotherapy

Junior - Neuro 2 (4 decks)

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