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Adult Neuro > 5- Vascular Syndromes > Flashcards

5- Vascular Syndromes Flashcards

1
Q

What is a CVA/Stroke?

A

Umbrella tern applied to conditions in which blood flow to the cerebral vessels becomes disrupted, either from clotting or rupture

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2
Q

What are the different types of strokes?

A 
Ischemic Stroke (70%)
Hemorrhagic Stroke (20%)
Unspecified Origins (10%)
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3
Q

What is an ischemic stroke?

A

Most common form

Results from thrombosis (static clot) or emboli (traveling clot)

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4
Q

What is a hemorrhagic stroke?

A

Bleeding into brain tissue
Can result from hypertension, aneurysms, or head injury
Tend to be the most fatal

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5
Q

What are the risk factors for CVA?

A 
Age (Men 19%>)
Race (AA 60%>)
HTN
High cholesterol
Cigarette smoking
Diabetes mellitus
Obesity
Prior stroke
Heart disease
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6
Q

What is a thrombi?

A

a clot formed by plaque development in a vessel wall (atherosclerosis of blood vessels)

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7
Q

What are some common sites of plaque formation in larger vessels?

A

Origin of carotid arteries
Vertebral arteries
Junction of basilar and vertebral arteries

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8
Q

What are some other factors or thrombotic strokes?

A

Most common type of CVA, occur gradually over several days, seen frequently in older persons with arteriosclerotic heart disease, not associated with exertion or activity and can occur when person is at rest

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9
Q

What is a cerebral infarct?

A

death of a portion of the brain

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10
Q

What are lacunar infarcts?

A

small clots located in the deep regions of the brainstem and subcortical structures

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11
Q

Where are lacunar infarcts found?

A

deeply penetrating arteries that supply the internal capsule, basal ganglia, and brainstem

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12
Q

How to lacunar infarcts commonly result?

A

occlusion of smaller branches of larger cerebral arteries

  • MCA and PCA
  • Anterior cerebral, Vertebral, Basilar
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13
Q

Do lacunar infarcts cause severe impairment? why or why not?

A

No, because they are small

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14
Q

What are emboli?

A

clots that dislodge from their site of origin and travel to a cerebral blood vessel where they become trapped and interrupt blood flow

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15
Q

Where do emboli typically affect?

A

smaller cerebral vessels (MCA)

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16
Q

What are come other factors of embolic strokes?

A

Sudden Onset
Associated with presence of cardiac disease (rheumatic heart disease, ventricular aneurysm, bacterial endocarditis… can also occur after recent MI)

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17
Q

Are hemorrhagic strokes commonly fatal?

A

Yes, however if the patient survives the intital hemorrhagic damage, the prognosis is generally good.

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18
Q

What do hemorrhagic strokes generally involve?

A

bleeding into brain tissue after rupture of a blood vessel wall
Results in edema and compression of brain tissue.
They occur suddenly and are associated with exertion and activity

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19
Q

What is an aneurysm?

A

bulge occuring ina blood vessel wall as a result of a clot formation

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20
Q

What are most aneurysms like?

A

Small, saccular structures called berry aneurysms (these commonly occur in the Circle of Willis or the junction of 2 vessels)

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21
Q

What course of action do aneurysms typically follow?

A

They tend to enlarge with time and weaken vessel walls until rupture occurs.

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22
Q

What is a Transient Ischemic Attack (TIA)?

A

“Mini Stroke” characterized by focal ischemic cerebral incidents that last for less than 24 hours

23
Q

How long to most TIAs last?

A

less than 1-2 hours

24
Q

What are the causes of TIAs?

A

atherosclerotic disease and emboli

25
Q

What else to TIAs do?

A

Might provide a warning of an impending larger stroke

26
Q

What are the signs and symptoms of a TIA?

A

Numbness and mild weakness on 1 side of body
Transient visual disturbances (blurred or fading vision)
Dizziness
Falls
Confusion and possible blackout

27
Q

What are common areas of arterial occulsions in the cortex?

A

MCA (Left and Right)
PCA
ACA

28
Q

What is the most common site of occlusion resulting in CVA?

A

Middle Cerebral Artery (MCA)

29
Q

What does the MCA supply?

A

Lateral surfaces of the frontal, temporal, and parietal lobes
Inferior surfaces of portions of the frontal and temporal lobes

30
Q

What symptoms occurs with a left hemisphere MCA occlusion?

A 
Contralateral hemiplegia
Contralateral Hemiparesthesia
Aphasia (Broca's or Wernicke's)
Cognitive Involvement
Affective involvement (emotional lability and depression..."Catastrophic response")
31
Q

What symptoms occur with a right hemisphere MCA occlusion?

A 
Contralateral hemiplegia
Contralateral Hemiparesthesia
Perceptual deficits (left neglect syndromes)
Apraxia
Cognitive involvement
Affective involvement (euphoria)
32
Q

What does the PCA supply?

A

Medial and inferior surfaces of temporal and occipital lobes (also thalmus and hypothalmus)

33
Q

What are the symptoms of PCA occlusion?

A

Memory loss
Visual perceptual deficits
Visual field cuts (Optic chiasm)

34
Q

What does the ACA supply?

A

Superior, lateral, and medial aspects of the frontal and parietal lobes
Basal ganglia and corpus callosum

35
Q

What does the basal ganglia control?

A

voluntary motor control
procedural learning
eye movements
emotional function

36
Q

ACA occlusion affects:

A

Contralateral Hemiplegia
Contralateral Hemiparesthesia
Cognitive Involvement
Apraxia
Affective Involvement
- If L hemisphere: emotional lability & depression
- If R hemisphere: euphoria & emotional dissociation may occur

37
Q

What are the 3 major symptoms or cerebellar disorders?

A

Incoordination
Ataxia
Intention tremors

38
Q

What does the posterior inferior cerebellar artery supply?

A

cerebellar peduncles and medulla

39
Q

What doe cerebellar artery occlusion typically involve?

A

the brainstem structures that are supplied by the cerebellar arteries

40
Q

What are the symptoms or PICA artery occlusion?

A

Ipsilateral hypertonicity and hyperactive reflexes

Vertigo, Nausea, Nystagmis

41
Q

Anterior Inferior Cerebellar and Superior Cerebellar Arterial Occlusion may result in:

A 
Ipsilateral ataxia
Ipsilateral hypotonicity
Hyporeflexia
Dysmetria
Adiadochokinesia (and Dysdiadochokinesia)
Movement Decomposition
Asthenia
Rebound phenomenon
Staccato voice
Ataxic gait
Intention tremor
Incoordination
Medulla Signs:
-Vestibular Signs (nystagmus, vertigo, nausea)
-Facial Sensory Impairment
-Dysphagia – difficulty swallowing
-Dysarthria – difficulty articulating words
-Bell’s Palsy
42
Q

What does the anterior spinal artery supply?

A

Medulla (pyramids, vestibular, hypoglossal, glossopharyngeal, and vagal nerve nuclei)

43
Q

What are the signs or anterior spinal artery occlusion?

A

Contralateral hemiplegia (pyramids)
Deviation of tongue to the affected side (hypoglossal nerve nuclei)
Dysphagia and loss of gag reflex (glossopharyngeal and/or vagal nuclei)
Nystagmus and balance disturbances (vestibular nuclei)

44
Q

What does the vertebral artery supply?

A

lateral aspect of the low medulla including accessory nuclei

45
Q

What occurs is accessory nerve nuclei are lost?

A

Dysphagia

46
Q

What does the basilar artery supply?

A

pons including corticospinal tracts, and abducens, trigeminal, and facial nerve nuclei

47
Q

What are some signs of basilar artery occlusion?

A

Contralateral hemiplegia (corticospinal tracts)
Medial or internal strabismus (abducens)
Loss of masseter reflex and corneal reflex (Trigeminal)
Bell’s Palsy and Hyperacusis (facial)

48
Q

Damaged cerebral tissue may not be apparent until ____ days post-insult.

A

7

49
Q

MRI can diagnose an ischemic event within ____.

A

2-6 hours

50
Q

How is stroke surgically treated?

A

Placement of metal clip at base of aneurysm, removal of abnormal vessel, or evacuation of hematoma

51
Q

How do you manage acute stroke?

A

Monitor patient’s neurological function
Prevent secondary complications
Regulate BP, cerebral perfusion, intracranial pressure
Pharmacological (improve blood flow and minimize tissue damage
- Heparin, Diuretics, Calcium channel blockers, thrombolytic and neuroprotective agents

52
Q

What is a cerebral infarct?

A

actual death of a portion of the brain

53
Q

What is Tissue Plasminogen Activator (tPA)

A

thrombolytic medication that modifies or interferes with glutamate release or enhances recovery from calcium overload (show promise)

Adult Neuro (10 decks)

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