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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the different types of strokes?

A
Ischemic Stroke (70%)
Hemorrhagic Stroke (20%)
Unspecified Origins (10%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an ischemic stroke?

A

Most common form

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a thrombi?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a cerebral infarct?

A

death of a portion of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are lacunar infarcts?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where are lacunar infarcts found?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How to lacunar infarcts commonly result?

A

occlusion of smaller branches of larger cerebral arteries

  • MCA and PCA
  • Anterior cerebral, Vertebral, Basilar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

No, because they are small

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where do emboli typically affect?

A

smaller cerebral vessels (MCA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Are hemorrhagic strokes commonly fatal?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is an aneurysm?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What course of action do aneurysms typically follow?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
What else to TIAs do?
Might provide a warning of an impending larger stroke
26
What are the signs and symptoms of a TIA?
Numbness and mild weakness on 1 side of body Transient visual disturbances (blurred or fading vision) Dizziness Falls Confusion and possible blackout
27
What are common areas of arterial occulsions in the cortex?
MCA (Left and Right) PCA ACA
28
What is the most common site of occlusion resulting in CVA?
Middle Cerebral Artery (MCA)
29
What does the MCA supply?
Lateral surfaces of the frontal, temporal, and parietal lobes Inferior surfaces of portions of the frontal and temporal lobes
30
What symptoms occurs with a left hemisphere MCA occlusion?
``` Contralateral hemiplegia Contralateral Hemiparesthesia Aphasia (Broca's or Wernicke's) Cognitive Involvement Affective involvement (emotional lability and depression..."Catastrophic response") ```
31
What symptoms occur with a right hemisphere MCA occlusion?
``` Contralateral hemiplegia Contralateral Hemiparesthesia Perceptual deficits (left neglect syndromes) Apraxia Cognitive involvement Affective involvement (euphoria) ```
32
What does the PCA supply?
Medial and inferior surfaces of temporal and occipital lobes (also thalmus and hypothalmus)
33
What are the symptoms of PCA occlusion?
Memory loss Visual perceptual deficits Visual field cuts (Optic chiasm)
34
What does the ACA supply?
Superior, lateral, and medial aspects of the frontal and parietal lobes Basal ganglia and corpus callosum
35
What does the basal ganglia control?
voluntary motor control procedural learning eye movements emotional function
36
ACA occlusion affects:
Contralateral Hemiplegia Contralateral Hemiparesthesia Cognitive Involvement Apraxia Affective Involvement - If L hemisphere: emotional lability & depression - If R hemisphere: euphoria & emotional dissociation may occur
37
What are the 3 major symptoms or cerebellar disorders?
Incoordination Ataxia Intention tremors
38
What does the posterior inferior cerebellar artery supply?
cerebellar peduncles and medulla
39
What doe cerebellar artery occlusion typically involve?
the brainstem structures that are supplied by the cerebellar arteries
40
What are the symptoms or PICA artery occlusion?
Ipsilateral hypertonicity and hyperactive reflexes | Vertigo, Nausea, Nystagmis
41
Anterior Inferior Cerebellar and Superior Cerebellar Arterial Occlusion may result in:
``` 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
What does the anterior spinal artery supply?
Medulla (pyramids, vestibular, hypoglossal, glossopharyngeal, and vagal nerve nuclei)
43
What are the signs or anterior spinal artery occlusion?
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
What does the vertebral artery supply?
lateral aspect of the low medulla including accessory nuclei
45
What occurs is accessory nerve nuclei are lost?
Dysphagia
46
What does the basilar artery supply?
pons including corticospinal tracts, and abducens, trigeminal, and facial nerve nuclei
47
What are some signs of basilar artery occlusion?
Contralateral hemiplegia (corticospinal tracts) Medial or internal strabismus (abducens) Loss of masseter reflex and corneal reflex (Trigeminal) Bell's Palsy and Hyperacusis (facial)
48
Damaged cerebral tissue may not be apparent until ____ days post-insult.
7
49
MRI can diagnose an ischemic event within ____.
2-6 hours
50
How is stroke surgically treated?
Placement of metal clip at base of aneurysm, removal of abnormal vessel, or evacuation of hematoma
51
How do you manage acute stroke?
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
What is a cerebral infarct?
actual death of a portion of the brain
53
What is Tissue Plasminogen Activator (tPA)
thrombolytic medication that modifies or interferes with glutamate release or enhances recovery from calcium overload (show promise)