CAPLAN CH10: Brain Embolism Flashcards
The most important risk factor for stroke after cardiopulmonary bypass surgery is ___.
aortic atheromatosis
What is the triad of fat embolism syndrome?
Respiratory distress
Decreased alertness
Petechial rash eveloping 24-49 hours after an injury
These strands probably form because of a degenerative process that causes fibrinous deposits on valve surfaces.
Lambl excrescences
Name diseases with similar lesions of the cardiac valves and endocardium.
SLE
APLA
NBTE
all likely have a similar pathogenesis
TRUE OR FALSE. Bioprosthetic valves have low thrombogenic tendencies, so long-term anticoagulation is ordinarily not prescribed?
TRUE
Six groups of cardiac disorders leading to stroke:
- Arrhythmias
- Valvular heart diseases
- Ventricular myocardial abnormalities
- Lesions in the cavity of the ventricles (tumors)
- Shunts
- Atrial lesion
What is the most common cause of brain ischemia?
Brain embolus
T/F. Brain emboli only loosely adhere to blood vessel walls.
TRUE
When does hemorrhagic transformation often occurs?
Day 2-7 after stroke
What do you call this description of a clinical pattern of embolic strokes: sudden, complete, or nearly complete clearing of sudden-onset severe neurological signs.
Spectacular shrinking deficits
Our of five emboli, how many goes to anterior circulation? posterior circulation?
4/5 anterior (equally on L and R)
1/5 posterior
Most frequent posterior circulation brain areas infarcted:
- PICA branch of ICVA- posterior inferior portion of the cerebellum
- SCA territory- superior surface of the cerebellum
- PCA- thalamic and hemispherical territories of the PCA
What is the essential cause of hemorrhagic infarction?
- Reperfusion of previously ischemic tissue
- Another cause is systemic hypoperfusion
Virchow’s Triad
- Circulatory stasis
- Endothelial injury
- Incrased blood coagulability
What is the ejection velocity of the left atrial appendage in patients with atrial fibrillation?
< 20 cm/s
Accordingf to the Framingham study:
What is the risk of stroke in:
a. AFIB + RHD?
b. AFIB alone?
A. 17.6x
B. 5.6x
Threshold of thrombi that cannot easily be detected?
< 2mm
Refers to the swirling hazes of echogenicity within the cardiac chambers.
Spontaneous echo contrast
Spontaneous echo contrast may be seen in _ % of patients with AFIB, and _% of patients with afib _ left atrial thrombi?
60%
85%
Two studies checking the utility of various durations of rhythm monitoring in detecting reater than 30-second instances of atrial fibrillation?
- EMBRACE
- CRYSTAL AF
Parameters that are studied to be related with increased chances of having atrial fibrillation:
- QT interval
- BNP
- NT-proBNP
ARISTOTLE drug?
Apixaban
Chaotic atrial activity, changing p-wave contour, and bradycardia, admixed with multiple and recurrent ectopic beats and runs of atrial and nodal tachycardia.
Sick sinus syndrome
Which arrhythmias are more likely to embolize in the brain? tacchyarrythmias or bradyarrythmias?
tachyarrhythmias