CAPLAN CH9: Penetrating and Branch Artery Flashcards
Can chronic white matter abnormalities present as Parkinson’s disease?
Yes. Multiple dilated perivascular spaces can be accompaned by WM changes and can be accompanied by cognitive and behavioral abnormalities and basal ganglioninc clinical dysfunction resembling PD.
What was the finding in the SPS 3 trial in terms of medications and bleeding?
Aspirin 325mg/day vs Aspirin 325mg/day + Clopidogrel 75mg/day
There is no significant reduction in recurrent stroke but inreased risk of bleeding and death
Small, discrete, often irregular lesions, ranging from 1 to 15mm in size
Lacunar infarcts
Most common locations of lacunes
putamen and pallidum
pons, thalamus, caudate, IC and corona radiata
RARE: peduncles, pyramid, SC white matter
NOT found: cerebral and cerebellar cortices
Characteristic vascular pathology
Focal enlargements and small hemorrhagic extravasation through the walls of the arteries
Arteries in spots being replaced by whorls, tangles and wisps of connective tissue obliterating the usual vascular layers
segmental arterial disorganization, fibrinoid degeneration and lipohyalinosis
Similar pathophysiology of penetrating artery disease and ICH?
Lipohyalinosis
The clinical-neurological findings of CADASIL are similar to CARASIL except___
- Premature baldness and back pain and severe spondylitis are additional major features.
- Arteries in CARASIL do not contain osmiophiliic materials
COL4A1 vs CADASIL
Unlike CADASIL, the in COL4A1, the temporal lobes are spared of the chronic white matter abnormalities
Major cause of fibrinoid degeneration and lipohyalinosis?
Hypertension
TRUE/FALSE. Headache caused by vascular distension OCCURS in patient with lacunes?
FALSE. Lacunes are small and deep. Because there is no accompanying overdistension of superficial arteries and deep arteries have no pain fibers.
Prior TIA occur in approximately __% of patients with lacunes?
20%
Most common cause of worsening of clinical neurological signs during the first week after stroke onset?
Lacunar infarction
TRUE OR FALSE. Lacunar syndromes are highly suggestive of deep cerebral infarction. 100% of the time, lacunar infarcts are found.
FALSE. In 16% of the time, it is not due to lacunar infarcts.
Combination of weakness, pyramidal signs and cerebellar-type ataxia
Homolateral ataxia and crural paresis (predominantly the lower limbs)
Abnormalities of motor function on one side of the body BUT no true paralysis and reflexes are not exaggerated, plantar response is flexor
non-pyramidal hemimotor syndrome (affected usually is the striatum and globus pallidus)