Cerebral Vascular Disease Flashcards
What kind of hemorrhage is classified with “the worst headache in my freaking life omg I’m gonna die please help”?
Subarachnoid
Reduction of brain flow rate by 60% causes what?
Neurons to stop generating electrical signals
Reduction of flow rate TO 20% for more than a few minutes resulted in what?
Necrosis of the involved tissue
What is an infarct?
A necrotic region of tissue
What is a stroke?
An abrupt incident of vascular insufficiency resulting in neurological function
Incidence of stroke increases or decreases with age? Which gender is more likely to have a stroke?
Increases with age
Men more likely, feminism yo
What are the two types of strokes?
Occlusive and hemorrhagic
What is the general difference between occlusive and hemorrhagic?
Occlusive: blot clot
Hemorrhagic: compromised (burst) artery
Is size of location more important in a stroke?
Location!!!!!!!!!!
What are some risk factors for stroke?
- smoking
- alcohol
- obesity
- heart disease
- genetics
- atrial fibrillation
What is a penumbra?
The region surrounding the area of permanent tissue damage
-area that will survive if you treat rapidly
Time is critical in a stroke, how much time do you have for treatment?
3 hours!!!!!
What are the two types of occlusive stroke?
Thrombotic and emboli
What is a thrombotic stroke?
A blood clot that forms locally over an atherosclerosis lesion
-usually has penumbras
What is an embolic stroke?
Thrombi formed not in the brain
- thrombi detaches and travels to the brain
- no penumbras
What is watershed infarct?
Hypoxia due to insufficient blood supply
-HYPOTENSION
What are the two types of hemorrhagic stroke?
Subarachnoid and intracerebral
What is a subarachnoid hemorrhage?
-superficial artery of the brain bursts
What is an intracranial hemorrhage?
Artery within the brain tissue bursts
What are common causes for subarachnoid hemorrhage?
- aneurysm rupture
- arteriovenous malformation
What are common causes of intracerebral hemorrhage?
- HYPERTENSION
- arteriovenous malformation
What areas are likely to suffer from watershed infarct? What shape does this normally take on?
- okay so arteries only supply a specific part of the brain, so the areas that are near the border of where the arteries stop are more susceptible.
- they are wedge shaped orrrrrrr if bad enough the whole brain can suffer
What are the advantages of the new england classifications of strokes?
-based on pathological features and is less complicated
What are the advantages of the mayo clinic classifications?
Take clinical features into account
-takes the size of vessels into account
Clinically, the stroke can be classified at which two things>
- focal: one particular area of the brain is affected with neural deficits at multiple sites
- diffuse: the whole brain is affected or multiple regions are affected. Patient is normally unconscious
Pathophysiologically, stroke can be classified as what?
- ischemic: reduced blood supply, decreased oxygenation of the brain tissue
- hemorrhagic: rupture of a blood vessel
What are the two types of hemorrhagic stroke?
- in the brain parenchyma-rupture of a small artery leading to accumulation of blood and compression on adjacent tissue
- in subarachnoid space: rupture of a superficial artery
SAME CLINICAL PRESENTATION, THE ONLY DIFFERENCE IS MECHANISM
SEVERE HEADACHE ASSOCIATED WITH STROKE INDICATED WHAT KIND OF STROKE?
HEMORRHAGIC
What is the difference between a transient ischemic attack and a stroke?
-deficits associated with TIA only last a few minutes to a few hours and are followed by a complete recovery
What is responsible for transient monocular blindness?
-TIA caused by emboli that detach from a plaque in the internal carotid artery, enter the ophthalmic artery and render the retina temporarily ischemic
What does TIA often precede?
A stroke
Blood cells can be occluded up to what percentage and still function normally?
70%
What is a paradoxical embolus?
Venous embolus that passes through a patent foramen oval and lodges in a cerebral artery
What are common locations for ischemic stroke?
- MCA (most common)
- internal carotid artery
- basilar artery
What are the biggest concerns with ischemic stroke?
- swelling of the brain!!!!!!!
- loss of demarcation between grey and white matter
- breakdown of myelin
- gliosis as reaction to injury
What are the main symptoms associated with strokes involving the MCA?
- sensory loss in face and upper extremity
- speech problems-aphasia
What is the difference in deficits between wernicke and broca
Wernicke: fluent, no sense speech
Broca: not fluent, makes sense speech
Lacunae strokes: involve what artery? What symptoms?
- MCA
- pure sensory or pure motor
- monoparesis
- isolated sensory loss
What are the main symptoms associated with strokes involving the ACA?
- sensory and motor loss in lower extremities
- urinary incontinence
What are the main symptoms of strokes involving the vertebral basilar system?
- vertigo
- sensory loss in trunk and limbs
What are the main symptoms of strokes involving the PCA?
- gaze paralysis-CN III
- visual field defect
- hemianopsia: eyes deviate towards the side of a lesion to compensate
What is an epidural hematoma?
Arterial bleed creates blood filled space between bone and dura mater
What is the presentation of an epidural hematoma?
Short loss of consciousness, lucid interval, neurological deterioration, death
What does the CT look like for an epidural hematoma?
-hematoma rarely crosses the suture line.
Lesions is lens shaped
What is the main difference between epidural hematoma and subdural hematoma?
Epidural hematoma is a high pressure system and subdural hematoma is a low pressure system
What is a subdural hematoma?
Rupture of bridging veins between dura and arachnoid matter
What are the main symptoms associated with a subdural hematoma?
- venous bleeding with a delayed onset of symptoms
- brain atrophy
- whiplash
What is subdural hematoma usually seen in?
SHAKEN BABY SYNDROME
Alcoholics
Elderly
What are the causes of subarachnoid hemorrhage?
- ruptured berry aneurysm
- marfans
- trauma
- congenital arteriovenous malformation
What kind of hemorrhage causes yellow CSF?
Subarachnoid hemorrhage
