cerebral vascular disease Flashcards by Mai Wells

most disabling neuro disorder and 3rd most common cause of death in US

stroke

How well did you know this?

Not at all

Perfectly

stroke
gender
race

males

blacks, indians, hispanics

How well did you know this?

Not at all

Perfectly

what is the most significant and treatable risk factor for stroke

HTN; 60% of stroke pts have a hx of HTN

How well did you know this?

Not at all

Perfectly

ischemic %

thrombotic
embolic

80% are ischemic
2/3s is thrombotic
1/3 is embolic

How well did you know this?

Not at all

Perfectly

embolic strokes arise from where

heart, aortic arch, large cerebral arteries

How well did you know this?

Not at all

Perfectly

what account for 20% of strokes

hemorrhagic, usually secondary to HTN

How well did you know this?

Not at all

Perfectly

aphasia, apraxia, hemiparesis, hemisensory losses, visual field defects

anterior circulation stroke

How well did you know this?

Not at all

Perfectly

coma, drop attacks, vertigo, N/V, ataxia

brain stem dysfunction

How well did you know this?

Not at all

Perfectly

preceded by TIA

thrombotic strokes

How well did you know this?

Not at all

Perfectly

occurs abruptly and without warning

embolic stroke- from somewhere else in body

How well did you know this?

Not at all

Perfectly

thrombolytic therapy within what time frame

within 3 hours/ up to 4 1/2 hours

How well did you know this?

Not at all

Perfectly

what therapy for ischemic stroke and TIA

antiplatelets (aspirin, plavix)

How well did you know this?

Not at all

Perfectly

what therapy for cardiac emboli

anticoagulant (heparin, warfarin)

How well did you know this?

Not at all

Perfectly

What is a common cause of subarachnoid hemorrhage

A ruptured cerebral aneurysm

How well did you know this?

Not at all

Perfectly

Smoking
ETOH
HTN
Obesity
PCOS
Marfan syndrome
Ehlers-Danlos syndrome

risk factor for a cerebral aneurysm

How well did you know this?

Not at all

Perfectly

Saccular Aneurysm (Berry aneurysm)

appearance
common?
age?

Small round outpouching
Most common cerebral aneurysm – about 75% of nontraumatic subarachnoid hemorrhages
fifth and sixth decade

How well did you know this?

Not at all

Perfectly

Small round outpouching

Most common cerebral aneurysm – about 75% of nontraumatic subarachnoid hemorrhages

Saccular Aneurysm (Berry aneurysm)

How well did you know this?

Not at all

Perfectly

Fusiform Aneurysm

A segment of the entire artery is widened circumferentially

How well did you know this?

Not at all

Perfectly

A segment of the entire artery is widened circumferentially

Fusiform Aneurysm

How well did you know this?

Not at all

Perfectly

PCOS and COA

associated with cerebral aneurysms

How well did you know this?

Not at all

Perfectly

AV malformations

% of SAH
acquired how
gender
age

10%
congenital
males
2nd to 4th decades

How well did you know this?

Not at all

Perfectly

fever in SAH?

102

How well did you know this?

Not at all

Perfectly

herald bleed

definition
symptom
occur when

aneurysmal leak
atypical headache with focal neuro signs
corresponding sentinel HA usually occuring 1-3 weeks prior to severe SAH

How well did you know this?

Not at all

Perfectly

Amyloid angiopathy

may occur due to aging and high blood pressure. It may cause many small, unnoticed bleeds before causing a large one.

How well did you know this?

Not at all

Perfectly

Intra-axial hemorrhage

the bleeding occurs within the brain itself, more commonly known as cerebral hemorrhage. This is more dangerous and difficult to treat.

Intra-axial hemorrhage : Intraparenchymal Intraventricular

Intraparenchymal – bleeding within the brain tissue, | Intraventricular – bleeding within the brain’s ventricles

Extra-axial hemorrhage – the bleeding occurs where Epidural hemorrhage Subdural hemorrhage Subarachnoid hemorrhage - Most frequently caused by trauma. - Often secondary to a ruptured cerebral aneurysm

Extra-axial hemorrhage – the bleeding occurs within the skull but outside the brain tissue Epidural hemorrhage – bleeding between the dura mater and the skull. Most frequently caused by trauma. Subdural hemorrhage – in the subdural space between the dura and arachnoid mater. Subarachnoid hemorrhage – occurs between the arachnoid and pia meningeal layers. Often secondary to a ruptured cerebral aneurysm

gold standard for cranial hemorrhage

Non contrast head CT is the gold standard

Crescent shaped hemorrhage is indicative of a ___ | Biconcave hemorrhage indicates ___

Crescent shaped hemorrhage is indicative of a subdural hematoma Biconcave hemorrhage indicates epidural

Medication tx for cranial hemorrhage

Painkillers Corticosteroids – to reduced swelling Anti-seizure medications Mannitol

Neurosurgery tx for cranial hemorrhage

Craniotomy to remove clot Surgical clipping – Clip the base of the aneurysm Endovascular coiling – An endovascular procedure designed to induce clotting at the site of the aneurysm

Goals include (2) cranial hemorrhage

Reduce intracranial pressure | Proper blood pressure management

TIA definition. | Symptoms typically resolve ____

A TIA is a neurologic dysfunction caused by a disruption in cerebral blood flow without the death of brain tissue. Symptoms typically resolve in less than a day.

``` Amaurosis fugax – temporary loss of vision Diplopia Aphasia – difficulty speaking Contralateral hemiparesis Paresthesia Change in mental status Dizziness Lack of coordination Poor balance ```

TIA

Amaurosis fugax

temporary loss of vision

TIA surgical tx

Carotid endarterectomy – removal of atherosclerotic plaque where the stenosis of the carotid artery is more than 70%

risk factors for a cerebral aneurysm

``` MAKE 0 SAH Marfan aortic coarctation kidney d/s(autosomal dominant/PCOS) Ehlers-Danlos syndrome/ETOH Smoking/sickle cell obesity atherosclerosis hx(familial, HTN, hyperlipdemia) ```

Do you use antiplatelet therapy for a TIA with a non cardiac source?

yes

A patient has been diagnosed with a TIA. You have good reason to believe there is a cardiogenic cause. What medication do you start the patient on immediately?

Heparin

Which are more common ischemic or hemorrhagic strokes?

Ischemic events make up about 85% of strokes

Give contraindications for giving TPA

``` Any possibility of intracranial bleeding Recent major surgery Recent head trauma Active bleeding Intracranial neoplasm ```

4 deadly D's of posterior circulation strokes

diplopia, dizziness, dysphagia, dysarthria

ischemic strokes not visible on CT for how long

6 hrs

order what labs for a stroke or aneurysm

PT/PTT, BUN/Cr, CBC, cardiac enzymes, troponins

etiology of subdural hematoma

rupture of BRIDGING VEINS, accumulation of blood between dura and arachnoid membranes

etiology of epidural hematoma

rupture of MIDDLE MENINGEAL ARTERY, accumulation of blood between skull and dura mater

epidemiology of subdural and epidural hemotoma

subdural: elderly and alcoholics epidural: severe trauma

epidural hematoma s/s

immediate loss of consciousness followed by a lucid interval(minutes to hours)

occipital lobe

vision

parietal lobe

perception, making sense of the world, arithmetic, spelling

temporal lobe

memory, understanding, language

executive functions, thinking, planning, organizing, problem solving, emotions, behavioral control, personality

frontal lobe

damage to left parietal lobe...

cause loss of co-coordination in right arm and leg

damage to wernickes area...

cause difficulty in understanding speech, reading, and naming objects

damage to broca's area...

can cause speech problems

damage to the motor area of the right cerebral hemisphere...

can cause weakness in the left arm, leg, and face

perception, making sense of the world, arithmetic, spelling

parietal lobe

memory, understanding, language

temporal lobe

cause loss of co-coordination in right arm and leg

damage to left parietal lobe

cause difficulty in understanding speech, reading, and naming objects

damage to wernickes area

can cause speech problems

damage to broca's area

can cause weakness in the left arm, leg, and face

damage to the motor area of the right cerebral hemisphere

right brain injury - paralyzed what side - what deficits - behavioral style - memory?

right brain injury - paralyzed left side - special perceptual deficits - quick impulsive behavioral style - memory deficits

left brain injury - paralyzed what side - what deficits - behavioral style - memory?

left brain injury - paralyzed right side - speech language deficits - slow cautious behavioral style - memory deficits

nerve roots - biceps - triceps - patella - achilles

- biceps C5 - triceps C7 - patella L4 - achilles S1

babinski

dorsiflexion of big toe and fanning of other toes; sign of UMN lesion, but normal reflex in the first year of life

``` cranial nerve rhyme 1-2... 3-4... 5-6... 7-8... ```

1-2... tie your shoes 3-4... kick the door 5-6... pick up sticks 7-8... close the gate

CONTRALATERAL paresis & sensory loss in LEG loss of control over BOWEL and BLADDER function cognitive and personality changes

anterior cerebral artery injury

CONTRALATERAL CNVII FACIAL nerve palsy and arm paralysis lower face gaze preference TOWARDS side of lesion

middle cerebral artery injury

hemisensory loss, visual field defects, cortical blindness, COLOR AGNOSIA, homonymous hemiopsia(one sided vision), vertigo

posterior cerebral artery injury

coma, CN signs, weakness, sensory loss, ataxia, vertigo

vertebrobasilar

sx are pure motor and pure sensory, ataxic hemiparesis or dysarthria

lacunar