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neurology > cerebral vascular disease > Flashcards

cerebral vascular disease Flashcards

1
Q

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

A

stroke

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2
Q

stroke
gender
race

A

males

blacks, indians, hispanics

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3
Q

what is the most significant and treatable risk factor for stroke

A

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

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4
Q

ischemic %

  • thrombotic
  • embolic
A

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

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5
Q

embolic strokes arise from where

A

heart, aortic arch, large cerebral arteries

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6
Q

what account for 20% of strokes

A

hemorrhagic, usually secondary to HTN

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7
Q

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

A

anterior circulation stroke

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8
Q

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

A

brain stem dysfunction

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9
Q

preceded by TIA

A

thrombotic strokes

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10
Q

occurs abruptly and without warning

A

embolic stroke- from somewhere else in body

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11
Q

thrombolytic therapy within what time frame

A

within 3 hours/ up to 4 1/2 hours

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12
Q

what therapy for ischemic stroke and TIA

A

antiplatelets (aspirin, plavix)

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13
Q

what therapy for cardiac emboli

A

anticoagulant (heparin, warfarin)

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14
Q

What is a common cause of subarachnoid hemorrhage

A

A ruptured cerebral aneurysm

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15
Q 
Smoking
ETOH
HTN
Obesity
PCOS
Marfan syndrome
Ehlers-Danlos syndrome
A

risk factor for a cerebral aneurysm

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16
Q

Saccular Aneurysm (Berry aneurysm)

  • appearance
  • common?
  • age?
A

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

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17
Q

Small round outpouching

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

A

Saccular Aneurysm (Berry aneurysm)

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18
Q

Fusiform Aneurysm

A

A segment of the entire artery is widened circumferentially

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19
Q

A segment of the entire artery is widened circumferentially

A

Fusiform Aneurysm

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20
Q

PCOS and COA

A

associated with cerebral aneurysms

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21
Q

AV malformations

  • % of SAH
  • acquired how
  • gender
  • age
A

10%
congenital
males
2nd to 4th decades

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22
Q

fever in SAH?

A

102

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23
Q

herald bleed

  • definition
  • symptom
  • occur when
A

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

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24
Q

Amyloid angiopathy

A

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

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25
Q

Intra-axial hemorrhage

A

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

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26
Q

Intra-axial hemorrhage :
Intraparenchymal
Intraventricular

A

Intraparenchymal – bleeding within the brain tissue,

Intraventricular – bleeding within the brain’s ventricles

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27
Q

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

A

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

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28
Q

gold standard for cranial hemorrhage

A

Non contrast head CT is the gold standard

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29
Q

Crescent shaped hemorrhage is indicative of a ___

Biconcave hemorrhage indicates ___

A

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

30
Q

Medication tx for cranial hemorrhage

A

Painkillers
Corticosteroids – to reduced swelling
Anti-seizure medications
Mannitol

31
Q

Neurosurgery tx for cranial hemorrhage

A

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

32
Q

Goals include (2) cranial hemorrhage

A

Reduce intracranial pressure

Proper blood pressure management

33
Q

TIA definition.

Symptoms typically resolve ____

A

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.

34
Q 
Amaurosis fugax – temporary loss of vision
Diplopia
Aphasia – difficulty speaking
Contralateral hemiparesis
Paresthesia
Change in mental status
Dizziness
Lack of coordination
Poor balance
A

TIA

35
Q

Amaurosis fugax

A

temporary loss of vision

36
Q

TIA surgical tx

A

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

37
Q

risk factors for a cerebral aneurysm

A 
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)
38
Q

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

A

yes

39
Q

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?

A

Heparin

40
Q

Which are more common ischemic or hemorrhagic strokes?

A

Ischemic events make up about 85% of strokes

41
Q

Give contraindications for giving TPA

A 
Any possibility of intracranial bleeding
Recent major surgery
Recent head trauma
Active bleeding
Intracranial neoplasm
42
Q

4 deadly D’s of posterior circulation strokes

A

diplopia, dizziness, dysphagia, dysarthria

43
Q

ischemic strokes not visible on CT for how long

A

6 hrs

44
Q

order what labs for a stroke or aneurysm

A

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

45
Q

etiology of subdural hematoma

A

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

46
Q

etiology of epidural hematoma

A

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

47
Q

epidemiology of subdural and epidural hemotoma

A

subdural: elderly and alcoholics
epidural: severe trauma

48
Q

epidural hematoma s/s

A

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

49
Q

occipital lobe

A

vision

50
Q

parietal lobe

A

perception, making sense of the world, arithmetic, spelling

51
Q

temporal lobe

A

memory, understanding, language

52
Q

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

A

frontal lobe

53
Q

damage to left parietal lobe…

A

cause loss of co-coordination in right arm and leg

54
Q

damage to wernickes area…

A

cause difficulty in understanding speech, reading, and naming objects

55
Q

damage to broca’s area…

A

can cause speech problems

56
Q

damage to the motor area of the right cerebral hemisphere…

A

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

57
Q

perception, making sense of the world, arithmetic, spelling

A

parietal lobe

58
Q

memory, understanding, language

A

temporal lobe

59
Q

cause loss of co-coordination in right arm and leg

A

damage to left parietal lobe

60
Q

cause difficulty in understanding speech, reading, and naming objects

A

damage to wernickes area

61
Q

can cause speech problems

A

damage to broca’s area

62
Q

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

A

damage to the motor area of the right cerebral hemisphere

63
Q

right brain injury

  • paralyzed what side
  • what deficits
  • behavioral style
  • memory?
A

right brain injury

  • paralyzed left side
  • special perceptual deficits
  • quick impulsive behavioral style
  • memory deficits
64
Q

left brain injury

  • paralyzed what side
  • what deficits
  • behavioral style
  • memory?
A

left brain injury

  • paralyzed right side
  • speech language deficits
  • slow cautious behavioral style
  • memory deficits
65
Q

nerve roots

  • biceps
  • triceps
  • patella
  • achilles
A
  • biceps C5
  • triceps C7
  • patella L4
  • achilles S1
66
Q

babinski

A

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

67
Q 
cranial nerve rhyme
1-2...
3-4...
5-6...
7-8...
A

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

68
Q

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

A

anterior cerebral artery injury

69
Q

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

A

middle cerebral artery injury

70
Q

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

A

posterior cerebral artery injury

71
Q

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

A

vertebrobasilar

72
Q

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

A

lacunar

neurology (10 decks)

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