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Neurosciences > Cerebrovascular > Flashcards

Cerebrovascular Flashcards

1
Q

Definition of a stroke

A

Destruction of a portion of brain tissue as a result of circulatory failure in the distribution of a specific arterial vessel

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2
Q

Ischemic strokes

A

Make up 87%

Defined as embolic or thrombotic

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3
Q

Hemorrhagic strokes

A

13% of strokes

Intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, or intraventricular hemorrhage

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4
Q

Stroke facts

A

1 in 4 are recurrent

Leading cause of disability

Reduces mobility in over half of survivors 65 and over

80% are preventable

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5
Q

Non- modifiable stroke risk factors

A

Race

Age

Gender

Genetics

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6
Q

Modifiable stroke risk factors

A

Hypertension

Heart disease

A-fib

Hypercholesterolemia

PFO

Carotid artery stenosis

Dissection

DM

OSA

Hypercoagulability

Depression

ETOH

Drug use

Smoking

Oral contraceptive pills

Migraine

Smoke exposure

Inactivity

Obesity

Poor nutrition

Post menopausal hormone therapy

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7
Q

Occlusion pathophysiology

A

Decreased blood flow due to blockage. Neurons are deprived of oxygen and glucose. Within seconds to minutes of loss of perfusion edema and cell death occur

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8
Q

Transient ischemic attack

A

A transient episode of neurological dysfunction caused by focal brain cell ischemia without acute infarction

Increased risk of stroke within 48 hours of a TIA.

Workup should include HCT, carotid ultrasound, CTA/MRA, echo, lipids, and ECG

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9
Q

Subjective assessment finding after stroke

A

Headache
Difficulty speaking
Dizziness
Loss of coordination
Falling
Dropping objects
Numbness and/or tingling
Visual abnormalities- blurred, double, or vision loss

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10
Q

Objective assessment findings after stroke

A

Decreased LOC
Disorientation
Aphasia
Gaze preference toward stroke
Motor weakness
Sensory abnormalities
Cerebellar signs

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11
Q

Possible cranial nerve deficits in strokes

A

Visual abnormalities: field cut, amaurosis fugax, diploma

EOM palsy

Facial weakness

Decreased cough or gag

Airway compromise

Dysarthria

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12
Q

Stroke timeline

A

Door to Dr- 10 minutes
Door to stroke team- 15 minutes
Door to CT- 25 minutes
Door to CT results- 45minutes
Door to drug- 60 minutes
Door to floor- 3 hours

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13
Q

Tests done for stroke

A

Non-contrast CT
Blood glucose
O2 saturation
CBC, BMP, PT/PTT, INR
EKG
Cardiac ischemia markers if doesn’t delay tPA

PRN
BAC
Pregnancy test
Toxicology
Hepatic function
CTA/MRA
Chest x-ray
EEG

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14
Q

BP goals

A

Pre-TPA <185/<110
Post TPA <180/<105

No-Go TPA <220/<120 lower by 15% within first 25 hours after onset

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15
Q

Anoxic injury

A

Technically a stroke
Caused by hypoxia/ischemia
Mostly poor prognosis

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16
Q

ICH Causes

A

Primarily caused by hypertension

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17
Q

BP goal for ICH

A

Systolic <140

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18
Q

Intraventricular hemorrhage

A

Usually an extension of ICH and rarely isolated
If risk of hydrocephalus place EVD

19
Q

Cerebral aneurysm

A

An abnormal local dilation in the wall and artery in Circle of Willis caused by defect, disease, or injury

20
Q

Risk factors for cerebral aneurysm

A

HTN, ETOH abuse, smoking, illicit drug use, connective tissue disease, family genetics

21
Q

Assessment of cerebral aneurysm

A

Usually asymptomatic and an incidental finding

Larger aneurysms can cause compression resulting in double vision, ptosis, increased eye pressure, and redness

Cavernous aneurysms can cause cranial nerve 3 or 4 palsy, proptosis, and increased intraoccular pressure

22
Q

Aneurysmal subarachnoid hemorrhage

A

Caused by aneurysm rupture resulting in blood in the subarachnoid space

Medical emergency with high morbidity and mortality

23
Q

Grading systems used for subarachnoid hemorrhage

A

HUNT and HESS: rates 1-5

World Federation of Neurological Surgeons Grading System: rates 0-5 with 0 being unruptured

24
Q

What is monitored for after a bleed

A

Hydrocephalus
Seizures
Vasospasm
Delayed cerebral ischemia
Cerebral edema
Increased cranial pressure

Arrhythmia
ECG changes
Left ventricle dysfunction
Stress cardiomyopathy

Airway protection
Pulmonary edema
Pneumonia

Cerebral salt wasting
SIADH

25
Q

Arteriovenous Malformation

A

Congenital mass of abnormal blood vessels

Used Spetzler Martin Classification System

Risk of rupture resulting in ICH or IVH

26
Q

Assessment findings and interventions of arteriovenous malformations

A

Presents with seizures, headache, stroke symptoms

Conservative is imaging and monitoring. If causing issues surgical reduction or resection

27
Q

What is a dural arteriovenous fistula

A

Pathological shunts between dural arteries and dural venous sinuses, meningeal veins, or cortical veins

Caused by trauma, venous thrombus, venous HTN, or are idiopathic

Due to the drainage pattern they are a hemorrhage risk

Also found in the spine

28
Q

Assessment findings in dural arteriovenous fistulas

A

Pulsatile tinnitus, headaches, seizures, progressive neuro deficits, dementia

Spinal may cause pain, lower extremity weakness, and sensory changes

29
Q

Interventions for dural arteriovenous fistulas

A

Same as arteriovenous malformations

30
Q

Cavernous malformations

A

Also called cavernous hemangiomas, canvernomas, or cavernous angiomas

Low flow, low pressure lesions made up of dilated capillaries with risk of rupturing

31
Q

Moya moya disease

A

Progressive large intracranial artery narrowing and the development of small vessel collaterals

Increased risk of ischemic and hemorrhagic strokes

32
Q

Cerebral venous sinus thrombosis overview and assessment

A

Thrombosis of cerebral veins or dural sinus causing increase in venous or capillary pressure

Leads to edema, venous infarct, or hemorrhage

Presents with headache, papilledema, and visual problems due to increased intraocular pressure. Can also have focal deficits and seizures

33
Q

Symptoms of anterior cerebral artery ischemic stroke

A

Altered mental status
Impaired judgement
Contralateral weakness and hypesthesia
Gait apraxia

34
Q

Middle cerebral artery ischemic stroke findings

A

Contralateral hemiparesis
Contralateral hypethesia
Contralateral homonymous hemianopsia
Gaze preference toward side of lesion
Agnosia
Receptive or expressive aphasia

35
Q

Posterior cerebral artery ischemic stroke symptoms

A

Homonymous hemianopsia, cortical blindness, visual agnosia
Altered mental status, impaired memory
Dizziness
Limb weakness
Paresthesias
Nausea
Language dysfunction

36
Q

Vertebrobasilar system ischemic stroke symptoms

A

Wide variety of cranial nerve, cerebellar, and brain stem deficits

Vertigo, nystagmus, diplopia, visual field deficits, dysphagia, dysarthria, facial hypesthesia, syncope, ataxia

Variety of neurological syndromes

37
Q

What is Hunt and Hess used for?

A

Grading of aSAH

38
Q

Hunt and Hess Grade 1

A

Asymptomatic

39
Q

Hunt and Hess grade 2

A

Severe headache
Stiff neck
No neuro deficit except cranial nerve palsy

40
Q

Hunt and Hess grade 3

A

Drowsy
Minimal nerve deficit

41
Q

Hunt and Hess grade 4

A

Stuporous
Moderate or severe hemiparesis

42
Q

Hunt and Hess grade 5

A

Deep coma
Decerebrate posturing

43
Q

World federation of neurological surgeons grading system for aSAH

A

0- unruptured

1- GCS 15

2- GCS 13-15

3- GCS 13-15 with focal neurological deficits

4- GCS 7-12 with or without deficits

5- GCS 3-6 with or without deficits

Neurosciences (5 decks)

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