Cerebrovascular Disease Flashcards
Which Cerebral artery is most commonly affected?
Middle Cerebral Artery
What gaze symptom will be present with Middle Cerebral A. issues?
Gaze TOWARD the side of the lesion
What symptoms will be present with Middle Cerebral A. issues?
- Gaze toward lesion
- Aphasia (issues with language comprehension)
- Hemineglect (lack of awareness of 1/2body)
- Hemianopia (loss of 1/2 visual field)
- Face-arm sensorimotor loss
What symptoms (2) will be present with Anterior Cerebral A. issues?
- Contralateral leg hemiplegia
- Alien hand syndrome (contralateral arm NOT under voluntary control)
What symptom will be present with Posterior Cerebral A. issues?
Contralateral Homonymous Hemianopia
Region between 2 vessels that is the most susceptible to ischemia and infarction?
Watershed infarcts
What shape are watershed infarcts?
Sickle shaped band of necrosis
What are the symptoms of a watershed infarct between ACA-MCA?
Proximal arm and leg weakness with aphasia
When may ACA-MCA watershed infarcts occur?
Internal Carotid A. stenosis
What is the symptom of a watershed infarct between the MCA-PCA?
Issues with higher order visual processing
Injury to the brain as a consequence of altered blood flow
Cerebrovascular disease
What are the 3 categories of Cerebrovascular Disease and what is all of their clinical designation?
- Thrombosis
- Embolism
- Hemorrhage
==> Stroke
A stroke involves neurologic symptoms that persist for more than 24 hours. If the symptoms resolve in less than 24 hours, what occurred?
Transient Ischemic Attack (TIA)
Carotid Stenosis
Atherosclerosis of internal carotid A. just beyond the bifurcation point
If Carotid Stenosis is present, thrombi are likely to form. What will the symptoms be if it embolizes to the CNS?
Contralateral face-arm weakness, sensory changes, visual field defects and aphasia
Thrombosis usually causes occlusions due to _____. How?
Atherosclerosis
– Rupture/ulceration/erosion of the plaque exposes blood to thrombogenic substances ==> clot!
What are 3 common sites in the brain for Thrombosis? What shape will the infarct be?
- Carotid bifurcation
- MCA origin
- Basilar ends
== Wedge shaped infarct
There are many sources of Emboli. Which vessel is most often affected by them?
MCA
What is the typical duration of a TIA?
10 minutes
Why are TIA’s neurologic emergencies?
Warning sign for potentially larger ischemic event
– Full stroke likely within 48 hours to 3 months
What can cause TIA’s?
Temporary emboli, thrombi, vasospasm
What are 3 common risk factors for a stroke?
HTN
DM
Hypercholesterolemia
What are the 2 types of strokes?
- Hemorrhagic
2. Ischemic Infarction
Hemorrhagic stroke
Intracerebral or subarachnoid hemorrhage
- emboli associated
Ischemic (pale) stroke
Bloodless infarction
- Thrombi associated
Deep brain hemorrhages are often associated with?
HTN
With Hypertensive Cerebrovascular Disease, what infarcts involve the lenticulostriate arteries?
Lacunar infarcts (lake-like) -- deep penetrating lenticulostriate arteries
With Hypertensive Cerebrovascular Disease, slit hemorrhages may occur. What vessels are affected and what results?
Small penetrating vessels
=> slit like cavities surrounded by macrophages
What are 5 syndromes that are associated with Hypertensive Cerebrovascular Disease?
- Vascular multi-infarct Dementia
- Binswanger Disease
- Charcot-Bouchard Microaneurysms
- Cerebral Amyloid Angiopathy
- Cadasil
Vascular Multi-infarct Dementia
Dementia and gait issues
Binswanger Disease
Area of subcortical white matter with myelin and axon loss
Charcot-Bouchard Microaneurysms and what they are associated with
Minute aneurysms in the Basal Ganglia
– associated with CHRONIC HTN
Cerebral Amyloid Angiopathy
Lobar hemorrhage with amyloid deposited in vessels
Cadasil
Recurrent strokes and dementia with an onset around 35
How is Cadasil inherited and what gene is overexpressed?
Autosomal Dominant
- Notch 3 gene
With Cadasil, what are the manifestations and changes?
Manifestations = recurrent strokes and dementia at 35 Changes = thickened media/adventitia, loss of smooth m. and PAS deposits
Localized dilation of blood vessel
Aneurysm
What is the most common cause of a subarachnoid hemorrhage?
Saccular (berry) Aneurysm in the anterior circulation of the circle of willis
Where are saccular (berry) aneurysms most often found?
Anterior circulation of the circle of willis
How do Aneurysms develop?
Over time due to defect in media of a vessel
When and in who do aneurysms usually rupture?
Females in their 5th decade
- ruptures associated with stool straining and sexual orgasm
What do Arteriovenous Malformations (AVMs) look like and what type of flow do they have?
Worm-like tangles with pulsatile shunting from A. to V.
= High flow
Where are AVMs most common?
MCA and posterior branches
Males are more likely to have AVMs, what mutations may be present?
(+) KRAS mutations
What are Cavernous Malformations/Hemangiomas?
Loosely organized vascular channels arranged back to back with NO intervening brain parenchyma
With Cavernous Malformations/Hemangiomas, what is the flow rate and is there shunting?
Low flow
– NO shunting
Loosely organized vascular channels arranged back to back with NO intervening brain parenchyma at the cerebellum and pons
Cavernous Malformations/Hemangiomas
What are the symptoms of AVMs and Cavernous Malformations?
Hemorrhage and neuro symptoms
