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NMSP > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

Which Cerebral artery is most commonly affected?

A

Middle Cerebral Artery

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2
Q

What gaze symptom will be present with Middle Cerebral A. issues?

A

Gaze TOWARD the side of the lesion

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3
Q

What symptoms will be present with Middle Cerebral A. issues?

A
  • 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
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4
Q

What symptoms (2) will be present with Anterior Cerebral A. issues?

A
  • Contralateral leg hemiplegia

- Alien hand syndrome (contralateral arm NOT under voluntary control)

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5
Q

What symptom will be present with Posterior Cerebral A. issues?

A

Contralateral Homonymous Hemianopia

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6
Q

Region between 2 vessels that is the most susceptible to ischemia and infarction?

A

Watershed infarcts

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7
Q

What shape are watershed infarcts?

A

Sickle shaped band of necrosis

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8
Q

What are the symptoms of a watershed infarct between ACA-MCA?

A

Proximal arm and leg weakness with aphasia

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9
Q

When may ACA-MCA watershed infarcts occur?

A

Internal Carotid A. stenosis

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10
Q

What is the symptom of a watershed infarct between the MCA-PCA?

A

Issues with higher order visual processing

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11
Q

Injury to the brain as a consequence of altered blood flow

A

Cerebrovascular disease

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12
Q

What are the 3 categories of Cerebrovascular Disease and what is all of their clinical designation?

A
  • Thrombosis
  • Embolism
  • Hemorrhage
    ==> Stroke
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13
Q

A stroke involves neurologic symptoms that persist for more than 24 hours. If the symptoms resolve in less than 24 hours, what occurred?

A

Transient Ischemic Attack (TIA)

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14
Q

Carotid Stenosis

A

Atherosclerosis of internal carotid A. just beyond the bifurcation point

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15
Q

If Carotid Stenosis is present, thrombi are likely to form. What will the symptoms be if it embolizes to the CNS?

A

Contralateral face-arm weakness, sensory changes, visual field defects and aphasia

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16
Q

Thrombosis usually causes occlusions due to _____. How?

A

Atherosclerosis

– Rupture/ulceration/erosion of the plaque exposes blood to thrombogenic substances ==> clot!

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17
Q

What are 3 common sites in the brain for Thrombosis? What shape will the infarct be?

A
  1. Carotid bifurcation
  2. MCA origin
  3. Basilar ends
    == Wedge shaped infarct
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18
Q

There are many sources of Emboli. Which vessel is most often affected by them?

A

MCA

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19
Q

What is the typical duration of a TIA?

A

10 minutes

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20
Q

Why are TIA’s neurologic emergencies?

A

Warning sign for potentially larger ischemic event

– Full stroke likely within 48 hours to 3 months

21
Q

What can cause TIA’s?

A

Temporary emboli, thrombi, vasospasm

22
Q

What are 3 common risk factors for a stroke?

A

HTN
DM
Hypercholesterolemia

23
Q

What are the 2 types of strokes?

A
  1. Hemorrhagic

2. Ischemic Infarction

24
Q

Hemorrhagic stroke

A

Intracerebral or subarachnoid hemorrhage

- emboli associated

25
Q

Ischemic (pale) stroke

A

Bloodless infarction

- Thrombi associated

26
Q

Deep brain hemorrhages are often associated with?

A

HTN

27
Q

With Hypertensive Cerebrovascular Disease, what infarcts involve the lenticulostriate arteries?

A 
Lacunar infarcts (lake-like)
-- deep penetrating lenticulostriate arteries
28
Q

With Hypertensive Cerebrovascular Disease, slit hemorrhages may occur. What vessels are affected and what results?

A

Small penetrating vessels

=> slit like cavities surrounded by macrophages

29
Q

What are 5 syndromes that are associated with Hypertensive Cerebrovascular Disease?

A
  1. Vascular multi-infarct Dementia
  2. Binswanger Disease
  3. Charcot-Bouchard Microaneurysms
  4. Cerebral Amyloid Angiopathy
  5. Cadasil
30
Q

Vascular Multi-infarct Dementia

A

Dementia and gait issues

31
Q

Binswanger Disease

A

Area of subcortical white matter with myelin and axon loss

32
Q

Charcot-Bouchard Microaneurysms and what they are associated with

A

Minute aneurysms in the Basal Ganglia

– associated with CHRONIC HTN

33
Q

Cerebral Amyloid Angiopathy

A

Lobar hemorrhage with amyloid deposited in vessels

34
Q

Cadasil

A

Recurrent strokes and dementia with an onset around 35

35
Q

How is Cadasil inherited and what gene is overexpressed?

A

Autosomal Dominant

- Notch 3 gene

36
Q

With Cadasil, what are the manifestations and changes?

A 
Manifestations = recurrent strokes and dementia at 35
Changes = thickened media/adventitia, loss of smooth m. and PAS deposits
37
Q

Localized dilation of blood vessel

A

Aneurysm

38
Q

What is the most common cause of a subarachnoid hemorrhage?

A

Saccular (berry) Aneurysm in the anterior circulation of the circle of willis

39
Q

Where are saccular (berry) aneurysms most often found?

A

Anterior circulation of the circle of willis

40
Q

How do Aneurysms develop?

A

Over time due to defect in media of a vessel

41
Q

When and in who do aneurysms usually rupture?

A

Females in their 5th decade

- ruptures associated with stool straining and sexual orgasm

42
Q

What do Arteriovenous Malformations (AVMs) look like and what type of flow do they have?

A

Worm-like tangles with pulsatile shunting from A. to V.

= High flow

43
Q

Where are AVMs most common?

A

MCA and posterior branches

44
Q

Males are more likely to have AVMs, what mutations may be present?

A

(+) KRAS mutations

45
Q

What are Cavernous Malformations/Hemangiomas?

A

Loosely organized vascular channels arranged back to back with NO intervening brain parenchyma

46
Q

With Cavernous Malformations/Hemangiomas, what is the flow rate and is there shunting?

A

Low flow

– NO shunting

47
Q

Loosely organized vascular channels arranged back to back with NO intervening brain parenchyma at the cerebellum and pons

A

Cavernous Malformations/Hemangiomas

48
Q

What are the symptoms of AVMs and Cavernous Malformations?

A

Hemorrhage and neuro symptoms

NMSP (28 decks)

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