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NMSP Exam 1 > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

Vascular territories:

Anterior cerebral artery issues affect what?

A

Deficits: Upper motor neuron-type weakness & cortical-type sensory loss; contralateral hemiplegia initially

  • Contralateral leg (more common than arm or face)
  • “Alien hand” syndrome: Semiautomatic movements of the contralateral arm not under voluntary control
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2
Q

Vascular territories:

Posterior cerebral artery issues affect what?

A

Contralateral homonymous hemianopia

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3
Q

Vascular territories:

Middle cerebral artery issues affect what?

A

This is most commonly the site of issue

Deficits: Aphasia, hemineglect (lack of awareness to half of body), hemianopia, face-arm or face-arm-leg sensorimotor loss

  • Gaze preference toward side of lesion
  • Lacunes: Small, deep infarcts involving penetrating branches of MCA or other vessels
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4
Q

What are the 3 categories of cerebrovascular diseases?

A
  • Thrombosis
  • Embolism
  • Hemorrhage
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5
Q

What is the difference between a transient ischemic attack and a stroke?

A

Both: Clinical designation
TIA: Symptoms disappear within 24h
Stroke: Acute onset and persist beyond 24h

Infarction is the resultant lesion on the brain parenchyma

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6
Q

What are the 4 most common cerebrovascular disorders?

A
  • Global ischemia (Blood pressure issues, strangulation, carbon monoxide, etc)
  • Embolism
  • Hypertensive intraparenchymal hemorrhage
  • Ruptures aneurysm
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7
Q

What are watershed infarcts?

A

Region between two vessels that is most susceptible to ischemia & infarction
- Damage to this region produces a sickle-shaped band of necrosis over the cerebral convexity a few centimeters lateral to the interhemispheric fissure

Can have secondary hemorrhagic transformation

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8
Q

What symptoms happen with infarct to the ACA-MCA watershed area?

A

Occlusion of the internal carotid artery, hypotension in pt w carotid stenosis

  • Proximal arm & leg weakness
  • Transcortical aphasia: (language issues)
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9
Q

What symptoms happen with infarct to the PCA-MCA watershed area?

A

Higher-order visual processing

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10
Q

Assortment of info about carotid stenosis

Where do thrombi formed here go if they embolize?

A
  • Atherosclerosis commonly leads to stenosis of internal carotid artery just beyond bifurcation
  • Carotid bruit continues into diastole
  • Thrombi formed here can embolize distally, esp to MCA, ACA, and ophthalmic artery
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11
Q

What are symptoms of carotid stenosis?

What can be done about stenosis?

A

Contralateral face-arm of face-arm-leg weakness, contralateral sensory changes, contralateral visual field defects, aphasia or neglect

Angioplasty or stenting or endarterectomy

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12
Q

Where are 3 primary sites of thrombosis?

A
  • Carotid bifurcation
  • Origin of MCA
  • Either end of basilar artery

Often d/t atherosclerosis

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13
Q

What are 6 common sources of emboli in cardioembolic infarcts?

A
  • Atrial fibrillation (Left atrial appendage)
  • Myocardial infarction (Hypokinetic or akinetic areas)
  • Valvular disease
  • Artery-to-artery emboli (Emboli from stenosed internal carotid artery, vertebral stenosis)
  • Dissection: Carotid or vertebral (atherosclerosis of aortic arch)
  • PFO (bypasses lungs and goes straight to brain; paradoxical embolus)
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14
Q

What are 4 sources of emboli that are not blood clots?

A
  • Air emboli
  • Septic emboli
  • Fat or cholesterol emboli
  • Marantic emboli (non-bacterial) from hypercoagulable states like advanced malignancy, amniotic fluid emboli, etc
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15
Q

What artery is most often affect by embolic infarction?

A

MCA

- Emboli lodge where blood vessel branch or pre-existing areas of luminal stenosis

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16
Q

What are shower emboli?

A

Fat after a long bone fracture

17
Q

Name 7 hypercoagulable states

A
  • Heritable coag factor disorders
  • Dehydration
  • Adenocarcinoma/malignancies
  • Surgery, trauma, childbirth
  • DIC
  • Hematologic disorders
  • Vasculitis
18
Q

What are symptoms of TIAs?

A

Positive or negative (doing something you don’t want or not doing something you do want) in motor, somatosensory, visual, auditory, olfactory, kinesthetic, emotional, cognitive

19
Q

Common causes of TIA

A

Previous TIA, migraines, seizures, non-neurologic conditions like arrhythmias or hypoglycemia

20
Q

What do TIAs indicate?

A
  • Warning sign for potentially larger ischemic injury to the brain
  • Neurological emergency even when symptoms cease
21
Q

What are the 2 different types of stroke? Are they associated with emboli or thrombi?

A

Hemorrhagic (red)

  • Emboli associated
  • Hemorrhage secondary to reperfusion of damages vessels

Ischemic (pale)

  • Thrombus associated
  • Can have secondary hemorrhage
22
Q

Hypertensive cerebrovascular disease:

Lacunar infarcts. What are they, what do they commonly affect?

A

Deep penetrating arteries & arterioles develop arteriolar sclerosis

  • Lenticulostriate arteries
  • Commonly affect basal ganglia
23
Q

Hypertensive cerebrovascular disease:

What are slit hemorrhages?

A

Small caliber penetrating vessels

24
Q

Hypertensive cerebrovascular disease:

What is hypertensive encephalopathy, what is a common RF for it?

What is vascular multi-infarct dementia?

What is Binswanger disease?

What are Charcot-Bouchard microaneurysms?

A

Malignant HTN; HTN is a risk factor most commonly a/w deep brain parenchymal hemorrhages

Vascular multi-infarct dementia: Dementia, gait abnormalities, pseudobulbar signs

Binswanger disease: Large area of subcortical white matter w myelin and axon loss

Charcot-Bouchard microaneurysms: A/w chronic HTN; minute aneurysms in the basal ganglia (less than 300 micrometers)

25
Q

Hypertensive cerebrovascular disease:

What is cerebral amyloid angiopathy?

What is CADASIL? What age does it present? What gene is a/w it? What happens to vessels and what stain does it use?

A

CAA: Lobar hemorrhage; same A beta amyloid deposited in the walls of vessels (same as in Alzheimer’s ) producing microbleeds

CADASIL: Cerebral autosomal dominant arteriopathy w subcortical infarcts and leukoencephalopathy

  • Recurrent strokes and dementia
  • First detectable ~35yo
  • NOTCH 3 gene
  • Thickening of media and adventitia, loss of smooth muscle cells, basophilic PAS+ deposits
26
Q

What is an aneurysm?

Where are they most
frequently located?

What increases incidence of aneurysm?

A

Localized abn dilation of blood vessel or the heart

Most frequently seen in anterior circulation (Circle of Willis, basilar SAH)
- Most frequent cause of clinically significant SAH is rupture of saccular (berry) aneurysm

Inc incidence if first-degree relative affected, adult (AD) polycystic kidney disease, Ehlers-Danlos, Marfans, and neurofibromatosis type 1 (NF1)

27
Q

A few things to note about aneurysms

A
  • Rupture more common in fifth decade of life and more frequent in females
  • Repeat bleeding common
  • First few days after SAH, inc risk of addt’l ischemic injurt from vasospasm
28
Q

What are the 4 groups of vascular formations? Which is most common?

A
  • AV malformations (most common)
  • Cavernous malformations/hemangiomas
  • Capillary telangiectasias
  • Venous angiomas
29
Q

Sx of AV malformations and Cavernous?

A

Hemorrhage & neurological sx

30
Q

What are cavernous malformations and where/what do they affect? What can be seen in surrounding area?

A

Distended, loosely organized vascular channels arranged back-to-back with no intervening brain parenchyma

  • Cerebellum, pons, subcortical regions
  • No AV shunting
  • Foci of old hemorrhage, infarction, calcifications seen in surrounding area
31
Q

What are AV malformations? Where are they most common? What gene mutation are they a/w?

A

Tangle of vascular channels w prominent pulsatile AV shunting and high blood flow
- Often in subarachnoid space, may extend into brain parenchyma
- Seen as arteries to veins without intervening capillaries
Often a/w KRAS oncogene, some RAS signaling

32
Q

What causes vascular dementia?

What is seen with this in the brain?

Binswanger disease?

A

Can be caused by cerebral atherosclerosis (from chronic HTN) or vessel thrombosis/embolus

Multiple bilateral grey matter (cortex, thalamus, BG) and white matter infarcts

Binswanger is subcortical white matter dementia (loss of white matter, myelin, axons)

33
Q

What are symptoms of vascular dementia?

A

Sx: Dementia, gait abnormalities, pseudobulbar signs (frequent, involuntary and uncontrollable outbursts of crying or laughing that are exaggerated d/t upper motor neuron lesions of CNIX)

NMSP Exam 1 (9 decks)

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