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Geriatrics > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

what is a stoke (CVA)

A

An insult to the CNS occurring on a primary vascular basis.

The insult can occur in the cortex of the brain, subcortical structures, brainstem, cerebellum or spinal cord.

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2
Q

what are the two types of strokes

A

primary ischemic

primary hemorrhagic

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3
Q

What is the percent of ischemic strokes?

A

80%
Cerebral embolism=30%
large artery thrombosis=30%
small artery thrombis (lacune) 20%

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4
Q

what percent of strokes are hemorrhagic?

A

20%
Intacerebreal hemorrhage-14%
Subarachnoid hemorrhage=6%

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5
Q

what is the epidemiology of stroke

A 
CVA affects 500,000 americans
3rd leading cause of death
Men>Women
Blacks>whites
Stroke doubles for each decade beyond 55
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6
Q

what are the factors that increase risk of CVA?

A 
Male, A. Fib, Hx of TIA/RIND
black, HTN, Genetic predisposition, age>55           Diabetes, PVD, Smoking, hyperlipidemia
Sickle cell Dz, Hx of CVA, 
Bruit or carotid stenosis
Valvular heart dz
hypercoaguable state
Polycythemia
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7
Q

what are the risk factor of CVA in younger population

A 
MVP
Patent foramen ovale
Migranious infarction
Hypercoaguable state
Illicit drug use
AVM/Aneurysm
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8
Q

What will be the presentation of the patient with CVA Hemispheric stroke

A

HA (most likely with hemorrhagic stroke or SAH)
Alteration in consciousness
speech disturbance
Visual field deficits-homonymous deficit
cognitive impairment
contralateral motor deficit/sensory deficit

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9
Q

what is the presentation of the patient with CVA (brainstem/ cerebellar stroke)

A

Dyarthria-difficulty with you motor part of speech controlling
Dysphagia-trouble swallowing
Ataxia-lack of voluntary muscle movements
Diplopia
Vertigo
Nystagmus
Nausea

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10
Q

what will strokes in a middle cerebral artery territory?

A

In dominant hemisphere would include aphasia / dysphasia

Contralateral motor weakness (central facial + arm > leg)

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11
Q

what will a stroke in a anterior cerebral artery territory?

A

Contralateral leg > arm or face Speech may be spared

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12
Q

what will a stroke in a posterior cerebral artery territory?

A

Contralateral homonymous hemianopsia

Speech unaffected – no weakness likely (motor cortex, speech area too far from site of CVA)

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13
Q

Vertebrobasilar artery stoke at base of brain (posterior cerebral artery) territory would cause?

A

bilateral blindness

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14
Q

what will a lacunar stroke look like?

A

Paresis affecting face / arm / leg equally with no sensory loss (because of predilection for internal capsule – resulting in pure motor stroke)

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15
Q

Lacunar stroke (thalamus)

A

pure sensory stroke

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16
Q

internal capsule stroke will show

A

pure motor stroke

17
Q

what is the berg balance scale?

A

a tool used for determining pts who can safely ambulate vs W/C

18
Q

what is the scale for berg balance scale and what does each range indicate for a fall risk?

A

scale 0-56
0-20 high fall risk
21-40 medium fall risk
41-56 low fall risk

19
Q

What should you do when evaluate a stroke victim?

A

assess for airway and breathing
Blood loss is not an issue in and of itself for cerebral bleeds – pts will not exsanguinate
Evaluate for level of consciousness
Obtain Hx from pt or family
Cognitive function/language
Evaluate CN/language/weakness/sensory/DTR/babinski/cerebellar

20
Q

which is more valuable diagnostic imaging for CVA CT or MRI?

A

CT is more valuable than an MRI
Do non-contrast CT 1st in case there is a hemorrhagic stroke
Then use an EKG to look for cardiac source for embolic stroke

21
Q

what do carotid and vertebral duplex scan look for?

A

embolus or stenosis

22
Q

what is the gold standard for thrombosis, stenosis, arterial dissection, vascular anomalies?

A

cerebral arteriography

23
Q

what are CI for TPA?

A 
hemorrhagic stroke
large infarct
>3hrs since onset
any question of coagulopathy
recent major surgery
prior stroke
severe HTN/metabolic disturbance
24
Q

what is the most common cause of Intracerebral hemorrhage (ICH)?

A

Hypertension

25
Q

where are the most common locations for ICH?

A

basal ganglia
thalamus
cerebellum
pons

26
Q

what is the management of ICH?

A

similar to ischemic stroke
must address intracranial pressure- can be lowered by intubating pt and placing on a vent and keep resp rate set at a point to maintain PCO2 between 25 and 30 this will diminish cerebral blood flow to a point where it will lower ICP

27
Q

What Meds are used in management of ICH?

A

mannitol- potent osmotic diuretic that reduced cerebral edema (has rebound effect)
evacuation of the hematoma may be indicated
control BP aggressively

28
Q

what is subarachnoid hemorrhage?

A

bleeding into the subarachnoid space
Very common etiology of SAH is head trauma
common with aneurysm or AVM

29
Q

how is subarachnoid hemorrhage confirmed?

A

Lumbar puncture that will show blood CSF

30
Q

what are the sign of subarachnoid hemorrhage?

A 
similar to meningitis due to meningeal irritation from blood:
stiff neck (nuchal rigidity)
photophobia
severe HA
low grade fever
31
Q

what are the complications associated with aneurysm’s?

A

Rebleed- clot forms in wall or aneurysm in those pts who survive
body will tend to break down clot in about 10-14days so this is when risk for rebleed is the highest
cerebral edema/ischemia and vasospasm
hydrocephalus

32
Q

what is a TIA

A

precursor to stroke
embolic phenomena- similar to stroke except the embolus moves on before infarction can occur- so pts symptoms are of ischemia (brain equivalent of angina in a way)

33
Q

what is the difference between TIA and CVA?

A

TIA resolves with no deficit
CVA has neurological deficit
CT of TIA is negative for infarction
CT for stroke is + for infarction

34
Q

what is the most common presenting symptom of TIA in the anterior circulation?

A

transient monocular blindness called amaurosis fugax

often described as a curtain

35
Q

what are carotid TIA symptoms?

A 
amaurosis fugax
aphasia 
hemiparesis
hemisensory deficit 
homonymous hemianopsia
36
Q

what are TIA symptoms for posterior curculation

A 
ataxia
bilateral visual loss
quadripareiss
perioral numbness
vertigo/syncope/dysarthria/diplopia/nausea/dysphagia
homonymous hemianopsia

Geriatrics (9 decks)

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