Cerebrovascular Disease Flashcards
Transient Ischemic Attacks
Sudden, focal neurological deficits which completely resolve within 24 hours
Stroke
A sudden, focal neurological deficit which does not completely resolve within 24 hours, but may variably improve over several weeks to months
What are some of the risk factors of ischemic cerebrovascular disease?
- Aterosclerosis
- Hypertension
- Diabetes
- Smoking
- Hyperlipidemia
Where is atherosclerosis predominantly found in the cerebral vasculature?
Atherosclerotic changes predominate at the bifurcation points of large, major cervical and intracranial arteries, perhaps partly due to more turbulent blood flow at these sites.
What are the 2 basic mechanisms of cerebral ischemic infarction?
- Thrombosis
- Embolism
What do the lenticulostriate arteries supply?
Deep structures such as the basal ganglia, internal capsule, thalamus, and corona radiata.
Lacunar Infarcts
Small lesions due to infarction of the lenticulostriate arteries
Amaurosis Fugax (monocular blindness)
Carotid territory TIA involving the ophthalmic artery or its retinal branches
What do non-ocular carotid territory TIAs cause?
Other carotid TIAs may cause hemispheral ischemia leading to hemiparesis or aphasia.
What do vertebrobasilar TIAs cause?
Vertebrobasilar territory TIAs cause ischemia of the brain stem, cerebellum, or visual (occipital) cortex, producing symptoms of ataxia, homonymous hemianopsia, or hemiparesis associated with “crossed” brain stem syndromes.
A hemiparesis with greater weakness of the face and upper limb suggests an infarct in…
Precentral MCA
A hemiparesis with greater weakness of the lower limb suggests an infarct in…
Precentral ACA
Sensory deficits limited to the face and upper limb likewise suggest an infarct in…
Postcentral MCA
Sensory deficits limited to the lower limb suggest an infarct in…
Postcentral ACA
Pure Sensory Stroke
Lacunar Syndrome of the Thalamus
Are lacunar strokes thrombotic or embolic?
Almost always thrombotic
What can improve functional recovery after stroke if administered rapidly?
IV tPA can be beneficial if administered within 3 hours of onset of symptoms
What is the greatest risk with tPA use?
Intracranial Hemorrhage
Why does rupture of blood into brain parenchyma cause ICP?
Arterial pressure is higher than ICP
What does a deep hemorrhage hint at as the cause?
HTN
What does a superficial hemorrhage hint at as the cause?
Head Trauma
What is the most common cause of cerebral hemorrhage?
HTN
Arteriovenous Malformations
AVMs are an abnormal connection of cerebral artery to vein, without intervening capillary bed, which enlarge slowly over time - risk for rupture and hemorrhage.
What is the most common cause for bleeding into the arachnoid space?
Trauma
Second to trauma what is the most common cause of subarachnoid hemorrhage?
Berry Aneurysm
What in the CSF on lumbar puncture can indicated subarachnoid hemorrhage?
Xanthochromia from breakdown of RBCs
