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Neuro > Cerebrovascular disease > Flashcards

Cerebrovascular disease Flashcards

1
Q

define a transient Ischemic attack

A

sudden, focal neurological deficits which completely resolve within 24 hours

are a serious warning of stroke risk

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2
Q

what is the most common cause of a stroke

A

ischemic infarction

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3
Q

what are stroke risk factors

A

atherosclerosis risk factors - hypertension, heart disease, diabetes, smoking, hyperlipidemia and a family history of vascular heart disease

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4
Q

where do atherosclerotic changes predominate

A

at the bifurcation points of large major cervical and intracranial arteries (more turbulent flow)

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5
Q

what are the 2 mechanisms of ischemic infarction

A
  1. local arterial thrombosis of an atheroma

2. embolic arterial occlusions from a proximal source

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6
Q

what is the most important factor in determining whether a patient is able to create collateral blood flow

A

a complete circle of willis

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7
Q

describe how a patient may have an asymptomatic occlusion of a cervical internal carotid artery

A

if a thrombosis is formed gradually, other arteries may detour blood flow to the potentially ischemic areas of the brain

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8
Q

how does a large artery infarction appear pathologically

A

the cerebral cortex will appear soft and swollen with less distinction of the gray-white matter junction and spotty hyperemia

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9
Q

microscopically 12-36 hours after a stroke how does the brain appear

A

ischemic neurons shrink and appear eosinophilic (“pink neurons”)

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10
Q

what is seen microscopically days after a stroke

A

macrophages scavenge necrotic debris and cyst formation occurs with astrocytes at the periphery of the infarction

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11
Q

what causes lacunar infarcts

A

thrombosis (not emboli)

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12
Q

what is a lacunar infarct

A

a small lesion of a perforator or lenticulostriate artery which are small branches from larger arteries that supply the deep structures of the brain

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13
Q

why are lacunar infarcts significant

A

they typically occur in the basal ganglia, internal capsule, thalamus and corona radiata- areas with complex and important functions so even a couple mm lesion can cause serious neurological deficits

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14
Q

what is amaurosis fugax

A

monocular blindness - one type of carotid territory TIA . Pt describes a lowered dark shade in one eye which gradually lightens up

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15
Q

what types of symptoms do vertebrobasilar territory TIAs cause

A

ataxia, homonymous hemianopsia, or hemiparesis associated with crossed brainstem syndromes

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16
Q

vertebrobasilar territory TIAs cause ischemia of what areas

A

brain stem. cerebellum, visual (occipital) cortex

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17
Q

carotid TIAs produce symptoms of

A

hemispheral ischemia leading to hemiparesis or aphasia

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18
Q

where does a hemiparesis with greater weakness of the face and upper limb suggest the location is

A

the precentral middle cerebral artery territory

19
Q

where does a hemiparesis with great weakness of the lower limb suggest the location is

A

precentral anterior cerebral artery territory

20
Q

where does sensory deficits limited to the face and upper limb suggest the infarct is

A

postcentral MCA

21
Q

where does sensory deficits limited to the lower limb suggest an infarct is located

A

postcentral ACA

22
Q

what kind of stroke is suggested by pure motor hemiplegia, ataxic-hemiparesis and clumsy hand-dysarthria

A

a lacunar stroke of the internal capsule, corona radiata or basilar pons

23
Q

a pure sensory stroke is indicated of what type of stroke

A

a lacunar syndrome from a small vessel occlusion involving the thalamus

24
Q

what is an atheroma

A

(arterial plaques) form from subintimal lipid deposition, smooth muscle proliferation & fibrosis.

25
Q

how do atheromas lead to stroke

A

Bulging atheromas or plaques can narrow or occlude the arterial lumen (thrombosis), or ulcerate and travel downstream (embolize).

26
Q

what are possible cardiac sources of an embolis

A

MI
A. fib
valvular lesion
R to L shunt (patent forman ovale)

27
Q

what are some hypercoaguable states that may contributed to a stroke

A

sickle cell anemia, polycythemia vera, vasoactive recreational drugs (cocaine)

28
Q

what other pathologies must be ruled out when a stroke is suspected

A

atypical presentation of tumor, hemorrhage, abscess, or encephalitis

29
Q

what is used to confirm the diagnosis of a stroke

A

MRI (CT is second best)

30
Q

should a source of embolism be looked for in a lacunar stroke

A

no - it is unlikely that an embolism would cause a lacunar stroke. they are typically thrombotic

31
Q

what is a carotid endarterectomy

A

the surgical removal of an atheromatous lesion

32
Q

when should a carotid endarterectomy be done

A

in patients with symptomatic lesions of 70-99% blockage at the origin of the internal carotid artery

33
Q

if carotid endarterectomy is not option what other treatments are available

A

stenting and angioplasty

34
Q

within what time frame should tPA be adminstered

A

within 3 hours of stroke onset

35
Q

what are the symptoms of a cerebral hemorrhage

A

severe headache, early impairment of consciousness (atypical for infarction)

36
Q

what is the cause of death in a severe hemorrhage

A

shifting or herniation of the brain

37
Q

what is the best imaging to identify a bleed

A

CT - blood is white

38
Q

what is the most common cause of cerebral hemorrhage

A

Hypertension

weakened walls of small, penetrating arterioles rupture. Typical bleeding sites: basal ganglia and thalamus

39
Q

what are causes of cerebral hemorrhage

A

hypertension
head trauma
rupture of congenitally abnormal blood vessels
bleeding within an ischemic infarction or tumor
systemic bleeding gidsorders
illicit drugs (via hypertension)
cerebral amyloid angiopathy (elderly patients)

40
Q

what’s the most common cause of a subarchnoid hemorrhage (SAH)

A

trauma

41
Q

what is a berry aneurysm

A
  • thinned out pouchings at intracranial arterial bifurcations
  • may enlarge over time with increased risk of rupture
42
Q

what is the most common location for a Berry aneurysm

A

the anterior circle of willis

43
Q

what is berry aneurysm syndromes

A
  • asymptomatic
  • warning leak - worst head of my life w/ meningeal signs
  • mass effect (CN III palsy)
  • massive, fatal SAH
44
Q

how would you evaluate symptomatic berry aneurysms

A
  • CT brain scan
  • lumbar puncture (if CT is normal to verify SAH)
  • cerebral angiogram
  • emergent clipping or endovascular coiling of aneurysm

Neuro (11 decks)

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