Cerebrovascular Disease Flashcards
What do Ischemia or hemorrhage manifest as?
FOCAL neurological deficits related to specific vascular territories (some migraines may mimic cerebrovascular disease)
TIAs
sudden, focal neurological deficits which completely resolve within 24 hrs
Stroke
sudden, focal neurological deficit which does not completely resolve within 24 hours but may variably improve over several weeks to months
Where do atherosclerotic changes predominate?
What are the two main mechanisms of ischemic infarction?
bifurcation points of major cervical and intracranial arteries
- arterial thrombosis of an atheroma (pale)
- embolic arterial occlusion from proximal sources (hemorrhagic)
What do the perforator or lenticulostriate arteries supply
deeper structures with significant functions, such as the basal ganglia, internal capsule, thalamus and corona radiata
Amaurosis fugax
monocular blindness
carotid territory TIA
involving the ophthalmic artery or its retinal branches
-patient describes lowered dark shade in one eye
Other carotid TIAs may cause what?
Hemiparesis or aphasia
Vertebrobasilar territory TIAS cuase
ischemia of the brainstem, cerebellum, visual cortex producing symptoms of ataxia, homonymous hemianopsia, or hemiparesis associated with crossed brainstem syndromes
lacunar infarcts in the in the thalamus may cause?
pure sensory stroke
lacunar Infarcts in the internal capsule, corona radiata, or basilar pons cause?
pure motor hemiplegia, ataxic-hemiparesis, and clumsy hand dysarthria
what can hypercoagulable states cause occlusions of?
- large and small arteries
2. cortical veins
what can hypercoaguable states cuase occlusions of?
- large and small arteries
2. cortical veins
What do symptomatic atheromatous lesions of 70-99% stenosis at the origin of the internal artery benefit from?
carotid endarterectomy
-surgically removal of this lesion
(complete 100% stenotic lesion precludes any surgery since its thrombotic occlusion extends from the neck to the base of the skull)
What drugs help reduce the risk of stroke?
- warfarin-large artery occlusion (carotid endarterectomy or interventional procedures)
- antiplatelet-small artery occlusion
- statin drugs
What drugs help reduce the risk of stroke?
- warfarin
- antiplatelet
- statin drugs
If a patient with a recent cerebral infarction develops impaired consciousness in absence of hypoglycemia, what must be considered?
increased intracranial pressure
-edema (within 3-5 days) or hemorrhagic transformation of an initially ischemic infarct
- ->hyperventilate to reduce intracranial pressure (vasoconstriction)
- ->intravenous mannitol-osmotic diuretic
How does a hemorrhagic stroke present?
- severe headache
- impairment or LOC
- focal neurological deficit
How does a hemorrhagic stroke present?
- severe headache
- impairment or LOC
- focal neurological deficit
What does a deeply located hemorrhage suggest was the cuase
hypertension
WHat does a superficial hemorrhages at the poles of the frontal, temporal , or occipital lobe often occur from
head trauma
What is the most common cause of cerebral hemorrhage?
hypertension
-weakened walls of lenticulostriate arteries rupture bleeding into the striatum and thalamus
also caused by:
- trauma
- warfarin
- bleeding disorder
- cocaine
- cerebral amyloid angiopathy
- AVM -arteriovenous malformations
- within brain tumors or ischemic infarcts
What is the most common cause of cerebral hemorrhage?
hypertension
-weakend walls of lenticulostriate arteries rupture bleeding into the striatum and thalamus
What is the common cause of subarachnoid hemorrhage? What about in the absence of that?
trauma #1
in absence of trauma-ruptured congenital berry aneurysm
What is a sentinel headache?
warning leaks from mild to moderate bleeding
What does xanthochromia of the CSF indicate?
breakdown of blood within the CSF prior to lumbar puncture-from subarachnoid blood
What does xanthochromia of the CSF indicate?
breakdown of blood within the CSF prior to lumbar puncture-from SAH?
What are some ways to visualize the aneurysm?
- non contrast CT brain scan
2. Emergent angiography-optimal imaging to locate
What happens to the berry aneurysm one it is located?
clipped
What is postoperative cerebral spasm minimized by?
the triple H therapy
- hypertension
- hypervolemia
- hemodilution
