Cerebrovascular Disease

Question 1

What do Ischemia or hemorrhage manifest as?

Answer 1

FOCAL neurological deficits related to specific vascular territories (some migraines may mimic cerebrovascular disease)

Question 2

TIAs

Answer 2

sudden, focal neurological deficits which completely resolve within 24 hrs

Question 3

Stroke

Answer 3

sudden, focal neurological deficit which does not completely resolve within 24 hours but may variably improve over several weeks to months

Question 4

Where do atherosclerotic changes predominate?

What are the two main mechanisms of ischemic infarction?

Answer 4

bifurcation points of major cervical and intracranial arteries

1. arterial thrombosis of an atheroma (pale)
2. embolic arterial occlusion from proximal sources (hemorrhagic)

Question 5

What do the perforator or lenticulostriate arteries supply

Answer 5

deeper structures with significant functions, such as the basal ganglia, internal capsule, thalamus and corona radiata

Question 6

Amaurosis fugax

monocular blindness

Answer 6

carotid territory TIA
involving the ophthalmic artery or its retinal branches
-patient describes lowered dark shade in one eye

Question 7

Other carotid TIAs may cause what?

Answer 7

Hemiparesis or aphasia

Question 8

Vertebrobasilar territory TIAS cuase

Answer 8

ischemia of the brainstem, cerebellum, visual cortex producing symptoms of ataxia, homonymous hemianopsia, or hemiparesis associated with crossed brainstem syndromes

Question 9

lacunar infarcts in the in the thalamus may cause?

Answer 9

pure sensory stroke

Question 10

lacunar Infarcts in the internal capsule, corona radiata, or basilar pons cause?

Answer 10

pure motor hemiplegia, ataxic-hemiparesis, and clumsy hand dysarthria

Question 11

what can hypercoagulable states cause occlusions of?

Answer 11

1. large and small arteries

2. cortical veins

Question 12

what can hypercoaguable states cuase occlusions of?

Answer 12

1. large and small arteries

2. cortical veins

Question 13

What do symptomatic atheromatous lesions of 70-99% stenosis at the origin of the internal artery benefit from?

Answer 13

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)

Question 14

What drugs help reduce the risk of stroke?

Answer 14

1. warfarin-large artery occlusion (carotid endarterectomy or interventional procedures)
2. antiplatelet-small artery occlusion
3. statin drugs

Question 15

What drugs help reduce the risk of stroke?

Answer 15

1. warfarin
2. antiplatelet
3. statin drugs

Question 16

If a patient with a recent cerebral infarction develops impaired consciousness in absence of hypoglycemia, what must be considered?

Answer 16

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

Question 17

How does a hemorrhagic stroke present?

Answer 17

1. severe headache
2. impairment or LOC
3. focal neurological deficit

Question 18

How does a hemorrhagic stroke present?

Answer 18

1. severe headache
2. impairment or LOC
3. focal neurological deficit

Question 19

What does a deeply located hemorrhage suggest was the cuase

Answer 19

hypertension

Question 20

WHat does a superficial hemorrhages at the poles of the frontal, temporal , or occipital lobe often occur from

Answer 20

head trauma

Question 21

What is the most common cause of cerebral hemorrhage?

Answer 21

hypertension
-weakened walls of lenticulostriate arteries rupture bleeding into the striatum and thalamus

also caused by:

1. trauma
2. warfarin
3. bleeding disorder
4. cocaine
5. cerebral amyloid angiopathy
6. AVM -arteriovenous malformations
7. within brain tumors or ischemic infarcts

Question 22

What is the most common cause of cerebral hemorrhage?

Answer 22

hypertension

-weakend walls of lenticulostriate arteries rupture bleeding into the striatum and thalamus

Question 23

What is the common cause of subarachnoid hemorrhage? What about in the absence of that?

Answer 23

trauma #1

in absence of trauma-ruptured congenital berry aneurysm

Question 24

What is a sentinel headache?

Answer 24

warning leaks from mild to moderate bleeding

Question 25

What does xanthochromia of the CSF indicate?

Answer 25

breakdown of blood within the CSF prior to lumbar puncture-from subarachnoid blood

Question 26

What does xanthochromia of the CSF indicate?

Answer 26

breakdown of blood within the CSF prior to lumbar puncture-from SAH?

Question 27

What are some ways to visualize the aneurysm?

Answer 27

1. non contrast CT brain scan

2. Emergent angiography-optimal imaging to locate

Question 28

What happens to the berry aneurysm one it is located?

Answer 28

clipped

Question 29

What is postoperative cerebral spasm minimized by?

Answer 29

the triple H therapy

1. hypertension
2. hypervolemia
3. hemodilution