CEREBROVASCULAR DISEASE Flashcards
What is a stroke?
The sudden or rapid onset of a neurologic deficit in the distribution of a vascular territory lasting >24 hours
What is a TIA?
The sudden or rapid onset of a neurologic deficit in the distribution of a vascular territory lasting less than 24 hours.
Most last less than 30 minutes
What if imaging shows a reversible ischemic insult to the brain cells that recover?
Still considered a TIA; now at higher risk for subsequent stroke/TIA’s
What is different about a stroke vs. a TIA?
A stroke causes irreversible damage
What is it known as when stroke signs and symptoms progressive over time?
Stroke-in-evolution
Who is at an increased risk for a stroke?
Men > Women; African Americans; Hypertension; Smokers; Atherosclerosis elsewhere; Afib; OCP’s alcoholics, and hyperlipidemia
What are the 4 main etiologies for a stroke?
Atherosclerosis, Lacunar infarcts, cerebral emboli, and cardioembolism
What type of vessels does atherosclerosis effect? How often does it cause an ischemic stroke?
Large vessels (carotid bifurcation or origin of internal carotid, external carotid, and vertebral/basilar arteries)
Involved in 50% of ischemic strokes
What type of vessels does lacunar infarcts effect? What are the risk factors & how do they present?
Small vessel (deep penetrating arterioles occlude/thrombose Risk factors = HTN, lipids, DM Often without SxS
What type of vessels do cerebral emboli effect?
Medium sized vessels – MCA and ACA
Usually a cardiac emboli from the heart (or artery) to the brain
What would cause a cardioembolism?
Atrial fibrillation, MI, or cardiomyopathy
When we prescribe someone with an anticoagulant, what are we mainly preventing?
A Cardioembolism due to Afib
What are the symptoms we look for in a stroke?
ABRUPT onset with focal deficits – aphasia, weakness, visual field changes
What artery is most commonly effected? How does a patient present?
Middle Cerebral Artery
Contralateral hemiplegia (arm/face more common) or hemisensory loss
Hemianopsia – visual field deficit
If dominant hemisphere = global aphasia
Non-dominant hemisphere = speech & comprehension preserved, possible anosognosia
How would symptoms present if the superior division of the MCA was occluded vs. the inferior division?
Superior = Broca’s (expressive) aphasia [broken words – can’t produce language]
Inferior = Wernicke’s aphasia [Can’t understand language – only random words come out]
How would symptoms present if the occlusion occurred in the distal Anterior Cerebral Artery?
Paralysis to opposite foot/leg
Incontinence
Grasp & Suck reflex are now present
Abulia (slow to respond/lack movement)
Impaired gait, behaviors, and memory
What would symptoms be if there was an occlusion in the vertebral artery?
None if their Circle of Wills is intact
What if the patient had an occlusion in both the vertebral & basilar arteries?
Cerebellar dysfunction
Total occlusion = pinpoint pupils & flaccid quadriplegia
Partial Occlusion = vertigo, ataxia, diplopia, contralateral weakness
What if a patient presents with only mild contralateral motor/sensory loss?
Lacunar stroke
What if a patient has monocular blindness, what is it known as? Where is the emboli?
Amaurosis Fugax
In the ophthalmic artery
How do we always start our stroke evaluations?
History – precise onset
PE = a detailed neuro exam
What if the patient you suspect has a stroke and their BP is 188/95?
DO NOT LOWER IT!!! Unless it’s over 200
What labs do you order when you suspect a stroke?
CBC, platelet, glucose, INR, PTT, ESR, Lipids, BUN/Cr
EKG
What diagnostic test do you get and why?
FIRST: CT to R/O HEMORRHAGE!!
SECOND: Arteriography (invasive but GOLD STANDARD)
MRA is good instead of arteriography but only for large vessels.
