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Neurology > CEREBROVASCULAR DISEASE > Flashcards

CEREBROVASCULAR DISEASE Flashcards

1
Q

What is a stroke?

A

The sudden or rapid onset of a neurologic deficit in the distribution of a vascular territory lasting >24 hours

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2
Q

What is a TIA?

A

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

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3
Q

What if imaging shows a reversible ischemic insult to the brain cells that recover?

A

Still considered a TIA; now at higher risk for subsequent stroke/TIA’s

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4
Q

What is different about a stroke vs. a TIA?

A

A stroke causes irreversible damage

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5
Q

What is it known as when stroke signs and symptoms progressive over time?

A

Stroke-in-evolution

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6
Q

Who is at an increased risk for a stroke?

A

Men > Women; African Americans; Hypertension; Smokers; Atherosclerosis elsewhere; Afib; OCP’s alcoholics, and hyperlipidemia

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7
Q

What are the 4 main etiologies for a stroke?

A

Atherosclerosis, Lacunar infarcts, cerebral emboli, and cardioembolism

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8
Q

What type of vessels does atherosclerosis effect? How often does it cause an ischemic stroke?

A

Large vessels (carotid bifurcation or origin of internal carotid, external carotid, and vertebral/basilar arteries)

Involved in 50% of ischemic strokes

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9
Q

What type of vessels does lacunar infarcts effect? What are the risk factors & how do they present?

A 
Small vessel (deep penetrating arterioles occlude/thrombose
Risk factors = HTN, lipids, DM
Often without SxS
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10
Q

What type of vessels do cerebral emboli effect?

A

Medium sized vessels – MCA and ACA

Usually a cardiac emboli from the heart (or artery) to the brain

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11
Q

What would cause a cardioembolism?

A

Atrial fibrillation, MI, or cardiomyopathy

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12
Q

When we prescribe someone with an anticoagulant, what are we mainly preventing?

A

A Cardioembolism due to Afib

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13
Q

What are the symptoms we look for in a stroke?

A

ABRUPT onset with focal deficits – aphasia, weakness, visual field changes

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14
Q

What artery is most commonly effected? How does a patient present?

A

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

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15
Q

How would symptoms present if the superior division of the MCA was occluded vs. the inferior division?

A

Superior = Broca’s (expressive) aphasia [broken words – can’t produce language]

Inferior = Wernicke’s aphasia [Can’t understand language – only random words come out]

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16
Q

How would symptoms present if the occlusion occurred in the distal Anterior Cerebral Artery?

A

Paralysis to opposite foot/leg
Incontinence
Grasp & Suck reflex are now present
Abulia (slow to respond/lack movement)
Impaired gait, behaviors, and memory

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17
Q

What would symptoms be if there was an occlusion in the vertebral artery?

A

None if their Circle of Wills is intact

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18
Q

What if the patient had an occlusion in both the vertebral & basilar arteries?

A

Cerebellar dysfunction

Total occlusion = pinpoint pupils & flaccid quadriplegia

Partial Occlusion = vertigo, ataxia, diplopia, contralateral weakness

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19
Q

What if a patient presents with only mild contralateral motor/sensory loss?

A

Lacunar stroke

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20
Q

What if a patient has monocular blindness, what is it known as? Where is the emboli?

A

Amaurosis Fugax

In the ophthalmic artery

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21
Q

How do we always start our stroke evaluations?

A

History – precise onset

PE = a detailed neuro exam

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22
Q

What if the patient you suspect has a stroke and their BP is 188/95?

A

DO NOT LOWER IT!!! Unless it’s over 200

23
Q

What labs do you order when you suspect a stroke?

A

CBC, platelet, glucose, INR, PTT, ESR, Lipids, BUN/Cr

EKG

24
Q

What diagnostic test do you get and why?

A

FIRST: CT to R/O HEMORRHAGE!!

SECOND: Arteriography (invasive but GOLD STANDARD)
MRA is good instead of arteriography but only for large vessels.

25
Q

When would you do an ultrasound for a stroke patient?

A

To screen and evaluate the common carotid

26
Q

How do we prevent a stroke?

A

Control = BP, lipids, DM, smoking cessation, exercise, diet

Full anticoag for Afib

27
Q

If onset of symptoms is less than 3 hours, how do we treat?

A

TPA

28
Q

What are the risks of a TPA?

A

Cerebral hemorrhage (which half can then die)

29
Q

When can we not use Heparin?

A

Recent bleeding, prior stroke, BP >185/110, seizure, neoplasm, and heparin within 48 hours,

30
Q

So when would we fully anticoagulated a patient?

A

Embolism from the heart

31
Q

How do we fully anticoagulate someone?

A

Heparin (or LMWH) + Warfarin

32
Q

What are the most likely causes for a TIA?

A

Embolic from carotid stenosis or plaque (listen for a bruit) or Embolism from cardiac source

33
Q

What are the symptoms of a TIA?

A

Contralateral hand/arm weakness, sensory loss, diplopia, ataxia, vertigo, CN palsies

34
Q

What is different about a TIA?

A

Symptoms only occur with episodes, exam is completely normal in between = no infarct!

35
Q

If a patient has a TIA, what must we warn them about?

A

They will most likely have a stroke within 5 years

36
Q

How can we treat a TIA?

A

Carotid endarterectomy to remove plaque if >70% stenosis

Carotid angioplasty/stenting (possible, need more data)

If LESS than 70% and not surgery candidate = Anti-platelet

37
Q

What is anti-platelet therapy?

A

Start when TIA is not cardiogenic; use Aspirin (up to 325mg/day) OR Clopidogrel

38
Q

How does a patient’s CT scan look with a lacunar infarct?

A

Small punched out hypodense areas

39
Q

How would we treat a patient with a lacunar infarct?

A

ASA + aggressive treatment of BP & lipids

40
Q

What are the main types of hemorrhagic strokes?

A

Intracerebral or Subarachnoid

41
Q

How do we diagnose a bleed?

A

CT scan, then a spinal tap to r/o SAH (looking for xanthochromia)

42
Q

If a patient presents with HA, vomiting, and rapid onset of hemiparesis (weakness), hemiplegia (paralysis), or hemisensory – what diagnosis?

A

Intracerebral hemorrhage

43
Q

What is an intracerebral hemorrhage?

A

Rupture of small arteries or microaneurysms

44
Q

What are the risk factors for an intracerebral hemorrhage?

A

HTN!, bleeding disorders, and trauma

45
Q

How do you treat a patient with an intracerebral hemorrhage?

A

Surgical decompression, VP shunt, elevate the head

46
Q

If a patient presents with a severe HA, like the worst of their life, with N&V, and some LOC, what diagnosis?

A

Subarachnoid bleed

47
Q

What causes a subarachnoid bleed?

A

Saccular (berry) aneurysm in the ACA

48
Q

How big does a saccular aneurysm need to put the patient at an increased risk?

A

> 6mm

49
Q

What PE findings might you see in someone with a SAH

A

+ kernig’s & Brudzinski

50
Q

How do you treat a SAH in a conscious vs. unconscious patient?

A

Conscious = bed rest & symptomatic then angiography when stable
Unconscious = Surgery

51
Q

What is the most common malformation in the CNS, often involving the middle cerebral artery?

A

Arterial Venous Malformation (AVM)

52
Q

How does someone develop an AVM?

A

Congenital

53
Q

What are the symptoms that may point us in the direction of an AVM?

A

Hemorrhage, HA, recurrent seizures, focal deficits

54
Q

How do you treat AVM?

A

CT & Angiography to confirm; surgery to treat

Neurology (11 decks)

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