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clin med III, exam 3 > cerebrovascular disease > Flashcards

cerebrovascular disease Flashcards

1
Q

list risk factors for stroke

A
  • HTN
  • DM
  • smoking
  • dyslipidemia
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2
Q

a stroke occurs as a result of one of what two pathologic processes

A
  • ischemia
  • hemorrhage
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3
Q

what happens in an ischemic stroke

A
  • thrombosis: local in situ obstruction
  • embolism: debris originating elsewhere that block artery
  • systemic hypoperfusion
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4
Q

how might signs/symptoms of a ischemic stroke caused by hypoperfusion be different than one caused by a clot

A
  • symptoms of brain dysfunction diffuse
  • circulatory compromise -> tachycardia, kidney dysfunction
  • neurological signs are bilateral
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5
Q

What are watershed infarcts

A
  • occur at the border between cerebral vascular territories with no or little anastomosis
  • secondary to low flow states from hypotension
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6
Q

brain hemorrhage can either be or

A
  • intracerebral hemorrhage: bleeding directly into brain tissue
  • subarachnoid hemorrhage: bleeding into CSF
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7
Q

two types of large vessel strokes

A
  • anterior circulation (carotid artery supply)
  • posterior circulation (vertebrobasilar system)
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8
Q

anterior circulation (carotid artery supply) involves what main branches

A
  • middle cerebral arteries
  • anterior cerebral arteries
    • anterior communicating artery
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9
Q

Posterior circulation involves what main branches

A
  • vertebral arteries
  • basilar artery
  • posterior cerebral arteries
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10
Q

most common CVA involes what artery

A

middle cerebral artery

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11
Q

clinical presentation

  • contralateral hemiplegia/hemianaesthesia (weakness/numbness) affecting face and arm greater than leg
A

stroke in middle cerebral artery

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12
Q

if dominant hemisphere is affected in stroke in middle cerebral artery, what will patient often present with

A

global aphasia

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13
Q

if nondominant hemisphere is affected in stroke in middle cerebral artery, what will patient often present with

A

hemineglect

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14
Q

clinical presentation

  • contralateral weakness and loss of sensation in the leg greater than arm
  • abulia: delay in verbal and motor response or perseverating speech (repeating questions)
A

stroke in the anterior cerebral artery

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15
Q

clinical presentation

  • impingement of cranial nerves
  • visual field deficits
A
  • anterior communicating artery
    • most common circle of willis aneursym
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16
Q

clinical presentation

  • contralateral homonymous hemianopia: blindness over half the field of vision
  • light touch and pinprink sensation reduced
A
  • posterior cerebral artery stroke
    • affects occipital cortex
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17
Q

wallenberg syndrome

A
  • patient has a constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain
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18
Q

lateral medulla recieves blood supply from

A

posterior inferior cerebellar artery (PICA)

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19
Q

clinical presentation

  • ipsilateral loss of facial pain and temperature sensation with contralateral loss of these senses over the body
  • vertigo, vomiting, ipsilateral ataxia, nystagmus, dysarthria, ipsilateral horner’s syndrome
A
  • stroke in posterior inferior cerebellar artery (PICA)
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20
Q

clinical presentation

  • “locked-in syndrome”
  • preserved consciousness
  • quadriplegia and facial weakness
  • lateral gaze weakness
A
  • stroke in basilar artery
    • affects pons
21
Q

What are lacunar strokes and what symptoms are they associated with

A
  • small vessel strokes
  • associated with chronic HTN
  • pure motor OR pure sensory
22
Q

why are you concerned about needing to intubate a stroke patient

A
  • Increased ICP -> decreased respiratory drive
  • decreased level of consciousness
23
Q

why does mean arterial pressure (MAP) usually elevate in a stroke

A
  • an appropriate response to maintain brain perfusion
24
Q

When should a high BP in a patient with an ischemic stroke be treated

A
  • do not start treating until BP > 220/120
    • ​*exception: treating with thrombolytics
25
Q

When should a high BP in a patient with a hemorrhagic stroke be treated

A
  • keep BP < 160/90
    • ​don’t want too low (<140) or else cause ischemia in other areas
    • antihypertensive: nicardipine drip commonly used
26
Q

first diagnostic test in the assessment of a stroke

A
  • noncontrast CT scan of brain
27
Q

Noncontrast CT brain results in hemorrhagic vs ischemic stroke

A
  • hemorrhagic: CT will show blood
  • ischemic: CT may be normal; ischemia takes a certain length of time to be evident on CT
28
Q

what situations are likely to cause a “normal” noncontrast CT in an ischemic stroke

A
  • symptoms present < 6 hours
  • affected area small
  • located in area of brain not well seen on CT

diagnosis of stroke in this situation is clinical

29
Q

What is the only antiplatelet that is effective for the early treatment of acute ischemic stroke? When should it be given?

A
  • Aspirin
  • if brain CT shows no bleed, full dose ASA should be given within 48 hours
30
Q

which antiplatelet medications are acceptable for secondary stroke prevention

A
  • aspirin
  • clopidogrel (plavix)
31
Q

desired blood pressure in patients with ischemic stroke who are recieving tPA

A
  • BP <185/110
32
Q

tPA can be used for acute ischemic stroke in what time period

A
  • < 3-4.5 hours
    • CT scan of brain must be normal
33
Q

Therapy for hemorrhagic CVA

A
  • anticoagulant (warfarin) and antiplatelet (Asa) drugs discontinued immediately
  • anticoagulant effects reveresed immediately
    • FFP, vit K and prothrombic complex concentrates (PCC)
  • lower ICP
34
Q

what are some methods to lower ICP in hemorrhagic CVA

A
  • elevated head on bed to 30 deg
  • analgesia, sedation
  • osmotic diuretics: mannitol
  • neuromuscular blockade
  • hyperventilation (short term)
35
Q

any brain hemorrhage warrants immediate consult with

A

neurosurgery

36
Q

secondary prevention of ischemic CVA

A
  • antiplatelets
  • warfarin in AFIB or prosthetic heart valve
37
Q

define transient ischemic attack (TIA)

A
  • transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction
38
Q

why are TIAs concerning

A
  • relatively brief ischemia can cause permanent brain injury
  • stroke risk in first two days after TIA is 4-10%
39
Q

TIA-stroke prevention includes what

A
  • daily asa therapy
  • EKG: r/o afib
  • carotid US
  • lipid lowering med
  • antihypertensive med
  • diet/lifestyle modification
40
Q

if patient who is on daily ASA still suffers a TIA, then what might possibly be added to treatment regimen

A
  • clopidogrel (plavix)
41
Q

stepwise approach to patient with high risk headache

A
  1. noncontrast brain CT
  2. lumbar puncture
    • look for RBCs -> SAH
42
Q

clinical presentation

  • “worst headache of my life”
  • “thunderclap” HA
A
  • subarachnoid hemorrhage
43
Q

most subarachnoid hemorrhage are caused by

A
  • ruptured saccular aneurysms
  • trauma
44
Q

number 1 risk factor for subarachnoid hemorrhage

A

smoking

45
Q

what is the leading cause of death and disability after an aneurysm rupture

A
  • vasospasm
    • aneurysm bleeds a little and surrounding vessels that supply that vessel clamp down to decrease amount of blood sent there -> ischemia
46
Q

champagne tap

A

defined as zero RBCs in the first and last tubes

47
Q

how can you differentiate between SAH and a traumatic tap

A
  • traumatic tap
    • RBC #s decrease from 1st tube - 4th tube
  • SAH:
    • RBC #s stay the same
    • xanthochromia (pink or yellow tint): most sensitive indicator
48
Q

what medication is used to prevent vasospasm after SAH

A
  • nimodipine
49
Q

management of SAH

A
  • ICU
  • nimodipine: prevent vasospasm
  • stop blood thinners
  • sz prophylaxis
  • surgery: clipping or coiling

clin med III, exam 3 (6 decks)

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