Cerebrovascular Disease Flashcards
What are the risk factors for CVD?
Non modifiable
Increasing age
Heredity
Modifiable
Hypertension Heart disease Diabetes Hyperviscosity COCP Smoking Dyslipidemia Diet and obesity
What are the important questions in CVD?
What is the anatomical site
What is the pathology
What is the mechanism
What is the aetiology
What are the risk factors
What are the common etiology of stroke?
THROMBOTIC
Atherosclerosis
Lipohyalinosis
CTD Vasculitis
EMBOLIC
Cardiac (Atheromas, myxoma, AF, VHD)
Arterial dissection
ICH Chronic untreated hypertension Trauma Anticoagulant therapy Bleeding diathesis Lipohyalinosis
What is a stroke?
A focal
Neurological deficit
Of sudden onset
Lasting > 24 hours
Caused by compromise of cerebral circulation
What is a TIA?
A focal
Neurological deficit
Of sudden onset
Lasting < 24 hours
With complete clinical recovery
Caused by focal hypoperfusion of the brain
What are the DDx for TIA/stroke?
Hypoglycemia
SOL
BPPV
Epilepsy post ictal state
Migraine
Multiple sclerosis
Transient global amnesia
What are the pathologies Of stroke?
Infarction (80%)
ICH (15%)
SAH (5%)
Cerebral venous sinus thrombosis
What are the good prognosis factors?
Infarction better than ICH
Embolic better than thrombotic infarction
Consciousness at presentation
Younger age
Small area of damage
Female sex
What is the cerebral vascular anatomy?
Anterior circulation
Posterior circulation
2x ICA
1x Basilar artery (2x vertebral)
Circle of Willis
Anterior
Middle
Posterior cerebral arteries
What are the pathological features of infarction stroke?
Thromboembolic phenomena
Middle cerebral artery common due to in -line branching from ICA
Can be non haemorrhagic or haemorrhagic infarction
MACROSCOPIC
6 hours - no change
48 hours - pale, soft and swollen
2 to 10 days - gelatinous and friable, clear boundary
3 weeks - liquefactive necrotic fluid filled cavity
MICROSCOPIC
12 hours - red neurons, cytotoxic and vasogenic edema, swelling of glia
48 hours - neutrophil infiltration
2-3 weeks - monocytes infiltration
What is the pathophysiology of TIA/ stroke?
Haemodynamic compromise or embolism
Reduction of cerebral blood flow < 20 mL/ 100g / min
Critical duration and magnitude of reduction
Metabolic O2 - glucose demand supply mismatch
Electrical failure
Ion pump failure
K+ efflux, Na+ influx, Ca2+ influx
Phopholipase- COX activation
Prostaglandins and Lactic acidosis
Neuronal damage
How do you differentiate anterior circulation from posterior circulation stroke?
Anterior Hemiparesis Hemisensory Dysphasia Amarousis fugax
Posterior Loss of consciousness Paraplegia Paraparesis Binocular blindness Vertigo tinnitus diplopia dysarthria
What are the contraindications for thrombolysis?
Beyond 3 hours of onset
Spontaneous recovery
Head injury or stroke within last 3 months
Surgery within last 3 weeks
BP > 180/110
On anticoagulant
Seizures
