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Neurologic Conditions > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

What are the sx for Asx Carotid Bruit?

A

No sx

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2
Q

Who gets Asx Carotid Bruits?

A

4% of pts >40yo

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3
Q

Carotid bruit are more ominous in ______.

A

Pt w/ vascular RF

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4
Q

Where can carotid bruit be heard BEST at?

A

Immediately under the angle of the mandible

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5
Q

Where can asx carotid bruits be heard?

A

Internal, common or external carotid

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6
Q

What are high pitched asx carotid bruits assoc w/?

A

Higher grade stenosis

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7
Q

What are the technical features of asx carotid bruit?

A
  • Carotid doppler US
  • Magnetic resonance agniography (MRA)
  • CT arterigoraphy
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8
Q

What are Bruits?

A

Turbulent BF through area of lumen narrowing

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9
Q

Where is turbulence greatest?

A

Arterial bifurcations

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10
Q

What are the MCC of bruits?

A

Atherosclerosis & Plaque formation

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11
Q

What is the management of asx carotid bruit?

A

Aggressive management of vascular RF, as aggressive as if the pt had incurred a stroke or heart attack

When bruit becomes sx the risk

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12
Q

If a bruit is heard best near the clavicle what does that mean?

A

Probably referred cardiac murmur

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13
Q

What is the significance of a sx bruit?

A
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14
Q

What is the risk of a stroke in a pt w/ an asx bruit?

A

<2%/year

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15
Q

What are the RF for strokes?

A
  • HTN***
  • DM
  • Hyperlipidemia
  • Alcohol
  • Smoking
  • Vasculitis
  • Carotid bruit
  • Embolic cardio d/o
  • Berry aneurysm
  • AVM
  • Coagulopathy
  • Anticarolipid Ab
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16
Q

What is a Transient Ischemic Attack (TIA)?

A

Focal neurological deficit is caused by reduced BF

Resolves completely w/in 24 hours

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17
Q

What is a Reversible Ischemic Neurologic Deficit (RIND)?

A

Same as TIA except lasts >24 hours & completely resolves w/in 2 weeks

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18
Q

Vascular causes of TIA happen in pt w/ ___.

A

Vascular RF

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19
Q

Non-vascular causes of TIA happen in pt w/ ____.

A
  • Partial or focal seizures
  • Migraine auras
  • an MS attack may be as breif as a couple of days
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20
Q

What are the PE findings of TIA/RIND?

A
  • During attack physical findings indicates stroke
  • May have carotid bruit or A-fib
  • Normal neuro exam
  • HTN is common
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21
Q

What is used to dx a TIA/RIND?

A

Clinical dx not technological exam

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22
Q

What are the technolgical features of TIA/RIND?

A
  • No imaging ABN
  • May be carotid stenosis Carotid doppler US or A-fib on ECG
  • ABN labs indicate RF
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23
Q

What is the prognosis of untx TIA?

A
  • 10% stroke in 6 mo
  • 6% stroke in 2yr
  • 13% sroke & die by 1yr
  • 23% die by 2nd yr
  • 33% die by 3rd yr
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24
Q

What are the RF for Atherosclerosis?

A
  • HTN**
  • DM
  • Age
  • Smoking
  • Genetics
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25
Q

What is the greatest RF for stroke?

A

Previous stroke or TIA

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26
Q

What is the 2nd greatest RF for stroke?

A

Atrial Fibrillation

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27
Q

What are the signs of ischemia to the Internal carotid artery?

A
  • Contralateral weakness & numbness
  • Speech disturbances
  • Monocular ischemia to ipsilateral eye
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28
Q

What is Amerosis fugax?

A

Transient loss of vision in one eye→ “shade being pulled down”

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29
Q

What causes Amerosis fugax?

A

Internal carotid artery or Ophthalmic artery problem

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30
Q

What are the signs of ischemia to the ACA?

A

Motor & sensory sx in leg

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31
Q

What are the signs of ischemia to the MCA?

A
  • Arm & leg weakness
  • Sensory loss
  • Speech compromised if in dominant hemisphere
32
Q

What are the signs of ischemia to the PCA?

A

Hemiopsia or complete cortical blindness

(near calcarine fissure)

33
Q

What are the signs of ischemia to the Basilar artery?

A

Loss of consciousness OR CN dysfxn

(brainstem)

34
Q

What are the treatable RF for TIA/RIND?

A

HTN, hyperlipidemia & DM

35
Q

What are the guidelines that should be followed to dec the RF for stroke?

A
  • Smoking cessation
  • BP <120/80
  • LDL <70
  • Cholesterol <100
  • Antiplatelet tx (81mg/day apsirin)
36
Q

What is the tx for stenosis >70% in internal carotid artery?

A

Carotid endarterctomy

37
Q

If there is A-fib present the stroke pt should be on ____ therapy.

A

Anticoagulation

38
Q

If no A-fib present the stroke pt should be on _____ therapy.

A

Begin anti-platelet therapy

39
Q

What is the MCC of Ischemic stroke?

A

Atherosclerosis in 85% of cases

40
Q

What is the hx of a pt w/ ATH Ischemic stroke?

A
  • Preceding TIA’s
  • Vascular RF
  • CAD or peripheral artery dz
41
Q

What are the PE findings of ATH Ischemic stroke?

A
  • Focal neuro deficits
  • Not rapidly improving during the exam
42
Q

What is the imaging test of choice for ATH Ischemic stroke?

A

Brain CT scan w/o contrast if urgent medical care being considered

43
Q

What will a CT scan w/o contrast immediately reveal?

A

Hemorrhage or acute blood

44
Q

How long will it take for an ischemic infarct to be visualized on CT?

A

may take 24 hours or longer

45
Q

What are the pros & cons of Brain MRI for ATH Ischemic stroke?

A
  • More sensitive than CT at showing ischemic infarctions
  • Less sensitive at detecting acute hemorrhage
46
Q

After a pt is stabilized what tests should be run to see if hemodynamically significantly stenosis is present in a pt w/ an ATH ischemic stroke?

A

Carotid Doppler US or MRA of the carotid arteries

47
Q

What test should be run to rule out A-fib?

A

EKG

48
Q

What is the timing of Embolic strokes?

A

More acute than ATH strokes

49
Q

What is the tx for ATH Ischemic stroke?

A
  • tPA <3 hrs after onset of stroke
  • Bed elevated >30 degrees
  • Monitor vital signs & neuro findings
  • Cardiac monitoring
50
Q

What are the CI of tPA tx?

A
  • Hemorrhage on CT
  • Seizure activity @ stroke onset
  • Recent intracranial hemorrhage, trauma or surgery
  • Active bleeding or bleeding d/o
  • Coagulation ABN
  • Uncontrolled HTN
  • Rapidly improving
51
Q

What indicates a Coagulative ABN?

A
  • Heparin w/in 48 hours
  • Prolonged PT (INR)
  • <100k platelets
52
Q

What are the Cardioembolic RF?

A
  • A-fib
  • Previous subendocardial MI
  • Mechanical prosthetic cardiac valve
  • Patent foramen ovale
  • Atrial myxoma
53
Q

What are the PE findings of Cardioembolic Ischemic stroke?

A
  • Acute in onset
  • Focal neuro deficits
  • Not rapidly improving during exam
  • A-fib detected as “irregular irregularity” of heart rhythm
  • Murmurs on auscultation
54
Q

What are the technical features of Cardioembolic Ischemic stroke?

A
  • CT & MRI appearance of ischemic infarction
  • A-fib or prior anterior wall MI on EKG common
  • Heart murmurs MC
  • Cardiomegaly on X-ray MC
55
Q

Cardioembolic stroke is more likely to undergo ____ ____ w/in 72 hours.

A

Hemorrhagic transformation

56
Q

What is the tx for Cardioembolic stroke?

A

tPA

57
Q

What is the management of Cardioembolic stroke?

A

LT anticoagulant therapy after the acute event unless there is a CI

58
Q

What is a Lacunar stroke?

A

Very small infarcts 2-3mm up to 1-2cm in size

59
Q

What do pt w/ lacunar strokes have a high incidence of?

A

DM & HTN

60
Q

What are the sx of Lacunar stroke

A

Many are asx, so by the time of the “1st stroke” there may be >10 lesions on MRI

61
Q

What is Thalamic syndrome?

A

Contralateral unilateral numbness & pain

62
Q

What is the prognosis of a Intraparenchymal (intralobal) hemorrhagic stroke?

A

Much more lethal d/t edema

63
Q

What is the hx of Intraparenchymal hemorrhagic strokes?

A
  • Very abrupt acute strokes
  • HA’s
  • Early seizures are freq
  • HTN
  • Fewer ATH RF
64
Q

What are the PE findings of Intraparenchymal hemorrhagic strokes?

A

Deteriorate quicker but otherwise similar to other types of strokes

65
Q

What is the best dx imaging for intraparenchymal hemorrhagic strokes?

A

Brain Ct w/o contrast (dx ~99% of cases)

66
Q

What causes intraparenchymal hemorrhagic strokes?

A

HTN

67
Q

What is the tx for Intraparenchymal hemorrhagic strokes?

A
  • Management of HTN
  • Dexamethasone & mannitol to manage brain edema
  • Keep bed elevated
  • Manage complications
  • ICP monitoring
  • Craniotomy can be life saving
68
Q

What are the sx of AVM?

A

Asx until they rupture & bleed

69
Q

What can pt present w/ if the AVM is peripheral near the cortex?

A

Seizures or HA’s

70
Q

How can AVM’s be discovered?

A

Incidentally upon brain imaging for HA or seizures

71
Q

Who gets AVM’s?

A

Pts younger than stroke pts

72
Q

What will be found on PE in AVM’s?

A

Large AVM or rupture can cause focal neuro deficits

No physical ABN

73
Q

What are the technological features of AVM?

A
  • Dx w/ CT or MRI
  • Arteriography is important for deciding definitive tx
74
Q

What are AVM’s?

A

Vascular anomalies or benign neoplasms in the brain

75
Q

What is the tx for AVM’s?

A

Left untx b/c M/M assoc w/ tx

Neurologic Conditions (15 decks)

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