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NMSP 1 > Cerebrovascular Disease > Flashcards

Cerebrovascular Disease Flashcards

1
Q

What are the deficits when the Anterior Cerebral Artery is affected?

A
  • upper motor neuron weakness
  • cortical sensory loss
  • contralateral hemiplegia (most often the leg)
  • “alien hand” syndrome (involuntary mvmts)
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2
Q

What is the major deficit when the Posterior Cerebral Artery is affected?

A
  • contralateral homonymous hemianopia

ex: lesion on the right causes loss of left vision field in both eyes

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3
Q

What are the major deficits when the Middle Cerebral Artery is affected (most common area of ischemia and infarcts)?

A
  • aphasia
  • contralateral face/arm/leg sensorimotor loss
  • gaze preference toward side of lesion

Lacunes: small, deep infarcts involving penetrating branches of MCA

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4
Q

What is a thrombosis versus an embolism?

A

Thrombosis: clotting of blood within a vessel

Embolism: plug; detached thrombus occluding a vessel

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5
Q

What is a “stroke” versus an “infarction”?

A

“stroke” is the clinical designation of symptoms

“infarction” is the actual lesion of brain parenchyma

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6
Q

What are the most common cerebrovascular disorders?

A
  • global ischemia (ex: d/t shock)
  • embolism
  • hypertensive intraparenchymal hemorrhage
  • ruptured aneurysm
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7
Q

Which is more limiting to the brain - lack of oxygen or lack of metabolic substrate?

A

lack of oxygen, since brain is highly aerobic

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8
Q

What are some causes of focal ischemia?

A
  • embolic/thrombotic arterial occlusion

- ATHEROSCLEROSIS in HTN

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9
Q

What type of area in the brain is most susceptible to ischemia and infarction?

A

-watershed regions

–damage is a SICKLE-SHAPED BAND OF NECROSIS over the cerebral convexity, a few cms lateral to the interhemispheric fissure

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10
Q

What causes watershed infarcts?

A
  • occlusion of internal carotid artery

- hypotension in patient w/ carotid stenosis

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11
Q

What are the symptoms of an ACA-MCA watershed infarct?

A
  • proximal arm and leg weakness

- transcortical aphasia (language issues)

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12
Q

What is the main symptom of an MCA-PCA watershed infarct?

A

deficits in higher-order visual processing

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13
Q

What is a common cause of internal carotid artery stenosis and where does it typically occur?

A
  • atherosclerosis
  • just beyond the carotid bifurcation

-thrombi are also common at the origin of the MCA and at either end of the basilar artery

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14
Q

What do you hear on physical exam of a patient with carotid artery stenosis?

A

a carotid bruit that continues into diastole

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15
Q

What is a consequence of thrombi that form in the internal carotid artery d/t stenosis?

A
  • thrombi can embolize distally
  • -especially to MCA, ACA, and ophthalmic artery

Symptoms:

  • CONTRALATERAL FACE/ARM WEAKNESS
  • contralateral sensory changes
  • CONTRALATERAL VISUAL FIELD DEFECTS
  • APHASIA
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16
Q

What are possible treatments of carotid stenosis?

A
  • angioplasty
  • stenting
  • endarterectomy (longitudinal cut to remove plaque)
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17
Q

What is an atheroma?

A

an intimal lesion that has a lipid core covered by a fibrous cap

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18
Q

What is the mechanism behind how atherosclerotic plaques cause thrombi?

A

-rupture, ulceration, or erosion of the plaque exposes blood to thrombogenic substances that lead to thrombosis and clots

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19
Q

True or False: thrombotic occlusions occur mostly d/t atherosclerosis

A

True

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20
Q

What is the shape of an infarct d/t a thrombus?

A

wedge-shaped

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21
Q

What are causes of cardioembolic infarcts?

A
  • afib
  • MI (hypokinetic or akinetic areas)
  • valvular dz (thrombi on diseased/prosthetic leaflet)
  • dissection (carotid or vertebral aa.)
  • PFO (paradoxical embolus; DVT becomes a stroke)
22
Q

What are sources of emboli?

A
  • air emboli (deep sea divers, iatrogenic)
  • septic emboli (bacterial endocarditis)
  • marantic emboli (proteinaceous)
  • -d/t non-bacterial thrombotic endocarditis
  • amniotic fluid emboli (childbirth)
  • fat/cholesterol emboli (long bone trauma)
  • -especially if you see megakaryocytes
  • -“shower emboli”
23
Q

What artery in the brain is most affected by embolic infarction?

A

MCA

–usually in areas where blood vessels branch or in pre-existing areas of luminal stenosis

24
Q

What are possible hypercoagulable states that can lead to neurologic effects?

A
  • coagulation factor disorders (Protein C, or Protein S)
  • dehydration
  • adenocarcinoma (or other malignancies)
  • surgery, trauma, childbirth
  • DIC
  • sickle cell, leukemia, polycythemia
  • vasculitis (temporal arteritis, SLE)
25
Q

What is a TIA (Transient Ischemic Attack)?

A
  • neurological deficit lasting <24hrs caused by temporary brain ischemia (usually 10 mins)
  • deficits longer than 10 mins probably produce some level of permanent cell death
26
Q

True or False: TIA’s are a warning sign of a potentially larger ischemic injury to the brain

A

True; it is a neurologic emergency since 15% of TIA pts will have a stroke that causes persistent deficits within 3 months (50% of those will occur within the next 48hrs)

27
Q

What are common causes of a TIA?

A
  • embolus that temporarily occludes, but dissolves
  • in situ thrombus formation
  • vasospasm
28
Q

What are the two types of stroke?

A

Hemorrhagic (Red, d/t emboli)

  • intracerebral or subarachnoid hemorrhage
  • can cause hemorrhage secondary to reperfusion

Ischemic (White, d/t thrombus)
-can have a hemorrhagic conversion d/t fragile vessels rupturing, leading to a secondary hemorrhage

29
Q

What are lacunar infarcts?

A
  • infarctions of the deep penetrating arteries that develop arteriolar sclerosis (lenticulostriate aa.)
  • single or multiple small cavitary localized infarcts
30
Q

What symptoms are associated with infarction of the lenticulostriate aa.?

A
  • pure motor hemiparesis (d/t the posterior limb of the internal capsule)
  • thalamic lacune causes contralateral somatosensory defecits
  • basal ganglia lacune causes hemiballismus
31
Q

What are slit hemorrhages?

A

–affect small caliber penetrating vessels to create slit-like cavities

–slit is surrounded by pigment-laden macrophages

–gliosis present

32
Q

What is hypertensive encephalopathy?

A

-occurs with BPs of 200/130

33
Q

What HTN risk factor is most commonly associated with deep brain parenchymal hemorrhages?

A

hypertensive encephalopathy

-potentially d/t malignant HTN

34
Q

What is Binswanger Disease?

A

-large area of subcortical white matter w/ myelin and axon loss

35
Q

What are Charcot-Bouchard Microaneurysms?

A

-minute (<300 micrometers) aneurysms in the basal ganglia, associated w/ chronic HTN

36
Q

What is Cerebral Amyloid Angiopathy?

A
  • causes lobar hemorrhage

- involves the same AB amyloid as Alzheimer Dz deposited in vessel walls producing microbleeds

37
Q

What is CADASIL (Cerebral Autosomal Dominant Ateriopathy w/ Subcortical Infarcts and Leukoencephalopathy)?

A
  • recurrent strokes and dementia
  • first symptomatic around age 35
  • thick media and adventitia, loss of smooth muscle
  • basophilic PAS+ deposits
  • NOTCH3 gene
  • -preferentially expressed in vascular smooth muscle
38
Q

What are risk factors for a stroke?

A
  • HTN
  • DM
  • hypercholesterolemia
  • cigarette smoking
  • family Hx
  • cardiac dz (valvular dz, afib, PFO, low EF)
  • hypercoagulability
39
Q

What is an aneursym?

A

-localized abnormal dilation of a blood vessel (or the heart)

40
Q

What is the most frequent cause of clinically significant subarachnoid hemorrhage?

A

rupture of berry aneurysm

usually in the Circle of Willis, so it begins as a basilar SAH

41
Q

What is the most common site of a berry aneurysm in the Circle of Willis?

A

at the junction of the anterior cerebral artery and the anterior communicating artery

42
Q

What type of aneurysm is most likely to be found at the basilar artery?

A

atherosclerotic (fusiform)

43
Q

True or False: aneurysms are present at birth

A

False; they develop over time d/t underlying defect in the media of the vessel

44
Q

What is a Giant Aneurysm?

A
  • can involve more than one artery

- over 2.5 cm wide

45
Q

What is a Mycotic Aneurysm?

A
  • caused by an infected artery wall
  • rare
  • Mucor, Candida, Aspergillis
46
Q

What is the demographic for ruptured berry aneurysms?

A

–females in their 40’s

–one-third of ruptures are associated with increased intracranial pressure (straining at stool, orgasms)

47
Q

What is the iconic phrase used to describe the pain of a ruptured aneurysm?

A

“worst headache I’ve ever had”

48
Q

What percentage of people die with the first ruptured aneurysm?

A

20-50%; repeat bleeding in survivors is common

50% of aneurysms >10 mm bleed per year

49
Q

What is a potential complication of a subarachnoid hemorrhage within the first few days, regardless of etiology?

A

-increased risk of ischemic injury d/t vasospasm, because the vessels are bathed in extravasated blood (especially likely if it involved the base of the brain and Circle of Willis)

50
Q

What is an AVM (arteriovenous malformation) and their common locations in the brain?

A
  • where an artery meets a vein w/o intervening capillaries
  • tangle, wormlike vascular channels w/ prominent pulsatile shunting and high blood flow
  • AVM can be located in the subarachnoid space, may extend into the brain parenchyma, or may be exclusively in parenchyma
51
Q

What arteries in the brain most commonly have AVM’s and what is the age demographic when they most commonly cause bleeds?

A

MCA and posterior branches

10-30 yrs old

NMSP 1 (9 decks)

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