Cerebrovascular Disease And Infections Dr. Martin

Question 1

ACA problem causes what

Answer 1

1. upper motor weakness, sensory loss (contralateral hemiplegia)
2. contralateral LEG*
3. Alien Hand Syndrome = semiautomatic movements or contralateral arm not voluntarily controlled

Question 2

PCA problem causes what

Answer 2

contralateral homonymous HEMIANOPIA (loss of vision for half of visual field on 1 or both eyes)

Question 3

MCA problem causes what

Answer 3

1. Aphasia
2. hemineglect : X awareness of half of body
3. hemianopia
4. face-arm-leg sensorimotor loss
5. gaze preference towards lesion***
6. Lacunes : small deep infarcts in MCA branches (small lakes)

Question 4

Most common artery effected by infarcts and ischemic events

Answer 4

MCA

Question 5

stroke vs TIA

Answer 5

stroke = SX acute and last longer then 24hrs 
TIA = SX acute and last less then 24hrs 

= RESULTS in infarction

Question 6

most common cerebrovascular disorders 4

Answer 6

1. global ischemia (low BP, CO poisoning, low P, cardiac arrest)
2. Embolism (atherosclerotic clot)
3. ruptured aneurysm
4. hypertensive intraparenchymal hemorrhage (from htn)

Question 7

reduced BF to brain , what factors infulance survival

Answer 7

1. Collateral circulation (Circle of Willis is intact)
2. ischemic duration
3. amount and acuteness of BF decrease

Question 8

focal ischemia

Answer 8

embolic, thrombotic, vasculitides (polyarteritis nodosa, primary angiitis), htn artherosclerosis

Question 9

Watershed infarcts is what and location

Answer 9

most susceptible to ischemia and infarction (inbetween ACA and MCA)
= sickle shaped necrosis over cerebral convexity lateral to interhemispheric fissure

Question 10

ACA-MCA problem can happen from what and effects

Answer 10

1. occlusion internal carotid artery
2. hypotension in carotid stenosis
   = proximal leg/arm weakness
   = aphasia (language problems)

Question 11

MCA-PCA problem effects

Answer 11

higher order visual processing

Question 12

cortical border infarction

Answer 12

ACA-MCA and MCA-PCA zones

Question 13

Internal border zone

Answer 13

infarct in the white matter only

between lenticulostriate arteries and other branches of MCA or ACA

Question 14

atherosclerosis happens most likely in what CNS artery and which artery can get effected if thrombi is thrown

Answer 14

1. internal carotid artery
2. ACA and MCA (sometimes ophthalmic artery) —-> contralateral leg/arm weakness + sensory loss, contralateral visual probs, aphasia

Question 15

TX carotid stenosis

Answer 15

angioplasty, stenting, endarterectomy

Question 16

most common sites for thrombi

Answer 16

1. carotid bifurcation
2. MCA origin
3. either end basilar artery

Question 17

thrombi cause what type of infarct

Answer 17

wedge shaped infarct

Question 18

artery most effected by embolic infarction

Answer 18

MCA

Question 19

marantic emboli

Answer 19

proteinaceous embolic (non-bacterial thrombotic endocarditis) NBTE, malignancy OR CHILD BIRTH AMNIOTIC FLUID

Question 20

shower emboli

Answer 20

fat after long bone fracture

Question 21

bone marrow embolization in brain shows up where

Answer 21

in the white matter all over as brown specs

Question 21

bone marrow embolization in brain shows up where

Answer 21

in the white matter all over as brown specs

Question 22

most common malignancy causing hypercoagability

Answer 22

adenocarcinoma

Question 23

TIA usually lasts how long and when is there permanent cell death
causes of TIA

Answer 23

1. 10min, if longer there can be permanent damage ( >1hr infarct only full recovery in 1 day)
2. previous TIA, hypoglycemia (elderly), migraines, seizures, other conditions

Question 24

TIA risks

Answer 24

15% stroke within 3mo 50% stroke in 48hrs NEUROLOGIC EM NEED TO BE WATCHED IN HOSPITAL

Question 25

MOA of TIA

Answer 25

emobli occludes and then dissolves | or Vasospasm

Question 26

hemorrhagic vs ischemic stroke

Answer 26

HEMORRHAGIC (RED) = intra-cerebral or subarachnoid, from EMBOLI, hemorrhage from reperfusion of damaged vessels ---> Blood leaks out ISCHEMIC (WHITE) = bloodless, from THROMBI (fibrin and hard), can become hemorrhagic if BV rupture

Question 27

ischemic stroke happens mostly in what artery

Answer 27

MCA** (also basilar, vertebral = surface vessels that can be compressed) also deep arteries like Basal Ganglia BVs, internal capsule

Question 28

bleed in Basal Ganglia and other deep arteries like thalamus, internal capsule can cause what

Answer 28

can go into ventricles causing hydrocephalus (MCA deep branches can do this)

Question 29

hypertensive cerebrovascular Dz can cause what

Answer 29

1. Lacunar infarcts : deep arteries like lenticulostriate arteries ** 2. Slit hemorrhages : small caliber penetrating vessels ----> slit like cavities 3 Hypertensive encephalopathy (clinicopathologic syndrome) = Malignant HTN causes this, deep brain parenchymal hemorrhages

Question 30

1. Lacunar infarcts in internal capsule (LENTICULOSTRIATE As) can cause 2. Thalamic lacune 3. Basal Ganglia Lacune

Answer 30

1. motor hemiparesis 2. contralateral sensory problems 3. hemiballismus (involuntary movements)

Question 31

hypertensive encephalopathy can cause what

Answer 31

1. deep brain parenchymal hemorrhages** 2. vascular multi-infarct dementia (pseudobulbular palsy, gait probs) 3. Binswanger Dz : LG of subcortical white matter myelin + axon loss 4. Charcot- Bouchard Microaneurysms (chronic hypertension) small in BG

Question 32

pseudobulbular palsy

Answer 32

can control facial movements (chewing, speaking, swallowing slurred speech, uncontrolled emotions, brain stem neural damage going to corticobulbular tract (Upper motor --> cranial nerve motor nuclei)

Question 33

gene for recurrent strokes

Answer 33

NOTCH 3 gene (Cerebral AD Arteriopahty with subcortical Infarcts + Leukoencephalopathy CADSIL)

Question 34

cerebral amyloid angioplasty CAA

Answer 34

lobar hemorrhage | =a B-amyloid deposit in BVs (same as in Alz Dz) ----> microbleeds

Question 35

CADASIL

Answer 35

Cerebral AD Arteriopahty with subcortical Infarcts + Leukoencephalopathy = recurrent stokes by around 35yo, then after 10-15 years (NOTCH 3) = media and adventiti thickens + loss of SM in BVs, = PAS+ deposits

Question 36

hyaline arteriosclerosis seen when

Answer 36

hypertensive bleed

Question 37

stroke in young pt think

Answer 37

1. hypercoag Dz 2. arterial dissection 3. PFO 4. sickle cell

Question 38

most common cause of subarachnoid hemorrhage

Answer 38

Berry Aneurysm (Saccular Aneurysm)

Question 39

most proximal aneurysm in circle of willis causes

Answer 39

basilar subarachnoid hemorrhage

Question 40

saccular aneurysm is what and common sites

Answer 40

ANTERIOR CIRCULATION (ACA) mostly** - MCA - Posterior Com A - Basilar A

Question 41

atherosclerotic aneurysm happens where and aneurysms form when

Answer 41

mostly in basilar A not during birth, over time from BV media defect

Question 42

mycotic aneurysm is caused by

Answer 42

1. candida 2. Mucor 3. Aspergillous

Question 43

rupture of aneurysm happens mostly from and prevalence

Answer 43

more in F, AD PKD, EDS type 4, Neurofibromatosis type1, Marfans - orgasm - stool straining (2% population has berry aneurysm)

Question 44

Aneurysms feel like what and survival

Answer 44

worst headache ever 25%-50% die from first rupture (common to rebleed) (subarachnoid hemorrhage as its healing can still get vasospasm from blood exposed to BVs ESP IF AT BASE OR CIRCLE OF WILLIS)

Question 45

TX Berry aneurysm

Answer 45

clip and coil | superglue

Question 46

cavernous malformations

Answer 46

distended loosely organized vascular channels (no parenchyma = cause hemorrhage or SAH =10-30yo

Question 47

AVM location and what is it

Answer 47

in subarachnoid space hemorrhage = in parenchyma = worm like tangle of BV+ pulsatile arteriovenous shunting high BF (A--> V without going through capillaries)

Question 48

AVM happens most likely in what A

Answer 48

MCA (and at times PCA)

Question 49

AVM mutation association

Answer 49

KRAS

Question 50

how an AVM can be TX

Answer 50

inject glue into it

Question 51

vascular Dementia causes what

Answer 51

1. dementia 2. gait problems 3. psudobulbar sign (CN4,5,7 lesion) cant control face muscles

Question 52

Vascular Dementia can be caused by

Answer 52

artherosclerosis thrombus chronic HTN

Question 53

Binswanger Dz.

Answer 53

subcortical white matter loss = dementia (type of vascular dementia)