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NMSP > Cerebrovascular Disease And Infections Dr. Martin > Flashcards

Cerebrovascular Disease And Infections Dr. Martin Flashcards

1
Q

ACA problem causes what

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

PCA problem causes what

A

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

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3
Q

MCA problem causes what

A
  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)
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4
Q

Most common artery effected by infarcts and ischemic events

A

MCA

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5
Q

stroke vs TIA

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

= RESULTS in infarction

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6
Q

most common cerebrovascular disorders 4

A
  1. global ischemia (low BP, CO poisoning, low P, cardiac arrest)
  2. Embolism (atherosclerotic clot)
  3. ruptured aneurysm
  4. hypertensive intraparenchymal hemorrhage (from htn)
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7
Q

reduced BF to brain , what factors infulance survival

A
  1. Collateral circulation (Circle of Willis is intact)
  2. ischemic duration
  3. amount and acuteness of BF decrease
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8
Q

focal ischemia

A

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

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9
Q

Watershed infarcts is what and location

A

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

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10
Q

ACA-MCA problem can happen from what and effects

A
  1. occlusion internal carotid artery
  2. hypotension in carotid stenosis
    = proximal leg/arm weakness
    = aphasia (language problems)
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11
Q

MCA-PCA problem effects

A

higher order visual processing

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12
Q

cortical border infarction

A

ACA-MCA and MCA-PCA zones

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13
Q

Internal border zone

A

infarct in the white matter only

between lenticulostriate arteries and other branches of MCA or ACA

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14
Q

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

A
  1. internal carotid artery
  2. ACA and MCA (sometimes ophthalmic artery) —-> contralateral leg/arm weakness + sensory loss, contralateral visual probs, aphasia
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15
Q

TX carotid stenosis

A

angioplasty, stenting, endarterectomy

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16
Q

most common sites for thrombi

A
  1. carotid bifurcation
  2. MCA origin
  3. either end basilar artery
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17
Q

thrombi cause what type of infarct

A

wedge shaped infarct

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18
Q

artery most effected by embolic infarction

A

MCA

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19
Q

marantic emboli

A

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

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20
Q

shower emboli

A

fat after long bone fracture

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21
Q

bone marrow embolization in brain shows up where

A

in the white matter all over as brown specs

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21
Q

bone marrow embolization in brain shows up where

A

in the white matter all over as brown specs

22
Q

most common malignancy causing hypercoagability

A

adenocarcinoma

23
Q

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

A
  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
24
Q

TIA risks

A

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

25
Q

MOA of TIA

A

emobli occludes and then dissolves

or Vasospasm

26
Q

hemorrhagic vs ischemic stroke

A

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

27
Q

ischemic stroke happens mostly in what artery

A

MCA** (also basilar, vertebral = surface vessels that can be compressed)

also deep arteries like Basal Ganglia BVs, internal capsule

28
Q

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

A

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

29
Q

hypertensive cerebrovascular Dz can cause what

A
  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
30
Q
  1. Lacunar infarcts in internal capsule (LENTICULOSTRIATE As) can cause
  2. Thalamic lacune
  3. Basal Ganglia Lacune
A
  1. motor hemiparesis
  2. contralateral sensory problems
  3. hemiballismus (involuntary movements)
31
Q

hypertensive encephalopathy can cause what

A
  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
32
Q

pseudobulbular palsy

A

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)

33
Q

gene for recurrent strokes

A

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

34
Q

cerebral amyloid angioplasty CAA

A

lobar hemorrhage

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

35
Q

CADASIL

A

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

36
Q

hyaline arteriosclerosis seen when

A

hypertensive bleed

37
Q

stroke in young pt think

A
  1. hypercoag Dz
  2. arterial dissection
  3. PFO
  4. sickle cell
38
Q

most common cause of subarachnoid hemorrhage

A

Berry Aneurysm (Saccular Aneurysm)

39
Q

most proximal aneurysm in circle of willis causes

A

basilar subarachnoid hemorrhage

40
Q

saccular aneurysm is what and common sites

A

ANTERIOR CIRCULATION (ACA) mostly**

  • MCA
  • Posterior Com A
  • Basilar A
41
Q

atherosclerotic aneurysm happens where and aneurysms form when

A

mostly in basilar A

not during birth, over time from BV media defect

42
Q

mycotic aneurysm is caused by

A
  1. candida
  2. Mucor
  3. Aspergillous
43
Q

rupture of aneurysm happens mostly from and prevalence

A

more in F, AD PKD, EDS type 4, Neurofibromatosis type1, Marfans

  • orgasm
  • stool straining

(2% population has berry aneurysm)

44
Q

Aneurysms feel like what and survival

A

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)

45
Q

TX Berry aneurysm

A

clip and coil

superglue

46
Q

cavernous malformations

A

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

47
Q

AVM location and what is it

A

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

48
Q

AVM happens most likely in what A

A

MCA (and at times PCA)

49
Q

AVM mutation association

A

KRAS

50
Q

how an AVM can be TX

A

inject glue into it

51
Q

vascular Dementia causes what

A
  1. dementia
  2. gait problems
  3. psudobulbar sign (CN4,5,7 lesion) cant control face muscles
52
Q

Vascular Dementia can be caused by

A

artherosclerosis
thrombus
chronic HTN

53
Q

Binswanger Dz.

A

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

NMSP (5 decks)

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