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IM: Neurology > Cerebrovascular Diseases > Flashcards

Cerebrovascular Diseases Flashcards

1
Q

Length of development

Hypertensive Intracerebral Hemorrhage

A

Develops over 30-90 minutes

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2
Q

Localization

Stroke presenting with contralateral hemiparesis
(leg > face/arm)

A

Anterior Cerebral Artery

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3
Q

Causes of Hemorrhagic Stroke

A

S – STRUCTURAL LESIONS (cavernoma,
AVM)
M – MEDICATIONS (anticoagulant)
A – AMYLOID ANGIOPATHY
S – SYSTEMIC DISEASES (liver disease,
leukemia)
H – HYPERTENSION
U - UNDETERMINED

SMASH U

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4
Q

sudden onset of maximal
deficit (<5min) with rapid improvement of initially massive symptoms (“spectacular
shrinking of deficits)

A

CARDIOEMBOLIC STROKE

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5
Q

Ischemic CVD Stroke presenting with clumsy hand syndrome, pure sensory or motor strokes and may be due to hypohyalinosis

A

Lacunar infarct

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6
Q

DIagnostics for CVD

Better imaging for posterior circulation ischemic strokes (poor images due to petrous bone); not sensitive in detecting acute hemorrhage; more expensive, less widely available, longer acquisition time than CT

A

MRI

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7
Q

Most common cause of Subarachnoid Hemorrhage
(non traumatic)

A

Ruptured
saccular aneurysm

Others: AVM, dural AVF, extension from IC
hemorrhage

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8
Q

Management of Ischemic Stroke

THROMBOLYTIC THERAPY

A

preferred agent: r-TPA (recombinant tissue plasminogen activator); give within 3h of stroke onset;

should not receive antiplatelet/anticoagulant within 24h of
treatment

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9
Q

Localization

Stroke presenting with contralateral
hemiparesis (face/arm >leg)

A

Middle Cerebral Artery

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10
Q

Most common site of atherosclerosis
with superimposed thrombosis

A

origin
of the internal carotid artery

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11
Q

Site of Ischemic CVD usually due to Embolus

A

Middle Cerebral Artery

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12
Q

Diagnostics for CVD

Initial neuroimaging of choice to
differentiate ischemic and hemorrhagic stroke
and exclude diagnosis that mimic stroke

A

Plain CT Scan

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13
Q

Transient episode of neurologic dysfunction caused by focal brain, spinal, or retinal schema without evidence of infarction; focal. abrupt
onset of symptoms <1h, resolves in 24h

A

Transient Ischemic Attack

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14
Q

Subarachnoid Hemorrhage Localization

Presentating with 3rd
nerve palsy

A

INTERNAL CAROTID ARTERY, POST COMMUNICATING A

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15
Q

Gold standard diagnostic for Subarachnoid Hemorrhage

A

Cerebral Angiography

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16
Q

Stroke which occurs often during sleep

A

ATHEROTHROMBOTIC STROKE

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17
Q

Most common site of Subarachnoid Hemorrhage

A

> Junction of anterior commissural artery with Anterior Cerebral Artery
Post commissural artery with Internal Carotid Artery
Bifurcation of Middle Cerebral Artery

18
Q

Management of Ischemic Stroke

Neuroprotection

A

Avoid hypotension,
hypoxemia, hypo/hyperglycemia, hyperthermia

“5H”

19
Q

Management of Ischemic Stroke

When to consider Surgery

A

> Cerebellar hemorrhage >3cm
neurologically deteriorating
Bleed associated with structural lesions (AVM, aneurysm) if with
good overall prognosis
Clinically deteriorating young patients with moderate or large lobar hemorrhage
Ventricular drainage for patients with intraventricular hemorrhage with moderate
to severe hydrocephalus
Basal ganglia/thalamic bleed, GCS 5 and above
Supratentorial hematoma with volume > 30 cc

20
Q

CSF finding of Subarachnoid Hemorrhage

21
Q

Common sites for hemorrhagic stroke

A

1) Basal ganglia (putamen, thalamus)
2) Deep cerebellum
3) pons- pinpoint pupils

Most common site – putamen/internal capsule

22
Q

Localization

Ischemic CVD Stroke presenting with ataxia, hemiplegia, horizontal gaze, palsy, nystagmus, vertigo, deafness, dizziness

A

Vertebrobasilar Artery

23
Q

Imaging of choice for Subarachnoid Hemorrhage

A

Cranial CT Scan

24
Q

Most common cause of Subarachnoid Hemorrhage

25
Q

Management of Ischemic Stroke

ANTITHROMBOTIC – cardioembolic

A

Anticoagulant
(Warfarin, also consider Heparin)

benefit of anticoagulant weighed
against risk of hemorrhagic conversion (large
infarctions, severe strokes, uncontrolled HPN - if present avoid anticoagulant if possible)

26
Q

Localization

Stroke presenting with contralateral homonymous hemianopia,
cortical blindness

A

Posterior Cerebral Artery

27
Q

Subarachnoid Hemorrhage Localization

Presenting with dysphagia, slurred
speech, ataxia, facial pain, vertigo, nystagmus,
Horner’s syndrome, diplopia

A

Vertebral a./ post inferior cerebellar a. – lateral
medullary/PICA syndrome

28
Q

Management of Ischemic Stroke

How to manage Intracranial Pressure?

A

> Elevate head 30-45deg
Mannitol IV
Hypertonic saline
Maintain serum osmolality 300- 320mosm/kg
Hyperventilation with target
pCO2 30-35 (effect lasts for 6h only for
impending herniation and not prophylaxis)

29
Q

Management of Ischemic Stroke

ANTITHROMBOTIC THERAPY- Non cardioembolic

A

Start ASA (Aspirin) as early as possible

Other options: clopidogrel, ASA + dipyridamole, cilostazol, trifusal

30
Q

Localization

Stroke presenting with monocular blindness
(amaurosis fugax)

A

Inernal Carotid Artery

31
Q

Sudden onset of focal or global
neurologic deficit > 24h due to an underlying vascular pathology

32
Q

Length of development

Anticoagulant Intracerebral Hemorrhage

A

Develops over 24-48 hours

33
Q

Subarachnoid Hemorrhage Localization

Bilateral leg paresis, abulia

A

Anterior Commisural Artery

34
Q

Subarachnoid Hemorrhage Localization

contralateral hemiparesis (mainly
face/hands); aphasia or contralateral visual
neglect

A

Middle Cerebral Artery

35
Q

Hallmark of Subarachnoid Hemorrhage

A

Sudden headache in the absence of
focal neurologic deficit

36
Q

MOST COMMON CAUSE OF HEMORRHAGIC STROKE

A

Hypertensive
Intracerebral Hemorrhage

37
Q

Hemorrhagic stroke presentation

A

> HEADACHE
VOMITING
INCREASED ICP (SBP>=220mmHg)
IMPAIRED CONSCIOUSNESS
EVOLUTION OF DEFICITS OVER MINUTES TO HOURS

38
Q

Management for Subarachnoid Hemorrhage

A

Pharmacologic: Nimodipine, anticonvulsant, BP
control (IV Nicardipine to maintain
SBP<150
Surgery: Clipping/coiling – ideally
within 72h from ictus

39
Q

Most common causes of Ischemic Cerebrovascular Disease

A
  1. Atherosclerosis
    w/ Thromboembolism
  2. Cardiogenic embolism
    (nonrheumatic AF); artery to artery. lacunar
40
Q

Localization

Ischemic CVD Stroke presenting with Aphasia

A

Left middle Cerebral Artery

41
Q

Localization

Ischemic CVD Stroke presenting with ataxia, dizziness, nausea vomiting

A

Cerebellar Artery

42
Q

Management of Ischemic Stroke

NEUROPROTECTIVE DRUGS

A

Citicholine or Cerebrolysin

IM: Neurology (5 decks)

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