Cerebrovascular Diseases Flashcards
Length of development
Hypertensive Intracerebral Hemorrhage
Develops over 30-90 minutes
Localization
Stroke presenting with contralateral hemiparesis
(leg > face/arm)
Anterior Cerebral Artery
Causes of Hemorrhagic Stroke
S – STRUCTURAL LESIONS (cavernoma,
AVM)
M – MEDICATIONS (anticoagulant)
A – AMYLOID ANGIOPATHY
S – SYSTEMIC DISEASES (liver disease,
leukemia)
H – HYPERTENSION
U - UNDETERMINED
SMASH U
sudden onset of maximal
deficit (<5min) with rapid improvement of initially massive symptoms (“spectacular
shrinking of deficits)
CARDIOEMBOLIC STROKE
Ischemic CVD Stroke presenting with clumsy hand syndrome, pure sensory or motor strokes and may be due to hypohyalinosis
Lacunar infarct
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
MRI
Most common cause of Subarachnoid Hemorrhage
(non traumatic)
Ruptured
saccular aneurysm
Others: AVM, dural AVF, extension from IC
hemorrhage
Management of Ischemic Stroke
THROMBOLYTIC THERAPY
preferred agent: r-TPA (recombinant tissue plasminogen activator); give within 3h of stroke onset;
should not receive antiplatelet/anticoagulant within 24h of
treatment
Localization
Stroke presenting with contralateral
hemiparesis (face/arm >leg)
Middle Cerebral Artery
Most common site of atherosclerosis
with superimposed thrombosis
origin
of the internal carotid artery
Site of Ischemic CVD usually due to Embolus
Middle Cerebral Artery
Diagnostics for CVD
Initial neuroimaging of choice to
differentiate ischemic and hemorrhagic stroke
and exclude diagnosis that mimic stroke
Plain CT Scan
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
Transient Ischemic Attack
Subarachnoid Hemorrhage Localization
Presentating with 3rd
nerve palsy
INTERNAL CAROTID ARTERY, POST COMMUNICATING A
Gold standard diagnostic for Subarachnoid Hemorrhage
Cerebral Angiography
Stroke which occurs often during sleep
ATHEROTHROMBOTIC STROKE
Most common site of Subarachnoid Hemorrhage
> Junction of anterior commissural artery with Anterior Cerebral Artery
Post commissural artery with Internal Carotid Artery
Bifurcation of Middle Cerebral Artery
Management of Ischemic Stroke
Neuroprotection
Avoid hypotension,
hypoxemia, hypo/hyperglycemia, hyperthermia
“5H”
Management of Ischemic Stroke
When to consider Surgery
> 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
CSF finding of Subarachnoid Hemorrhage
Bloody
Common sites for hemorrhagic stroke
1) Basal ganglia (putamen, thalamus)
2) Deep cerebellum
3) pons- pinpoint pupils
Most common site – putamen/internal capsule
Localization
Ischemic CVD Stroke presenting with ataxia, hemiplegia, horizontal gaze, palsy, nystagmus, vertigo, deafness, dizziness
Vertebrobasilar Artery
Imaging of choice for Subarachnoid Hemorrhage
Cranial CT Scan
Most common cause of Subarachnoid Hemorrhage
Trauma
