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becky: neuro MSK > CEREBROVASCULAR DISEASES > Flashcards

CEREBROVASCULAR DISEASES Flashcards

1
Q

what is cerebrovascular disease?

A

Abnormality of the brain resulting from a
pathologic process of blood vessels
-arteries
-arterioles
-veins
-venous sinuses

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2
Q

basilar artery stroke

A

PONS LOCKED IN

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3
Q

Ischemia

A

lack of blood flow, reversible

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4
Q

infarction

A

death of tissue due to lack of blood flow

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5
Q

thrombosis

A

formation of clot within vessel, generally due to atherosclerosis

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6
Q

embolism

A

blood clot formed elsewhere travels to brain and lodges in cerebral vessel

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7
Q

hemorrhage

A

blooding (into the brain, subarachnoid space, etc)

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8
Q

stroke is…

A

ACUTE NEUROLOGIC CHANGE due to interruption of blood supply or bleeding of blood vessel

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9
Q

TIA

A

Brief episode of focal neurologic
dysfunction from brain or retinal
ischemia w/o evidence of acute
infarction on MRI
–Duration of symptoms typically <1 hr
(but by definition <24 hrs)
most last 15-20 minutes

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10
Q

___ day risk of stroke after TIA is 3-17% with highest risk in first ___ days

A

90 day risk of stroke after TIA is 3-17% with highest risk in first 30 days

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11
Q

Those with TIA have an 18.8% stroke risk in the next __ years

A

10 years

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12
Q

what else looks like stroke?

A

hypoglycemia/hypoxia
seizures (Todd’s paralysis)
migraines
multiple sclerosis attacks
brain tumor swelling

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13
Q

one of largest risk factors for stroke is

A

age`

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14
Q

modifiable risk factors for stroke

A

Hypertension
Pregnancy
Diabetes
OCPs
High cholesterol
Alcohol abuse
Heart Disease
Obesity
Smoking
Physical activity
Drug abuse
Obstructive sleep apnea

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15
Q

non modifiable risk factors for stroke

A

Older age (72% occur in people > age 65)
* Male gender
* Family history
* Race (Blacks > Whites)

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16
Q

___ strokes account for all stroke subtypes

A

87%
large vessel atherosclerosis
cardio-aortic embolism
small vessel subcortical strokes

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17
Q

hemorrhagic strokes account for ___% of strokes

A

13%

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18
Q

large vessel thrombotic infarction

A

over 50% have had warning episodes
-onset often during sleep, awakens with deficits
-symptoms depend on vessel involved

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19
Q

ACA stroke is rare or common?

A

rare!!! legs

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20
Q

face and arm weakness is a ___ stroke

A

MCA

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21
Q

MCA infarction will present as….

A

hemiparesis (contra face/arm)
aphasia (dominant side!)
neglect (non-dominant WORSE over dominant)
cortical sensory loss
homonymous hemianopsia (loss of field on one side)
Paralysis of conjugate gaze to opposite side —eyes look towards the lesion! AWAY FROM WEAK SIDE

22
Q

aphasia

A

motor/expressive aphasia: Broca’s
-anterior MCA, decreased fluency

sensory/receptive aphasia: Wernicke’s
-posterior MCA, fluent, poor comprehension

23
Q

ACA infarction

A

hemiparesis (leg over arm)
hemisensory loss (more leg)
urinary incontinence
slowness, delay, lack of spontaneity
akinetic mutism

24
Q

PCA infarction causes

A
  • Homonymous hemianopsia
  • Visual hallucinations, color abnormalities
  • Cortical blindness
  • Some contralateral sensory deficit
  • Inability to read (alexia)
  • Top of the basiliar syndrome
25
Q

dominant MCA causes

A

contralateral weakness arms/face, neglect with/without numbness
gaze deviation
aphasia

26
Q

non dominant MCA

A

contralateral weakness arm/face
neglect with or without numbness
gaze deviation

27
Q

ACA stroke causes

A

– Contralateral leg weakness
– Motivation, organization behaviors

28
Q

vertebrobasilar (posterior circulation problem)

A

– Sensory &/or motor abnormalities in any combo of
extremities/face
– Vertigo, clumsiness, ataxia,
– Diplopia, Dysarthria, Dysphagia
– Nausea/vomiting
– Hearing loss, hiccups

29
Q

PCA stroke

A

Contralateral Homonymous Hemianopsia
– Splenium of corpus callosum- alexia w/o agraphia
– May affect thalamus

30
Q

CARDIOEMBOLIC STROKES LOOK LIKE

A

multiple tiny ones coming from the heart

Most cerebral emboli arise in the heart
– atrial fibrillation
–myocardial infarction (heart attack) with
mural thrombus (clot within the chambers)
– akinetic segment of the heart wall
– endocarditis (infection of heart valves)

31
Q

A FIB

A
  • Affects 1-2 million Americans, especially
    elderly
  • 5x increased risk for stroke
  • 2x increased risk of death
  • Oral anticoagulation therapy reduces the risk
    of stroke by 2/3
32
Q

AFIB anticoagulation

A

Warfarin (Coumadin)
* New Class of Medicines= Novel Oral
Anticoagulants
* Rivaroxaban (Xarelto)
* Apixaban (Eliquis)
* Dabigatran (Pradaxa)

33
Q

other sites besides afib for embolic infarction

A

–aorta
–large intracranial arteries
–patent foramen ovale

34
Q

embolic stroke of uncertain source (ESUS)

A

Subset of cryptogenic strokes
* Non-lacunar stroke
* No source large vessel disease
* No cardiac etiology found

35
Q

Lacunar infarction

A
  • Small infarcts of less than 1.5 cm
  • Occlusion of small penetrating vessels in
    the putamen, caudate, internal capsule,
    pons, thalamus, and corona radiata.
  • Usually related to hypertension and
    diabetes
36
Q

lacunar infarction affects

A

face arm leg equally

37
Q

classic syndromes for lacunar infarction

A

– Pure motor stroke: Hemiparesis (face, arm,
and leg)-internal capsule or base of pons
– Pure sensory stroke: face, arm and leg- posterolateral thalamus
– Sensorimotor stroke: thalamus and internal
capsule
– Dysarthria, clumsy hand syndrome: base of
pons
– Ataxia-Hemiparesis: Pons/Internal capsule or
subcortex

38
Q

thalamic stroke looks like….

A

contra sensory loss to all modalities
spontaneous pain, dysesthesias
-may develop thalamic pain syndrome
mild hemiparesis

39
Q

AICA cerebellar stroke causes

A

hearing loss, facial weakness, ataxia, horners

40
Q

lateral medullary syndrome

A

PICA/vertebral artery
cerebellar peduncle
dysarthria
contra hemiparesis
hearing loss
dizziness

41
Q

NIH STROKE SCALE

A

1a: LOC
1b: LOC questions
1c: commands: open close eyes, grip and release
2. best gaze
3: visual field
4. facial palsy
5. motor arm (pronate!)_
6. motor leg (raise leg to 30 deg supine x5seconds)
7. limb ataxia
8. sensory with safety pin
9. best language
10. dysarthria
11. extinction/neglect

41
Q

superior cerebellar artery

A

ipsi ataxia, scanning speech

42
Q

tPA

A
  • Clot busting medication
  • Only FDA approved medication for acute strokes
  • Contraindications
    – > 4.5 hours from last known normal
    – Hemorrhage (internal, intracranial)
    – Head trauma or stroke in past 3 months
    – Severe uncontrolled high blood pressure (<185/110)
    – Endocarditis or aortic dissection
    – Bleeding disorder or anticoagulated
    – Glucose < 50
43
Q

post stroke complications

A
  1. Possible worsening - edema
  2. Hemorrhagic conversion
  3. Infection
  4. Aspiration
  5. MI
  6. Blood clots in legs (DVTs) -> lungs (PE)
  7. Pressure ulcers
44
Q

If worsening, what needs to happen?

A

repeat imaging
keep blood pressure up
head of bed down/supine

45
Q

hemorrhagic strokes involve what?

A

change in responsiveness/loss of consciousness

46
Q

hypertension usually leads to what stroke?

A

hemorrhagic stroke

47
Q

clinical signs of intracranial hemorrhage

A

Focal neurologic deficits rapid in onset
* Symptoms of increased intracranial pressure
common (headache, vomiting, decreased
consciousness)
* CT readily shows blood

48
Q

intracerebral hemorrhage causes

A

Hypertension: most common
* Trauma
* Rupture of arteriovenous malformation (AVM)
* Rupture of a cerebral aneurysm
* Bleeding into brain tumor
* Hemorrhagic transformation of infarct
* Bleeding disorders, (liver disease/leukemia)
* Amyloid angiopathy

49
Q
A

becky: neuro MSK (14 decks)

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