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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
dominant MCA causes
contralateral weakness arms/face, neglect with/without numbness gaze deviation aphasia
26
non dominant MCA
contralateral weakness arm/face neglect with or without numbness gaze deviation
27
ACA stroke causes
– Contralateral leg weakness – Motivation, organization behaviors
28
vertebrobasilar (posterior circulation problem)
– Sensory &/or motor abnormalities in any combo of extremities/face – Vertigo, clumsiness, ataxia, – Diplopia, Dysarthria, Dysphagia – Nausea/vomiting – Hearing loss, hiccups
29
PCA stroke
Contralateral Homonymous Hemianopsia – Splenium of corpus callosum- alexia w/o agraphia – May affect thalamus
30
CARDIOEMBOLIC STROKES LOOK LIKE
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
A FIB
* 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
AFIB anticoagulation
Warfarin (Coumadin) * New Class of Medicines= Novel Oral Anticoagulants * Rivaroxaban (Xarelto) * Apixaban (Eliquis) * Dabigatran (Pradaxa)
33
other sites besides afib for embolic infarction
–aorta –large intracranial arteries –patent foramen ovale
34
embolic stroke of uncertain source (ESUS)
Subset of cryptogenic strokes * Non-lacunar stroke * No source large vessel disease * No cardiac etiology found
35
Lacunar infarction
* 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
lacunar infarction affects
face arm leg equally
37
classic syndromes for lacunar infarction
– 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
thalamic stroke looks like....
contra sensory loss to all modalities spontaneous pain, dysesthesias -may develop thalamic pain syndrome mild hemiparesis
39
AICA cerebellar stroke causes
hearing loss, facial weakness, ataxia, horners
40
lateral medullary syndrome
PICA/vertebral artery cerebellar peduncle dysarthria contra hemiparesis hearing loss dizziness
41
NIH STROKE SCALE
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
superior cerebellar artery
ipsi ataxia, scanning speech
42
tPA
* 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
post stroke complications
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
If worsening, what needs to happen?
repeat imaging keep blood pressure up head of bed down/supine
45
hemorrhagic strokes involve what?
change in responsiveness/loss of consciousness
46
hypertension usually leads to what stroke?
hemorrhagic stroke
47
clinical signs of intracranial hemorrhage
Focal neurologic deficits rapid in onset * Symptoms of increased intracranial pressure common (headache, vomiting, decreased consciousness) * CT readily shows blood
48
intracerebral hemorrhage causes
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

becky: neuro MSK (14 decks)

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