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NEUROLOGY II > Cerebrovascular Diseases > Flashcards

Cerebrovascular Diseases Flashcards

1
Q

T/F: If symptoms neurologic deficit improves for less than or equal to 24 hours, it is still stroke

A

F = transient ischemic attack

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2
Q

Three main processes of cerebral vascular occlusion

A

Atherosclerosis with superimposed thrombosis
Cerebral embolism
Occlusion of small cerebral vessels

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3
Q

T/F: Intracerebral hemorrhage can be caused by coagulopathies that arise endogenously

A

T

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4
Q

T/F: Vascular malformations of the brain is the most common cause of intracerebral hemorrhage

A

F= Chronic hypertension leading to rupture

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5
Q

This is the initial step of artherogenesis inside the lumen of the artery

If the cerebral blood flow is less than _______, infarction occurs

A

Endothelial dysfunction

less than 12 ml/min

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6
Q

Ischemic core is (hypo/hyper)intense on MRI

This contains at risk but viable neurons

A

HYPERINTENSE

Penumbra

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7
Q

4 important processes that contribute to cerebral ischemia

A

Impaired Energy metabolism
Activation of phospholipases
Alteration of neuronal membrane function
Excitotoxicity

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8
Q

Explain how impairment of energy metabolism occurs due to cerebral ischemia

A

When there is cerebral ischemia > reduced glucose and oxygen > reduced ATP > impairs choline and phosphocholine > damage to phospholipids in the cell membrane

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9
Q

Explain how activation of phospholipases occurs due to cerebral ischemia

A

Phospholipase activates arachidonic acids > fatty acids , free radicals , protein kinase C > attack the cell membrane > neuronal membrane damage

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10
Q

Explain how alteration of neuronal membrane function occurs due to cerebral ischemia

A

alterations in ionic exchange, receptor functions, and neurotransmissions > neuronal dysfunction

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11
Q

Explain how excitotoxicity occurs due to cerebral ischemia

A

Ischemia increases glutamate levels > activates NMDA channel > raises intracellular calcium > produces NO and formation of free radicals

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12
Q

This clinical stroke syndrome refers to:

  1. Maximum neurologic deficit at onset and symptoms does not worsen further
  2. Abrupt in onset that is virtually static or steadily progressive over a period of minutes or hours
  3. It evolves more slowly with a stepwise progression
  4. Characterized by severe/worst headache; almost instantaneous
A
  1. Embolic stroke
  2. ICH
  3. Thrombotic or artherothrombotic stroke
  4. SAH
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13
Q

1st essential feature of stroke:

2nd essential feature:

A

1st: abruptness
2nd: focal signature and the size of infarct or hemorrhage

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14
Q

3 criteria at which stroke is identified

A

Temporal profile of the clinical syndrome
Focal brain disease/tissue damage
Clinical setting

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15
Q

T/F: The TOAST classification is the 5 subtypes of hemorrhagic stroke according to their etiology

T/F: In TOAST classification, small vessel occlusion is the most common

A

F- ischemic stroke

F= large artery atherosclerosis

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16
Q

T/F: The evolution of clinical phenomena in central thrombosis is more variable than that of embolism and hemorrhage

A

T

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17
Q

T/F: The stroke cannot be preceded by minor signs or transient attacks of focal neurologic dysfunction

A

F= half of the patients experience minor signs prior to stroke

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18
Q

One of the characteristic “minor signs” preceding stroke

A

Stuttering

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19
Q

Atheromatous plaques preferentially form where?

A

Branching points and curves of cerebral arteries

20
Q

What are the frequent sites of atheromatous plaques in these vessels?

Internal Carotid Artery
Vertebral Artery
MCA
Proximal PCA
Proximal ACA

A

Internal Carotid Artery - at the ORIGIN from the COMMON CAROTID
Vertebral Artery - CERVICAL PART of VA and their JUNCTION forming the BASILAR ARTERY
MCA- at the STEM or MAIN BIFURCATION
Proximal PCA - as they wind around the MIDBRAIN
Proximal ACA- as they pass anteriorly and curve over the CORPUS CALLOSUM

21
Q

T/F: Cerebral embolism is usually due to cardioembolic

T/F: Hemorrhagic infarction nearly always indicates embolism

A

T
T

21
Q

Most common cause of cerebral embolism

A

Atrial fibrillation

22
Q

What do you check when there is possible cardioembolism?

A

Carotid bruit, murmurs, heart rhythm, ECg

23
Q

If the patient has cardioembolic infarct, which scoring system must be used?

A

CHA2DS2-VASc score (new)

23
Q

T/F: Small vessel disease affects the penetrating arteries

What are the two mechanisms of these lacunar thromboses?

What scale is used?

On MRI, cerebral small vessel disease is hyperintense on which area of the head?

A

T
2 mechanisms:
Lipohyalinosis
Atheroma formation

Fazeka scale

Periventricular areas

24
Q

Explain the pathophysiology of ischemic infarction

A

Loss of O2 and glucose supply d/t vascular occlusion > collapse of energy-producing processes > disintegration of cell structures and membranes > necrosis > Na-ATPase pump gets damaged > necrotic tissue swells (cytotoxic edema) > compresses adjacent brain parts > herniation > deterioration of the px

24
Q

Identify the use of the ff scoring systems:

Fazekas
ABCD3-I
CHADS2M CHA2DS2-VASc
TOAST

A

Fazekas: Small vessel disease
ABCD3-I: TIA
CHADS2M CHA2DS2-VASc: AF (Cardioembolic Stroke)
TOAST (Ischemic Stroke)

25
Q

Range of mean blood pressures

A

50-150 mmHg

25
Q

What happens on these CBF?

50-55

12-23

6-8

A

50-55 - normal

12-23 - critical level of hypoperfusion that abolishes function and leads to tissue damage

6-8 - marked atp depletion, increase in extracellular K, Intracellular Ca2+, cellular acidosis, leading to necrosis

26
Q

T/F: CBF of 10-12 causes irreversible infarction regardless of duration

At what CBF causes reversible infarction regardless of duration?

A

T

23

27
Q

Hemorrhagic stroke is histologically known as

A

Charcot-Bouchard Microaneurysms

28
Q

T/F: Ischemic stroke is more fatal than primary intracerebral hemorrhage

A

F- PIH is more fatal

29
Q

Most common sites of cerebral hemorrhage

A
  1. Putamen and adjacent internal capsule
  2. Lentiform Nucleus
  3. Basal ganglia
30
Q

T/F: Lobar hemorrhages are strictly associated with hypertension

A

F= not strict

31
Q

T/F: Hydrocephalus may occur from the compression of the lateral ventricles

A

F- third ventricle

32
Q

This imaging modality is the best for ischemic stroke

this is best for hemorrhage:

A

Ischemia- MRI
Hemorrhage- CT Scan

33
Q

This sequence of MRI can detect infarcted lesion within minutes, earlier than CT and other MRI sequences

A

Diffusion weighted

34
Q

Color of hemorrhage and infarct on CT Scan

A

Hemorrhage- white
Infarct - dark

35
Q

Color of hemorrhage and infarct on MRI

A

Hemorrhage- white
Infarct - dark

36
Q

T/F: Results from a T1 weighted MRI are similar to that of a CT scan

T/F: MRA is not as accurate as CT angiography in measuring the degree and morphology of changes within a cerebral or intracranial vessel

A

T

T

37
Q

This demonstrates atheromatous plaques and stenosis of large vessels, particularly of the carotid but also of the vertebrobasilar arteries

A

Doppler Ultrasound Flow Studies

38
Q

This is requested if you want to know the blood flow or the presence of stenosis in cerebral circulation

A

Transcranial doppler

39
Q

NIHSS below _____ will have an 80% good/excellent outcome

NIHSS above _____ will have less than 20% good or excellent outcome

A

12-14
20-26

40
Q

polymorphism on chromosome _____ have putative connections to vascular disease

A

chromosome 12

41
Q

This drug is the most consistently useful drug in the prevention of thrombotic and possibly, embolic strokes

A

Heparin

NEUROLOGY II (4 decks)

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