Cerebrovascular Diseases Flashcards
Enumerate and define the boundaries of the ACA segments
A1 horizontal: ICA to ACOM
A2 vertical: ACOM to callosomarginal artery
A3 callosal: distal to callosomarginal artery
Enumerate and define the boundaries of the ICA segments
C1: cervical segment C2: petrous (horizontal) segment C3: lacerum segment C4: cavernous segment C5: clinoid segment C6: supraclinoi) segment C7: communicating segment
Enumerate and define the boundaries of the MCA segments
M1 horizontal or sphenoidal segment: origin to bi/trifurcation (the limen insulae)
M2 insular segment: bi/trifurcation to circular sulcus of insula where it makes hairpin bend to continue as M3
M3 opercular segment: opercular branches (those within the Sylvian fissure)
M4 cortical segment: branches emerging from the Sylvian fissure onto the convex surface
Enumerate and define the boundaries of the PCA segments
P1: basilar artery to Pcom
P2: Pcom to the posterior aspect of the midbrain
P3: posterior aspect of the midbrain to calcarine fissure
P4: distal to the anterior limit of the calcarine fissure
Enumerate and define the boundaries of the vertebral arteries segments
V1 preforaminal: origin to C6 transverse foramen
V2 foraminal: C6 to the C2
V3 atlantic or extradura): C2 to the dura
V4 intradural: dura to basilar artery
Branches of the A1 segment of the ACA
A1 (horizontal): ICA to ACOM
1 medial lenticulostriate artery
2 recurrent artery of Heubner3 Acom
Branches of the A2 segment of the ACA
A2 vertical: ACOM to callosomarginal artery
1 orbitofrontal artery
2 frontopolar artery
Branches of the A3 segment of the ACA
A3 callosal: distal to callosomarginal artery
1 pericallosal artery
2 callosomarginal artery (runs in the cingulate sulcus)
Segments of the ICA that has no branches
C1: cervical segment
C3: lacerum segment
C5: clinoid segment
Branches of the C2 segment of the ICA
C2: petrous (horizontal) segment
1 caroticotympanic artery
2 vidian artery
Branches of the C4 segment of the ICA
C4: cavernous segment
1 meningohypophyseal trunk
2 inferolateral trunk
Branches of the C6 segment of the ICA
C6: supraclinoid segment
1 ophthalmic artery
2 superior hypophyseal artery
Branches of the C7 segment of the ICA
1 Pcom
2 anterior choroidal artery
3 ACA
4 MCA
What is the ABCD2 scoring?
1 point age>=60 1 point BP: S >=140 or D >=90 Clinical feature: 2 points unilateral 1 point speech 1 point Diabetes Duration 2 points >=60 mins 1 point 10-59 mins
ABCD2 Scores 2day Risk of stroke
0-3: 1%
4-5: 4.1%
6-7: 8.1%
CHA2DS2-VASc
Congestive Heart Failure Hypertension Age>75* Diabetes Stroke/TIA/TE* Vascular Disease Age>65 Sex
*2 points
score>=2 is HIGH RISK
HASBLED
Hypertension >160 Abnormal liver renal function Stroke Bleeding tendency Labile INR Elderly>65 Drugs (alcohol)
> =3 high risk
Speltzer Martin Scoring
size of nidus 6cm = 3 eloquence of adjacent brain non-eloquent = 0 eloquent = 1 venous drainage superficial only = 0 deep = 1
Risk of aneurysmal rupture for ruptured?
3-4% first 24 hours then 1-2%/day first month, 3% per year after 3 months
Sensitivity of CT scan in detecting SAH in 12 hours
98-100%
Angiogram sensitivity in detecting aneurysm
x
Stroke RCT: ATC
Antiplatelet Trialist Collaboration
ASA vs Placebo
Odds reduction of composite outcome by 33%
Stroke RCT: CAPRIE
Clopidogrel vs Aspirin in at Risk for Ischemic Events
Clopidogrel 8.7% reduction compared to Aspirin
Stroke RCT: MATCH
Management of Atherothrombotic Risk with Clopidogrel
Clopidogrel+Aspirin vs Clopidogrel
Negative study
Higher hemorrhage in dual antiplatelet
Stroke RCT: CHARISMA
Clopidogrel for High Risk and Ischemic Stabilization Management and Avoidance
Clopidogrel+Aspirin vs Aspirin
Same
Increased hemorrhage in dual antiplatelet
Stroke RCT: SPS3
Secondary Prevention of Small Subcortical Strokes
Clopidogrel + Aspirin vs Aspirin
Same
Increased hemorrhage in dual antiplatelet
Stroke RCT: CSPS1
Cilostazol in Stroke Prevention Study
Cilostazol vs Placebo
41.7% risk reduction of recurrent ischemic strome
Stroke RCT: TOSS
Trial of Cilostazol Symptomatic Intracranial Stenosis
Cilostazol+Aspirin vs Aspirin
Progression of intracranial stenosis by MRA was less in dual antiplatelet
Stroke RCT: TOSS 2
Trial of Cilostazol in Symptomatic Intracranial Stenosis
Cilostazol+Aspirin vs Clopidogrel+Aspirin
No difference in rate of ICAS progression
But more hemorrhage in Clopidogrel
Stroke RCT: CATS
Canadian American Stroke Study
Ticlopidone vs Placebo
30% Composite outcome reduction
Stroke RCT: TASS
Ticlopidone vs Aspirin Stroke Study
Ticlopidone vs Aspirin
Reduced stroke or death by 12%
Neutropenia in Ticlopidone
Stroke RCT: ESPS1
European Stroke Prevention Study 1
Dipyrimadole+Aspirin vs placebo
33% reduction
Stroke RCT: ESPS2
European Stroke Prevention Study 2
4 arms
Dipyridamole+Aspirin vs
Dipyridamole vs
Aspirin vs placebo
Stroke reduction compared to placebo: 37.8% 18% 16% No increased bleeding