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Cerebrovascular Diseases Flashcards

1
Q

Enumerate and define the boundaries of the ACA segments

A

A1 horizontal: ICA to ACOM
A2 vertical: ACOM to callosomarginal artery
A3 callosal: distal to callosomarginal artery

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2
Q

Enumerate and define the boundaries of the ICA segments

A 
C1: cervical segment
C2: petrous (horizontal) segment
C3: lacerum segment
C4: cavernous segment
C5: clinoid segment
C6: supraclinoi) segment
C7: communicating segment
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3
Q

Enumerate and define the boundaries of the MCA segments

A

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

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4
Q

Enumerate and define the boundaries of the PCA segments

A

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

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5
Q

Enumerate and define the boundaries of the vertebral arteries segments

A

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

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6
Q

Branches of the A1 segment of the ACA

A

A1 (horizontal): ICA to ACOM
1 medial lenticulostriate artery
2 recurrent artery of Heubner3 Acom

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7
Q

Branches of the A2 segment of the ACA

A

A2 vertical: ACOM to callosomarginal artery
1 orbitofrontal artery
2 frontopolar artery

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8
Q

Branches of the A3 segment of the ACA

A

A3 callosal: distal to callosomarginal artery
1 pericallosal artery
2 callosomarginal artery (runs in the cingulate sulcus)

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9
Q

Segments of the ICA that has no branches

A

C1: cervical segment
C3: lacerum segment
C5: clinoid segment

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10
Q

Branches of the C2 segment of the ICA

A

C2: petrous (horizontal) segment
1 caroticotympanic artery
2 vidian artery

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11
Q

Branches of the C4 segment of the ICA

A

C4: cavernous segment
1 meningohypophyseal trunk
2 inferolateral trunk

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12
Q

Branches of the C6 segment of the ICA

A

C6: supraclinoid segment
1 ophthalmic artery
2 superior hypophyseal artery

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13
Q

Branches of the C7 segment of the ICA

A

1 Pcom
2 anterior choroidal artery
3 ACA
4 MCA

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14
Q

What is the ABCD2 scoring?

A 
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
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15
Q

ABCD2 Scores 2day Risk of stroke

A

0-3: 1%
4-5: 4.1%
6-7: 8.1%

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16
Q

CHA2DS2-VASc

A 
Congestive  Heart Failure
Hypertension
Age>75*
Diabetes
Stroke/TIA/TE*
Vascular Disease
Age>65
Sex

*2 points
score>=2 is HIGH RISK

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17
Q

HASBLED

A 
Hypertension >160
Abnormal liver renal function
Stroke
Bleeding tendency
Labile INR
Elderly>65
Drugs (alcohol)

> =3 high risk

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18
Q

Speltzer Martin Scoring

A 
size of nidus
      6cm = 3
eloquence of adjacent brain
    non-eloquent = 0
    eloquent = 1
venous drainage
    superficial only = 0
    deep = 1
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19
Q

Risk of aneurysmal rupture for ruptured?

A

3-4% first 24 hours then 1-2%/day first month, 3% per year after 3 months

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20
Q

Sensitivity of CT scan in detecting SAH in 12 hours

A

98-100%

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21
Q

Angiogram sensitivity in detecting aneurysm

A

x

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22
Q

Stroke RCT: ATC

A

Antiplatelet Trialist Collaboration

ASA vs Placebo

Odds reduction of composite outcome by 33%

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23
Q

Stroke RCT: CAPRIE

A

Clopidogrel vs Aspirin in at Risk for Ischemic Events

Clopidogrel 8.7% reduction compared to Aspirin

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24
Q

Stroke RCT: MATCH

A

Management of Atherothrombotic Risk with Clopidogrel

Clopidogrel+Aspirin vs Clopidogrel
Negative study
Higher hemorrhage in dual antiplatelet

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25
Stroke RCT: CHARISMA
Clopidogrel for High Risk and Ischemic Stabilization Management and Avoidance Clopidogrel+Aspirin vs Aspirin Same Increased hemorrhage in dual antiplatelet
26
Stroke RCT: SPS3
Secondary Prevention of Small Subcortical Strokes Clopidogrel + Aspirin vs Aspirin Same Increased hemorrhage in dual antiplatelet
27
Stroke RCT: CSPS1
Cilostazol in Stroke Prevention Study Cilostazol vs Placebo 41.7% risk reduction of recurrent ischemic strome
28
Stroke RCT: TOSS
Trial of Cilostazol Symptomatic Intracranial Stenosis Cilostazol+Aspirin vs Aspirin Progression of intracranial stenosis by MRA was less in dual antiplatelet
28
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
28
Stroke RCT: CATS
Canadian American Stroke Study Ticlopidone vs Placebo 30% Composite outcome reduction
29
Stroke RCT: TASS
Ticlopidone vs Aspirin Stroke Study Ticlopidone vs Aspirin Reduced stroke or death by 12% Neutropenia in Ticlopidone
30
Stroke RCT: ESPS1
European Stroke Prevention Study 1 Dipyrimadole+Aspirin vs placebo 33% reduction
31
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 ```
32
Stroke RCT: ESPRIT
European/Australasian Stroke Prevention in Reversible Ischemia Dipyridamole+Aspirin vs Aspirin Dual antiplatelet 20% reduced composite outcome No increased bleeding
33
Stroke RCT: PROFESS
Prevention Regimen for Effectively Avoiding Second Stroke Dipyridamole+Aspirin vs Clopidogrel Similar rates of recurrent ischemic stroke More hemorrhage in dual antiplatelet
34
Stroke RCT: TACIP
Trifusal Aspirin in Cerbral Infarction Prevention Trifusal vs Aspirin Similar efficacy Less hemorrhage in trifusal
35
Stroke RCT: TAPIRSS
Trifusal vs Aspirin in the Prevention of Infarction: A Randomized Stroke Study Trifusal vs Aspirin No significant difference in combined endpoint Less hemorrhage in Trifusal
36
Stroke RCT: WARSS
Warfarin Aspirin Recurrent Stroke Study Warfarin vs Asprin No significant difference
37
Stroke RCT: WASID
Warfarin Aspirin in Symptomatic Intracranial Disease Warfarin vs Aspirin No significant difference
38
Stroke RCT: CSPS2
Cilostazol Stroke Prevention Study 2 Cilostazol vs Aspirin Non inferiority
39
Antidote for Dabigatran
Idarucizumab
40
FUNC scoring
``` Volume Location Age GCS Cognitive Impairment ```
41
30day mortality risk ICH scoring
``` GCS Volume Intraventricular Hemorrhafe Infratentorial Age ```
42
FUNC scoring
``` Volume Location Age GCS Cognitive Impairment ```
43
30day mortality risk ICH scoring
``` GCS Volume Intraventricular Hemorrhafe Infratentorial Age ```
44
FUNC scoring
``` Volume Location Age GCS Cognitive Impairment ```
45
30day mortality risk ICH scoring
``` GCS Volume Intraventricular Hemorrhafe Infratentorial Age ```
46
Sensitivity of CT scan in detecting SAH in 24 hours
93%
47
Sensitivity of CT scan in detecting SAH in 6 days
57-85%
48
If CT Scan is unavailable, the most sensitive MRI studies for detecting SAH are?
T2 Gradient Echo | FLAIR
49
If cerebral angiogram is negative in SAH, repeat when?
7-14 days
50
In SAH, surgery may be delayed if there is:
Ischemia or severe angiographic vasospasm
51
For poor grade SAH (HHIV-V), early surgery may be done if:
Hematoma | Hydrocephalus
52
ICH lifetime risk in a patient with AVM
=105-age
53
Morbidity risk of AVM for each bleed
30-50%
54
Mortality risk of ruptured AVM for each bleed
10%
55
Bleeding risk in a patient with AVM if unruptured
2-4% per year
56
Overall mortality rate from AVM hemorrhage for adults
1%
57
Overall mortality rate from AVM hemorrhage for children
2%
58
ICH lifetime risk in a patient with AVM
=105-age
59
Morbidity risk of AVM for each bleed
30-50%
60
Mortality risk of ruptured AVM for each bleed
10%
61
Bleeding risk in a patient with AVM if unruptured
2-4% per year
62
Overall mortality rate from AVM hemorrhage for children
2%
63
Overall mortality rate from AVM hemorrhage for adults
1%
64
In SAH, surgery may be delayed if there is:
Ischemia or severe angiographic vasospasm
65
For poor grade SAH (HHIV-V), early surgery may be done if:
Hematoma | Hydrocephalus
66
Consistent risk factors that increase risk of hemorrhage in AVM
1 deep venous drainage 2 single draining vein 3 venous stenosis 4 high MAP in the feeding artery
67
Inconsistent risk factors that increase risk of hemorrhage in AVM
1 intranid aneurysms 2 deep location 3 small nidus 4 venous stasis
68
Potential risk factors that increase risk of hemorrhage in AVM
``` 1 hypertension 2 increasing age 3 smoking 4 pregnancy 5 vertebrobasilar supply 6 perforating supply ```
69
AVM score for Radiosurgery
=0.1Volume + 0.02Age + 0.5Location 1 point if: BG, thalamus, brainstem
70
Treatment of choice for cavernous malformation
Microsurgery
71
Types CCF
type A: a direct connection between the intracavernous ICA and CS type B: dural shunt between intracavernous branches of the ICA and CS type C: dural shunts between meningeal branches of the ECA and CS type D: B + C
72
CHADS2
``` Congestive Heart Failure Hypertension Age>75 Diabetes Stroke/TIA/TE ```
73
Fisher Grading
1: no subarachnoid (SAH) or intraventricular haemorrhage (IVH) detected 2: diffuse thin (1 mm in thickness +/- intracranial haemorrhage (ICH) or IVH 4: no or thin SAH + ICH or IVH
74
WFNS Classification
``` GCS 15 GCS 13-14 without deficit GCS 13-14 with focal neurological deficit GCS 7-12 GCS ```
75
Absolute Contraindications to rTPA
x
76
In cerebral infarction, there is a early ___1_____ diffusivity followed by later ___2_____ diffusivity on MRI
1 Reduced | 2 Elevated
78
Brainstem syndromes
X
79
In cerebral infarction, there is a early ___1_____ edema followed by later ___2_____ edema on MRI
1 cytotoxic | 2 vasogenic
80
Mode of action of Citcoline
x
81
High risk cardioembolic source 9
``` 1 AF 2 recent MI 3 Atrial myxoma 4 Rhematic MS 5 Prosthetic valves 6 Infective Endocarditis 7 Marantic Endocarditis 8 dilated CM 9 Left thrombus ```
82
low risk cardioembolic source 6
``` 1 PFO 2 Mitral annular calcification 3 Mitral valve prolapse 4 Mitral valve strands 5 Aortic stenosis 6 Atrial septal aneurysm ```
83
Exclusion criteria for rtpa treatment with time window of 4.5 hours (4)
1 >80 years old 2 anticoagulant use 3 NIHSS>25 4 history of both ischemic stroke and diabetes

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