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NMSP Exam 1 > Cerebrovascular Diseases & Infections > Flashcards

Cerebrovascular Diseases & Infections Flashcards

1
Q

Describe the deficits associated with the Anterior Cerebral Artery area

A

Upper motor neuron type weakness & Cortical type sensory loss, contralateral hemiplegia

Contralateral leg more than arm or face

Alien hand syndrome

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2
Q

Describe the deficits associated with the posterior cerebral artery

A

contralateral homonymous hemianopia

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3
Q

Describe the deficits associated with the middle cerebral artery

A

Most common for infarcts or ischemic events
Aphasia, Hemineglect, Hemianopia, Face-arm sensorimotor loss
Gaze preference toward lesion
Lacunes: small deep infarcts involving penetrating branches of MCA

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4
Q

What are the three major categories of cerebrovascular diseases

A

Thrombosis
Embolism
Hemorrhage

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5
Q

What are the most common cerebrovascular disorders

A

Global ischemia
Embolism
Hypertensive Intraparenchymal hemorrhage

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6
Q

What are the two types of reduction in blood flow and their respective causes

A

Global ischemia: General reduction of perfusion
–cardiac arrest, shock, severe hypotension

Focal Ischemia: Localized area
– Embolic or thrombotic arterial occlusion, atherosclerosis in hypertension

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7
Q

What deficits occur if the ACA-MCA watershed area infarcts

A

Proximal arm and leg weakness

Transcortical aphasia: language issues.

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8
Q

What deficits occur if the MCA-PCA watershed area infarcts

A

Higher order visual processing

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9
Q

What is the main cause of thrombotic occulsions

A

Atherosclerosis

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10
Q

Which cerebral artery is most affected by embolic infarction

A

MCA

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11
Q

If someone were to be diagnosed with shower emboli, what preceding event caused it?

A

long bone fracture

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12
Q

What is a transient ischemic attack

A

a neurological deficit that is less than 24 hrs in duration caused by temporary brain ischemia

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13
Q

What does a TIA mean for the future

A

impending Stroke.

15% will have debilitating stroke within 3 mo of that 15% 1/2 of them will have it within 48 hrs

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14
Q

Describe the two types of stroke

A

Hemorrhagic - bleeding

Ischemic - thrombus associated; hemorrhagic conversion is secondary bleeding of ischemia

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15
Q

Describe lacunar infarcts

A

Deep penetrating arteries produce single or multiple small <15 mm infarcts

  • -pure motor hemiparesis
  • -thalamic lacune: contralateral sensory deficits
  • -Basal Ganglia: hemiballismus
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16
Q

Describe hypertensive encephalopathy

A

Malignant HTN

HTN is most common risk factor for deep brain parenchymal hemorrhages

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17
Q

Chronic hypertension is associated with what disease process

A

Charcot-bouchard microaneurysms

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18
Q

What is Cerebral Amyloid Angiopathy

A

Lobar Hemorrhage - same B amyloid deposits in walls of vessels producing microbleeds

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19
Q

What is CADASIL

A

Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts & Leukoencephalopathy

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20
Q

Describe CADASIL

A

Recurrent strokes and dementia

First detectable approx 35 y/o

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21
Q

Aneurysms are the most common cause of what

A

Subarachnoid Hemorrhage

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22
Q

Where is the most likely place to find an aneurysm in the circle of willis

A

Anterior Communicating and Anterior Cerebral artery connection

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23
Q

In what decade of life are aneurysms most likely to rupture

A

in the 5th decade of life

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24
Q

What percentage of people die with their first ruptured aneurysm

A

25-50%

25
Q

What are the four groups of vascular malformations

A
  • Arteriovenous malformations
  • Cavernous malformations/hemangiomas
  • Capillary telangiectasias
  • Venous Angiomas
26
Q

Where in the brain vasculature are Vascular malformations most likely

A

MCA & posterior branches

27
Q

How does tuberculosis meningitis invade the CNS

A

Seeding CSF from subepidural or sub-meningeal granulomas

28
Q

How does Herpes simplex and Zoster invade the CNS

A

Produce latent infection of sensory ganglia and ascend through sensory nerves

**rabies ascends through motor nerves

29
Q

Why is compliment and ABX so ineffective in fighting CNS infection?

A

BBB does not allow those molecules in

30
Q

What treatment can be used to slow or reverse cerebral edema caused by infection

A

corticosteroids

31
Q

if someone had dense exudate located mostly in the sagittal sinus, what would be the likely etiology of their meningitis

A

Pneumococcal

32
Q

If someone had dense exudate around the basal area of their brain, what would be the likely etiology of their meningitis

A

H. Influenzae

33
Q

Describe the spinal tap of someone with bacterial meningitis

A

Cloudy
Neutrophils
Little glucose
Increased protein

34
Q

Describe the spinal tap of someone with viral meningitis

A

Clear
lymphocytes
Normal glucose
Increased protein

35
Q

What is the likely etiology of meningitis in a neo nate

A

E. Coli

Grp B Strep

36
Q

What is the likely etiology of meningitis in a 3m-2 yr unvaccinated kid

A

H. Influenzae B

37
Q

What is the likely etiology of meningitis of an adolescent/young adult

A

N. Meningitidis

38
Q

What is the likely etiology of meningitis in the elderly

A

Strep pneumo & Listeria

39
Q

What is the presentation and spinal tap like for someone with a brain abscess

A

Progressive focal neurologic deficits

CSF: High WBC, High Protein, Normal Glucose

40
Q

Someone comes in for brain surgery. You didnt review the chart and Putoff is your preceptor. He mentions the thick dura of the patients brain and asks what likely left this sign.

A

Subdural empyema.

Extradural abscesses associated with osteomyelitis

41
Q

Christian went to military training this summer and was packed in with 100 other sweaty anxious docs. He gets meningitis, what etiology of meningitis is he likely to get and why would kristen be mad at him?

A

N. Meningitidis - colonizes crowded populations. dorms barracks etc

transmitted by direct contact. Kissing, sharing water bottles etc

42
Q

Describe the disease process with chronic meningitis of TB

A

subarachnoid space fills with gelatinous exudate with obliterative endarteritis

Predilection for base of the brain (arachnoiditis)

43
Q

What is a tuberculoma

A

Well circumscribed Intraparenchymal mass; central caseous necrosis; inactive lesions calcify

44
Q

Describe neurosyphillis

A

occurs in 10% of untreated people

  • -Chronic meningitis -> communicating hydrocephalus
  • -Paretic neurosyphilis (delusions of grandeur)
  • -Tabes Dorsalis (Damage to sensory nerves)
45
Q

What family of viruses cause 80% of viral meningits

A

Enterovirus

Most self limiting

46
Q

Describe West Nile Virus

A

Polio like syndrome with paralysis

CSF: colorless, increase pressure, increase protein, normal glucose

Both neuronophagia and microglial nodules

47
Q

What areas of the brain are affected by HSV-1

A

Inferior & medial temporal lobes

Orbital gyri of frontal lobes

48
Q

What percent of neonates delivered to mothers with HSV-2 will develop sever encephalitis

A

50%

49
Q

Where does CMV localize in the brain and what is the complication

A

Periventricular sub ependymal regions -> sever hemorrhagic necrotizing ventriculoencephalitis & choroid plexitis

50
Q

What is the complication of congenital CMV

A

periventricular necrosis -> sever brain destruction -> microcephaly & periventricular calcification

51
Q

Describe the acute phase and the post infection phase of polio

A

Acute: Neurophagia of the anterior horn (flaccid paralysis)

Post-polio: 25-35 years. Progressive weakness with decreased muscle mass and pain (FDR)

52
Q

Describe the rabies infection

A

1-3 month incubation

Nonspecific sx (malaise, HA, Fever) with local paresthesias around wound.

hydrophobia

Negri bodies

53
Q

What is a unique complication of HIV meningitis

A

IRIS (Immune reconstitution Inflammatory syndrome) After antivirals are started, immune system kicks into high gear

Also increases chance of primary CNS Lymphoma

54
Q

Describe Progressive multifocal leukoencephalopathy

A

JC Polyomavirus - asymptomatic at first but comes back with immune suppression

Ill-defined destruction of white matter; subcortical area of demyelination with lipid-laden macrophages in the center

55
Q

Describe subacute sclerosing panencephalitis

A

Paramyxovirus

Rare, progressive clinical syndrome
–Cognitive decline, spasticity of limbs, & seizures

Children or young adults not vaxxed against measles ->
widespread gliosis and myelin degeneration

56
Q

if you patient has diabetes which fungal meningoencephalitis are they likely to come down with

A

mucormycosis

57
Q

Describe toxoplasmosis infection

A

Opportunistic infection for HIV and pregnancy

Brain abscesses develop near gray-white junction of cerebral cortex and deep gray nuclei

58
Q

Describe the histo of toxoplasmosis infection

A

Central focus of necrosis, petechial hemorrhages surrounded by acute and chronic inflammation

59
Q

Describe the spongiform changes seen in prion diseases

A

intracellular vacuoles in neurons and glia

NMSP Exam 1 (17 decks)

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