Cerebrovascular disorders Flashcards
Stroke/ TIA- Sx
- Sudden onset of weakness in face, arm, leg
- Unilateral
- Numbness
- loss of vision, double vision
- Trouble talking (language problem), slurred speech
- True vertigo
- Incoordination on one side
Cardioembolic stroke- Eti
- 25-30% ischemic stroke
- Afib and post MI- begins in heart
- Can go to any vessel
- Anterior and middle cerebral most common
Lacunar stroke- Eti
- 25% ischemic stroke
- Small arteries, small stroke
- DM and HTN
- Better prognosis
Transient ischemic attack- Eti
- Highest risk of progression to stroke in 1 month
- Embolization commonly
- Afib, heart dz, MI
- Hx of vascular disease
Transient ischemic attack- Sx
- Acute, focal neurologic deficit
- Resolves within 24 hours
- Weakness on contralateral arm
- Numbness and paresthesia
- Transient monocular blindness (Amaurosis fugax)
Transient ischemic attack- Dx
- CT or MRI scan within 24 hrs
- Asses for underlying cause
Transient ischemic attack- Tx
- Anticoagulants
- Aspirin
- Angioplasty or stenting
Lacunar infarct- Tx
Aspirin
- Tx chronic dz
Lacunar infarct- Dx
-MRI
Carotid artery obstruction- Anterior- Sx
- Anterior: Sensory loss in contralateral leg
- Arm weakness
- Contralateral grasp reflex
- Paratonic rigidity
- Confusion
- Behavioral and memory disturbance
- Incontinence
Carotid artery obstruction- Middle- Sx
- Contralateral hemiplegia
- Hemisensory memory loss
- Homoymous hemianopia
- Eyes deviated to side of lesion
- Drowsiness, stupor and coma
Vertebrobasilar obstruction- Posterior- Sx
- Spontaneous pain
- Macular sparing hemionymous hemiopia
- Mild hemiparesis
Vertebrobasilar obstruction- Vertebral- Sx
- Clinically silent
Vertebrobasilar obstruction- Basilar- Sx
Coma with pinpoint pupils
- Flaccid quadriplegia
- Sensory loss
- Cranial nerve abn
- Diplopia,
Ischemic stroke- Dx
- CT or MRI
- Determine cause
Ischemic stroke- Tx
- IV throbolytics before 4.5 hrs
- Aspirin if tPA contraindicated
- Manage systemic sx
Intracerebral hemorrhage- Eti
- Spontaneous, non truamatic
- No vascular anomolies
- HTN- microaneuryisms
- Advanced age, male
Intracerebral hemorrhage- Sx
- LOC
- Vomiting, HA
- Rapidly evolving neuro deficit- hemiplegia
Intracerebral hemorrhage- Dx
CT scan
Intracerebral hemorrhage- Tx
- Supportive tx
- Ventricular drainage, hemostasis
Spontaneous subarachnoid hemorrhage- Eti
- 5-10% strokes
- Trauma
- Old, female, ethnic, smoker with high alcohol consumption
Spontaneous subarachnoid hemorrhage- Sx
- Sudden, severe HA
- N/V
- Signs of meningeal irritation, nuchal rigidity
- Transient LOC to coma to death
Spontaneous subarachnoid hemorrhage- Dx
- CT
- CSF exam
- Cerebral arteriography
Spontaneous subarachnoid hemorrhage- Tx
- Prevent further hemorrhage
- Greatest within first days
Intracranial aneurysm- Eti
- Polycystic disease, coarctation of aorta
- Smoking, HTN, hypercholesterol
- Circle of willis
- Old, female, ethnic, smoker with high alcohol consumption
Intracranial aneurysm- Sx
- Asymptomatic, nonspecific until rupture
- Same sx as subarachnoid:
- Sudden, severe HA
- N/V
- Signs of meningeal irritation, nuchal rigidity
- Transient LOC to coma to death
Intracranial aneurysm- Dx
- Angiography
Intracranial aneurysm-Tx
Prevent hemorrhage- surgically or endovascularaly
Arteriovenous malformations- Eti
- Congenital vascular malformation
- Assoc with arterial aneurysm
- Supratentoral most common
- Sx manifest before age 40
Arteriovenous malformations- Sx
- Hemorrhage
- Recurrent seizure
- HA
- Focal neuro deficiencies depending on brain region affected
Cranial bruit- over ipsilateral eye
Arteriovenous malformations- Dx
- CT
- Arteriography
Arteriovenous malformations- Tx
- Surgery to prevent further hemorrhage
Subclavian steal syndrome- Eti
- Subclavian artery stenosis
Subclavian steal syndrome- Sx
- Unequal upper extremity BP
- Vertigo and syncope
- Ulcerated or gangrenous fingers
Subclavian steal syndrome- Tx
Revascularization
Amaurosis fugax- Eti
- TIA of retina
- Emboli stuck in retinal vessel
- HTN, hypercholesterol
Amaurosis fugax- Sx
- Curtain of blindness, monocular
- Whitened, edematous retina
- Cherry red fovea
Pseudotumor cerebri- Eti
- Lots of causes: thrombosis, otitis media, mastoiditis, pulm dz, lupus…
- Benign intracranial htn
- Overweight women 20-44
Pseudotumor cerebri- Sx
- HA, diplopia
- Enlargement of blind spots
- Papilledema
- Abducens nerve dysfunction
Pseudotumor cerebri- Dx
- Lumbar puncture
- CT- RO lesion
- MR venography
Pseudotumor cerebri- Tx
- Acetaxolamide- reduction of CSF
- Tx underlying cause
