Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med- Neuro > Cerebrovascular Dz Lecture > Flashcards

Cerebrovascular Dz Lecture Flashcards

1
Q

Sudden or rapid onset of a neurologic deficit in the distribution of a vascular territory lasting over 24 hours

A

Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The sudden onset of a neurologic deficit in the distribution of a vascular territory lasting less than 24 hours

**most last less than 30 mins

A

TIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

REVERSIBLE ischemic insult to brain cells that recover, but increases risk of subsequent stroke

A

TIA

**increase in frequency of TIAs is a bad sign!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

worsening signs or symptoms over time ..describes what type of stroke?

A

Stroke-in-evolution (progressive stroke)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What percentage of strokes are ischemia/infarct?
What percentage are hemorrhagic?

A

Ischemic/infarct: 85%

Hemorrhagic: 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3rd leading cause of death in US
over 200,000 deaths per year
Men 1.3x more common
Blacks 1.3x more common

A

Strokes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MC cause of death in patients with cebrovascular disease

A

MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most powerful risk factor for developing a stroke?

A

HTN!

..esp systolic BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the goal BP to keep under for preventing strokes?

A

under 140/90

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Smoking increases risk of by 2-4x

A

Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diabetes Mellitus increases risk by 3x

A

Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HTN
Smoking
Atherosclerosis
Diabetes Mellitus
Atrial fibrillation
others: male gender, OCPs, excess ETOH, hyperlipidemia

A

Risk factors for stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Atherosclerosis: large vessels often involved *involved in ____% of all ischemic strokes (infarct)

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  • Adequacy of collateral circulation
  • Development of Circle of Willis
  • Duration of insult/restoration of blood flow.
A

Pathological outcomes depend on these

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

SMALL vessel disease- deep penetrating arterioles occlude/thrombose

A

Lacunar infarcts (aka lipohyalinosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Small vessel disease (Lacunar infarcts) account for ___% of ischemic strokes

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Major risk factor of Lacunar infarcts (small vessel disease)

A

HTN!

..lipids and DM also contribute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The defect on CT or MRI of a very small stroke or TIA (lacunar infarct) is less than…

A

1.5 cm (most are under 5 mm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

May be without symptoms..detected by CT scan as incidental finding

A

Lacunar (aka lopohyalinosis), or small vessel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Atherosclerosis of: base of aorta carotid bifurcation origin of internal carotid external carotid vertebral/basilar arteries

A

increase risk of ischemic stroke!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Embolism from heart or artery to brain

*blood clot breaks off, occludes more distant/distal vessel

A

Cerebral emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why is a well developed Circle of Willis important?

A

This can be protective against stroke!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Cardiac emboli often lodge in _____ sized vessels (MCA, ACA)

A

MEDIUM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Artery to artery emboli often cause _____ or ___________

A

TIAs or small neuro deficits

*lodge, then break up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Frequent source:
Carotid bifurcation or internal carotid

*often small emboli: Platelets/fibrin/RBCs

A

Artery to artery emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

~20% of ischemic strokes

*OFTEN CAUSED BY A FIB

A

Cardioembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

MI with mural thrombus (35% incidence post large anterior wall MI) can lead to….

A

Cardioembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

A fib***
MI with mural thrombus
Dilated cardiomyopathy
VHD

can all cause…

A

Cardioembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

ABRUPT onset of non-convulsive focal defect in a vascular territory

A

Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

80-90% have NO warning symptoms

(10-20% have warning, TIA)

A

Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
  • Contralateral hemiparesis or hemisensory loss
  • Hemianopsia (visual field defect)
  • If dominant hemisphere..Aphasia
  • If non dominant..speech and comprehension preserved. may develop anosognosia (denial/neglect of deficit) or a confusional state
A

MIDDLE CEREBRAL ARTERY (MCA) involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Less common..

*Sx more pronounced in leg, associated language, gait disturbance

A

ANTERIOR CEREBRAL ARTERY (ACA) involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Least common..
Crossed contralateral dysfunction (motor/sensory) plus ipsilateral bulbar/cerebellar signs: vertigo, dizziness, gait disturbance, diplopia, facial palsy, dysarthria, etc

A

Posterior circulation (ie Vertebral artery off subclavian) involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

HTN Deep penetrating arterioles
Small infarcts up to 1.5 cm on CT/MRI
*clinical syndrome depending on where infarct is; may also present as TIA

A

Lacunar strokes/infarcts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Transient monocular blindness
Embolism to ophthalmic artery (off carotid)

A

Amaurosis fugax (carotid disease present)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Image of choice for stroke within the first 48 hours?

A

CT scan!

(CTs are better than MRIs the first 48 hours after intracranial hemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Detection of infarcts on CT limited to _____ and ______

A

SIZE and TIMING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

only 5% of strokes are visible in 1st 12 hours, but more than ____% are visible at one week

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

More readily available
Less expensive
No contrast required

A

Benefits of CT (over MRI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Changes of infarct may be seen as early as one hour- usually not available or needed emergently

A

MRI/MRA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

True or False…

MRI/MRA provide better detail than CT for small lesions and other pathology.
*Better for imaging of POSTERIOR FOSSA

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Non invasive with excellent resolution of large vessels

*Replaces need for arteriogram in some patients
*May be difficult to differentiate complete vs near complete occlusions.

A

Magnetic resource angiogram (MRA)

43
Q

3 to 4.5 hours is the window for…

A

giving tPA!!

44
Q

DO NOT CORRECT ISCHEMIC STROKE PATIENT’S HYPERTENSION UNTIL IT REACHES…

A

over 200 systolic over 100 diastolic

*body regulates itself! so don’t mess with it

45
Q

When do you start to correct an ischemic stroke patient’s HTN?

A

2 weeks after they come to the ER

46
Q

What type of stroke patient is it OK to lower BP in?

(but must do cautiously)

A

Hemorrhagic stroke

47
Q

Screening tool for evaluating COMMON CAROTID and ORIGIN OF INTERNAL CAROTID ARTERY

limitations: may be difficult to differentiate between complete vs near complete occlusions

A

Carotid doppler ultrasound (duplex)

**non invasive but limited capability

48
Q

MOST ACCURATE
**GOLD STANDARD** for extra and intracranial disease

A

Arteriography

*also most invasive!

49
Q

Gold standard for strokes!! most accurate (but invasive)

Complications: contrast reaction, kidney failure, plaque rupture, stroke
(*non ionic contrast has reduced complications)

A

Arteriography

50
Q

Risk factor modification:

Aggressive control of… BP, Lipids, Diabetes
*smoking cessation, exercise, diet

A

Prevention of Stroke

51
Q

Full anticoagulation for A fib pts!
*Warfarin (Coumadin) therapy long term

..this is essential for?

A

Prevention of strokes

52
Q

Abrubt onset of symptoms with transient focal neuro deficit dependent on involved anatomy (anterior, posterior circulation).

*Sx may vary during episodes.
*Exam between episodes is normal.
*Warning for subsequent stroke.

A

TIAs

53
Q
  • *-Embolic from carotid stenosis/plaque*****
  • Embolic from cardiac source
  • Severe carotid stenosis with transient hypotension
  • Small vessel occlusion: Lacunar infarcts may mimic
A

TIA causes!

54
Q

How can you possibly predict/pick up an emboli from carotid stenosis/plaque?

A

By listening for bruits in carotid arteries!

55
Q

Surgical tx of a carotid TIA which removes plaque

A

Carotid endarterectomy

56
Q

Best results if SYMPTOMATIC blockage and greater than 70% stenosis

*significantly reduces risk of subsequent ipsilateral stroke

A

Carotid endarterectomy

57
Q

Can be done in select* pts with symptoms and 50-70% stenosis

A

Carotid endarterectomy

(this has MAJOR complications)

58
Q

These drugs are indicated for all patients with:

less than 70% stenosis and TIA symptoms
diffuse cerebrovascular dz
pts who are poor surgical candidates
patients with asymptomatic carotid disease

A

Anti-platelet agents

59
Q

These agents prevent platelet aggregation and release of vasoactive substances like thromboxane A2

A

Anti platelet agents

60
Q

Inhibits cyclooxygenase Inhibits synthesis of thromboxane A2,
increasing both platelet aggregation and vasoconstriction

A

Aspirin

61
Q

lasts permanently for life of platelet (about 8 days)

*325 mg/daily

A

Aspirin

(SE= GI side effects and bleeding)

62
Q

Decreases frequency of TIA’s and risk of subsequent stroke
Also applies to patient with prior stroke- ↓incidence of recurrence.

A

Aspirin

63
Q

75mg/day
Inhibits platelet aggregation and prevents activation of glycoprotein IIb/IIIa (a fibrinogen binder)

*Decreases atherosclerotic events

A

Clopidogrel (Plavix)

64
Q

Slightly better outcomes compared to ASA alone but expensive!

*alternative to ASA in patients with recurrent TIA’s or ASA intolerance/allergy.

A

Clopidogrel (Plavix)

(SE= diarrhea, rash)

65
Q

Usually good prognosis for recovery over ~4-6 weeks
Tx= supportive measures plus ASA or Clopidogrel.

*AGGRESSIVE LONG TERM TX OF BP AND LIPIDS!!*****

A

Lacunar infarct tx

66
Q

What is essential to control long term in pts with lacunar infarct?

A

BP and Lipids!

67
Q

True or false…

You should hospitalize ALL stroke patients and most TIA patients (esp if first TIA episode)

A

TRUE

68
Q

Cerebral infarct= thrombotic or embolic occlusion of major vessel.

Treatment dependent on timing!

What image must you obtain first to rule out hemorrhage?

A

head CT scan!

69
Q

If onset of cerebral infarct (NO HEMORRHAGE) is within 4.5 hours, what can you give?

A

thrombolytic therapy with tPA (bolus infusion up to 90 mgs) over 1 hour

70
Q

If within 4.5 hours, can give bolus infusion up to 90 mgs over 1 hour

A

tPA (thrombolytic therapy)

71
Q

Thrombolytic therapy increases the chances of a favorable outcome by about …..

A

50%

72
Q

True or false..
Thrombolytics cause neurologic outcome improved at 3 mos and 1 yr with decrease in expected deficit and reduction of initial deficit.

A

True

73
Q

Cerebral hemorrhage in 6 to 7% (half will die)

. ..risk of?

A

tPA

74
Q

Recent bleeding
Prior stroke
BP over 185/110
Recent major stroke

A

Contraindications of tPA

75
Q

Loose mesh stent placed in thrombus obstructing cerebral vessel

*removes thrombus and restores blood flow.

A

Solitaire device

76
Q

What did the SWIFT-PRIME trial show?

A

that tPA plus Solitare device works better than tPA alone!

3 months later.. tPA alone, 35% functioning
tPA+solitare, 60% functioning

77
Q

Which study showed…
tPA alone, 3 months later 35% of pts function independently
tPA plus Solitare, 3 months later 60% of pts function independently

A

SWIFT-PRIME

78
Q

True or False..

Heparin preparations are used for immediate and short term anticoagulation (days)

A

TRUE

79
Q

Is Warfarin used for short or long term oral anticoagulation?

A

LONG! (works by inhibiting production of clotting factors in liver)

80
Q

Best diagnostic for detecting or ruling out a hemorrhage?

A

CT scan!!

81
Q

If CT scan is negative, what can you do to rule out a subarachnoid hemorrhage?

A

Spinal tap

82
Q

Major risk factor of intracerebral hemorrhage?

A

HTN

83
Q

HTN
Heme and bleeding disorders
Trauma
Anticoagulant therapy
Liver dz

..all risk factors of?

A

Intracerebral hemorrhage

84
Q

Rapid evolution of neuro deficit often progressing to hemiparesis, hemiplegia or hemisensory loss; 50% mortality *Loss of or impaired consciousness develops in 50%. *Vomiting and headache are common.

A

Intracerebral hemorrhage

85
Q

Most due to bleeding from saccular aneurysms
*highest risk if greater than 6 mm

A

Subarachnoid bleed

86
Q

Sudden onset of severe headache followed by:
N/V
impaired or loss of consciousness
+/- neuro deficit.

*Meningeal signs often present: Kernigs and Brudzinski signs

A

Subarachnoid bleed

87
Q

If suspected and CT is negative…
do CSF tap and look for blood or xanthochromia

A

Subarachnoid bleed

88
Q

Treatment: If patient is conscious.. bed rest, symptomatic and supportive care with cautious reduction of B.P.

*Angiography once patient stable
*Surgery or coil placement to prevent re-bleeding where applicable.

A

Subarachnoid bleed

89
Q

Most common vascular malformation of CNS often involving MCA and branches.

*Tangled web of arteries connected directly to veins- congenital
up to 70% bleed
often by age 40
Males>Females
some familial trends
2-3% risk bleed per year

A

Arterial Venous Malformations (AVM)

90
Q

S/S: hemorrhage (30-60%), headache (5-25%), recurrent seizure (20-40%), focal deficits
CT may confirm hemorrhage;
angiography necessary for diagnosis.
Treatment: surgery if lesion is accessible.

A

Arterial Venous Malformations (AVM)

91
Q

Carotid bifurcation
Internal carotid

..common sources of?

A

Artery to artery emboli

92
Q

Strokes involving anterior circulation (ie anterior choroidal, anterior cerebral, middle cerebral arteries)

are associated with what type of symptoms?

A

Hemispheric:

aphasia
apraxia (difficulty with skilled movements)
hemiparesis
hemisensory losses
visual field defects

93
Q

Strokes involving posterior circulation (vertebral and basilar arteries)
are associated with what symptoms?

A

Brainstem dysfunction:

Coma
Drop attacks
Vertigo
N/V
Ataxia

94
Q

______ strokes are often preceded by TIAs

______ strokes occur abruptly without warning

(choices: embolic, thrombotic)

A

Thrombotic strokes usually preceded by TIAs (Thrombotic have TIAs)

Embolic strokes usually abrupt without warning

(thrombotic strokes are when a clot forms in one of the arteries that supplies the brain)

95
Q

Usually caused by embolus from carotid or left ventricle

Sxs:
Contralateral hemiplegia (arm/face > legs)
Hemianesthesia
dominant hemisphere: global aphasia (receptive and motor)
non-dominant hemisphere: anosognosia (denial/neglect of deficit), contructional apraxia

A

Middle cerebral artery (MCA)

96
Q

What happens if there is an occlusion in the anterior cerebral artery (ACA) proximal to anterior communicating artery and the circle of willis is intact?

A

NO symptoms!

97
Q

If distal occlusion….

Paralysis of opposite foot/leg
Sensory loss to toes, foot and leg
Urinary incontinence
Grap reflex
Suck reflex
Abulia (slowness to respond)
Impaired gait/stance
Behavioral changes
Memory disturbances

A

Anterior cerebral arery (ACA)

98
Q

Contralateral hemiparesis or hemisensory loss
Hemianopsia (visual field defect)

dominant hemisphere: aphasia
non dominant hemisphere: anosognosia (denial) or a confused state

A

Middle cerebral artery (MCA)

99
Q

Less common

Sx more pronounced in leg, associated language, gait disturbance

A

Anterior cerbral artery (ACA)

100
Q

HTN, deep penetrating arterioles
small infarcts up to 1.5 cm on MRI/CT

clinical syndrome depends on location
may present as TIA

A

Lacunar infarct

101
Q

AKA multi-infarct dementia

Classically hypertensive patients
+/- history of TIA or stroke

Usually manifests as forgetfulness in absence of depression and inattentiveness
*typically occurs in stepwise fashion, related to area of CNA affected

A

Vascular dementias

102
Q

DO NOT CONFUSE THIS WITH A STROKE

Classic triad:
Cannot close 1 eye
Cannot raise eyebrow
Periauricular pain

A

Bell’s Palsy

103
Q

What nerve is involved in Bell’s Palsy?

A

Facial nerve

Clin Med- Neuro (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions