Cerebrovascular Sign & Symp. Of Disease Flashcards
______% all strokes caused by significant carotid stenosis
< 25%
What is the most common type of stroke?
Ischemic stroke
Atherosclerosis causes stenosis which leads to ______blood supply & _______
1) Decreased
2) cerebral ischemia
_______ presents the highest risk of TIA/stroke
ICA stenosis
Embolization of atherosclerotic material which lodges in a distal artery & leads to _______
Cerebral ischemia
Stroke can be caused by _______ embolus
Cardiac
What is the strongest risk factor for stroke?
1) HTN
* shearing forces of the blood can exert too much pressure on intracranial vessels leading to hemorrhage
What is a dissection?
Intimal tear that leads to thrombus/ embolus formation
What is polycythemia Vera ?
Thickening of the blood reduces flow & may lead to ischemia distally
- increased risk of thrombus/embolus formation
________ & _________ can lead to stroke
1) vasospasm
2) intracranial hemorrhage
What is the #1 cause of vascular disease?
Atherosclerosis formation
Atherosclerosis formation is accumulation of ______, _______, ______, ________ & ________
1) atheroma
2) smooth muscle
3) collagen
4) fibrin
5 platelets
Where does Atherosclerosis formation occur??
Within & beneath the intima
______ mm IMT measurement that indicates risk for stenosis
> 1.2 mm
What is the most common cerebrovascular site for atherosclerosis formation?
2nd most common?
1) CCA bifurcation
2) origin of the CCA
Modifiable rusk factors for stroke can be…..
Reduced or controlled to reduce the risk of stroke
List the risk factors for stroke (& how to reduce them if applicable)
1) HTN (treated with medication)
2) diabetes (treated with med)
3) hyperlipidemia (treated w/ med)
4) smoking (quit)
5) inactivity (exercise)
6) obesity (exercise & diet)
7) poor nutrition (change eat habits)
* other major risk factors
8) gender (> men, women die more)
9) race (blacks > whites)
10) age (increase with age)
11) fam hx of TIA or stroke
What is the main risk factor for stroke?
HTN
What is a TIA
Symptoms?
Transient ischemic attack
Symptoms last <24 hrs
What is RIND?
Symptoms?
Reversible ischemic neurological deficit
Resolve over time
>24 hrs but < 72hrs
What is a CVA?
Symptoms?
Cerebrovascular accident
Symptoms or damage is permanent
What is a brain infarction?
Insufficient blood supply to the brain due to stenosis or occlusion
What is a subarachnoid hemorrhage?
Rupture of intracranial vessels
What is hemispheric symptoms?
Specific symptoms are related to right & left brain with loss of functionality
Right brain controls left side of body- RICA stenosis = ________
Left brain controls right side of body- LICA stenosis = ________
1) left paresis, paresthesia
2) right paresis, paresthesia
Stroke is the _____ leading cause of death in the US
4th
85% of strokes are caused by _____
Ischemia (other causes include hemorrhage, vasospasm)
______ in the ______ is the most common cause of stroke, _____ is the second
1) atheroma
2) CCA bifurcation
3) cardiac emboli
The neurological exam is to identify ___________ in the _______ & differentiate ________ from _______ lesions
1) an abnormality
2) nervous system
3) peripheral
4) central nervous system lesion
What does the Neurological exam evaluate? (7)
1) general appearance
2) cognition
3) examination of cranial nerves
4) motor system evaluation
5) sensory exam
6) reflex exam
7) coordination & gait evaluation
General appearance evaluates 4 things. List them
1) level of consciousness (do they know basic facts, year, season, President)
2) personal hygiene/dress (clean, dress appropriate for temp)
3) posture & motor activity (involuntary movements or tremors)
4) vital signs
Cognition evaluates covers….
Comprehension, attention & calculation, ability to follow simple commands & orientation
Examination of cranial nerves evaluates…
evaluation smell, sight, muscle movement in the face, speech, hearing
Sensory exam evaluates…..
pain sensation (pin prick), light touch sensation (brush), position sense, stereognosis, graphesthesia, & extinction
The
With the Reflex exam ….
A reflex hammer is used to assess deep tendon reflexes
The clinical examination for cerebrovascular disease is evaluated by _____, ______, & ______
1) palpitation ( palpate by placing two fingers over the artery)
2) auscultation
3) blood pressure
Bounding pedal pulses refers to ________________ that are ______ with the heartbeat
1) Normal, easily palpable pulses that
2) are in sync
Where do you listen for a CCA stenosis?
At the level of the carotid bifurcation to identify a possible bruit
*ask the patient to hold their breath while listening for flowspunds
________stenosis, ______ hematocrit & _______ cardiac output can cause bilateral bruits
1) aortic valve stenosis
2) low hematocrit
3) increased cardiac output
Bruits are described as…. (3)
1+ mild
2+ moderate
3+ severe
A bruit that occurs throughout the cardiac cycle indicates_______
A possible severe stenosis
> 90% stenosis does NOT usually cause a bruit due to……
Significant reduction in flow
A bruit can be missed if ……
Cardiac output is low
The BP in the arms should not differ more than _______ or a ______ is suspected in the arm with the lower pressure
1) 20mmHg
2) subclavian steal
List the symptoms of cerebrovascular disease (5)
1) carotid bruit
2) headache
3) dizziness
4) syncope
5) dysarthria (disturbed speech)
Carotid bruit heard through systole & diastole usually indicates a _________
Significant stenosis
Bilateral bruits heard proximally can indicate____
Aortic valve stenosis
Carotid artery massage is used to …….
Assess the cause of syncope
The carotid artery is massaged at the level of the ______ for _____
1) cricoid cartilage
2) 5-10 seconds
Carotid sinus massage will lead to bradycardia & hypotension if ……
Carotid sinus hypersensitivity is present
Carotid sinus massage should NOT be performed on patients with an ________ or _______
1) occluded carotid
3) TIA/CVA
List the ICA disease symptoms
1) unilateral symp. W/ contralateral side stenosis(lt side disease= rt side symptoms)
2) parestheia
3) paresis
4) paralysis
5) Broca Aphasia
6) Hollenhorst plaques
7) amarosis fugax
Paresthesia is
Tingling of the skin
Paresis is
Weakness
Define Paralysis
Unable to move
Hollenhorst plaques are _______ that originates from atherosclerotic lesions in the _______ carotid artery or aorta & lodge on the small branches of ________
1) cholesterol emboli
2) ipsilateral (same side)
3) retinal artery
* usually identifies by an optometrist on a standard vision exam because the patient is asymptotic
Amaurosis Fugax is ________________
Can be referee to as _____________
1) Temporary partial or total monocular blindness
2) TIA of the eye
Ophthalmic artery branches from the ________
ICA
Amaurosis fugax is caused by _______ side stenosis
RICA stenosis leads to ____ amaurosis fugax
Ipsilateral
Right
List the vertebral/basilar disease symptoms
1) vertigo
2) ataxia
3) bilateral visual blurring or double vision
4) bilateral homonymous hemisnopia
5) bilateral paresthesia
6) drop attack
7) dysphasia
Vertigo
Unable to maintain equilibrium
Ataxia
Lack of coordination
Bilateral homonymous hemisnopia
Half of the field of view disrupted in each eye
Drop attack is
Falling to the ground without loss of consciousness
Dysphasia
Trouble swallowing
List the MCA disease symptoms
1) Wernicke aphasia
2) dysphasia
3) behavioral changes
4) severe hemiparesis in contralateral face:arms
1) Wernicke aphasia (AKA) is…
1) receptive aphasia
2) totally in comprehensive, unable to understand speech, speak, or follow directions
ACA disease symptoms
1) loss of coordination
2) incontinence
3) severe leg hemiparesis or hemiplegia in contralateral leg
4) facial dropping or asymmetry
PCA disease symptoms
1) dyslexia
2) cons
Broca Apasia is (AKA ______)
1) expressive aphasia
2) can understand others & follow directions but unable to speak
