Cerebrovascular symptoms and treatments

Question 1

Transient Ischemic Attack (TIA)?

- Duration of symptoms

Answer 1

• When a patient’s symptoms resolve in <24 hours
• Usually sudden and brief
• Last 10-15 mins
• often multiple in nature

Question 2

TIA’s affect what?

Answer 2

• TIA’s affect the side of the body opposite its physical location in the brain with the exception of amaurosis fugax (loss of vision in one eye)
• Patients who present with multiple TIA’s in a short period of time are at a much higher risk for an impending stroke

Question 3

Reversible ischemic neuorological deficity (RIND)?

Answer 3

Symptoms lasting >24 hours but completely resolve thereafter

Question 4

Cerebral vascular accident (CVA)?

Answer 4

• Major stroke

- symptoms that do not resolve and leave the patient with a permanent deficit

Question 5

maurosis fugax?

Answer 5

• A degree of blindness affecting one eye which is usually described by the patient as “like a shade being pulled over one eye”
• The blindness may affect all or only a portion of the patient’s visual field or it may simply be “blurred vision”

Question 6

Syncope?

Answer 6

• Episodes of blacking out

Question 7

Aphasia?

Answer 7

Loss of speach

Question 8

Symptoms of potential stroke? (6)

Answer 8

1. Amaurosis fugax
2. synscope
3. dizziness
4. numbness
5. altered speech
6. hemiparesis
7. headache

Question 9

Hemiparesis?

Answer 9

Unilateral weakness of a limb or limbs on one side of the body

Question 10

amaurosis fugax usually occurs from what vessel?

Answer 10

ICA

Question 11

What is the most common cause of stroke?

Answer 11

infarction of the middle cerebral artery (MCA)

Question 12

Affected artery MCA signs and symptoms?

Answer 12

Dysphasia or aphasia
Contralateral hemiparesis or hemiplegia more severe in the face and upper extremity
Confusion
Behavioral changes
Agitated delirium

Question 13

dysphasia?

Answer 13

swallowing difficulties

Question 14

Affected artery: ICA signs and symptoms?

Answer 14

Contralateral weakness
Numbness or paralysis
Ipsilateral amaurosis fugax
Aphasia
Bruit
Occasional alteration in level of consciousness

Question 15

Affected artery: ACA S/S?

Answer 15

Contralateral hemiparesis, especially of lower extremity
Incontinence
Loss of coordination
Impaired motor and sensory functions

Question 16

Affected artery: PCA s/s?

Answer 16

Dyslexia

Coma without paralysis

Question 17

Affected arteries: vertebrobasilar s/s?

Answer 17

Facial numbness
Diplopia (double vision) 
Vertigo
Dysphagia
Amnesia
Ataxia (loss of full control of bodily movements)

Question 18

Carotid: anterior circulation s/s?

Answer 18

Unilateral motor and sensory deficits
Paresthesia-tingling or numbness on one side
Dysphasia and or aphasia
Monocular disturbances
Behavioral abnormalities

Question 19

Vertebrovascular- posterior circulation s/s?

Answer 19

Bilateral motor and sensory deficits
Vertigo (a spinning sensation)
Ataxia (unsteadiness-muscular incoordination)
Bilateral visual field defects including diplopia
Bilateral paresthesia
Drop attack-falling to the ground without other symptoms or loss of consciousness

Question 20

Nonlocalizing symptoms?

Answer 20

Dizziness-lightheadedness
Syncope-a transient loss of conciousness
Headache
Confusion

Question 21

Endarterectomy?

- who can get the procedure?

Answer 21

• most symptomatic patients with a stenosis >70% diameter reduction are treated surgically
• Some surgeons are performing endarterectomies in patients who are asymptomatic with a stenosis of >60%

Question 22

Non-surgical methods for treating carotid atherosclerosis?

Answer 22

• balloon angioplasty and atherectomy

- greater risk of acute embolization secondary to these procedures

Question 23

Medical therapy in patients with carotid disease is offered in the form of?

Answer 23

• Daily aspirin (81mg)

- in patients with mild to moderate levels of stenosis and no history of hypertension

Question 24

Anticoagulants and platelet inhibitors may be administered to patients with?

Answer 24

Occasional TIA’s

Question 25

Example of a platelet inhibitor?

Answer 25

Clopidogrel (Plavix)