Brainscape's Knowledge GenomeTM

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


See full index

Nervous System > CM- Clinical Aspects of Vascular Disease > Flashcards

CM- Clinical Aspects of Vascular Disease Flashcards

1
Q

What is the age and gender at highest risk for stroke?

A

Women > men
Risk increases with age
[women experience more strokes b/c they tend to live longer than men]

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

What are the 2 major categories of CVA [cerebrovasular accident]?
Which accounts for the majority of cases?

A
  1. Ischemic stroke - due to infarcts from blocked arteries [80%]
  2. Hemorrhagic stroke- due to ruptured vessel, or repurfusion of affected area [20%]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 4 major arteries that supply blood to the brain? Which areas of the brain are supplied by each?

A
  1. Two internal carotids supply most of the cerebral hemispheres
  2. Two vertebral arteries join to form basilar artery to supply the brainstem, cerebellum, and occipital cortex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the key collateral pathway of the brain that connects anterior and posterior circulatoin?
What are the components of the pathway?

A

Circle of Willis:

  • posterior communicating arteries
  • proximal anterior cerebral and posterior cerebral arteries
  • anterior communicating artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

A patient presents with right-sided hemiplegia and hemianesthesis.
They also have homonymous hemianopia of the right visual field [they cannot see the full right or full left visual fields].
They experience aphasia.

What is the likely location of the stroke?

A

Left middle cerebral artery

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

A patient presents with left-sided hemiplegia and heimanesthesis.
She has homonymous hemianopsia of the left visual field.
When asked to pantomime hammering a nail, she seem unable to remember how to use a hammer.
She is also demonstrating sensory neglect.

What is the most likely site of the CVA?

A

She is domonstrating apraxia and sensory neglect so the stroke is in the non-dominant hemisphere.

The other symptoms point to:

Right MCA

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

What 5 structures in the brain can be damaged by a stroke in the anterior cerebral arteries?

A
  1. frontal lobe
  2. parietal lobe
  3. corpus callosum
  4. caudate
  5. internal capsule
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A patient presents with right sided hemiplegia especially in her leg.
She demonstrates a grasp reflex and urinary incontinence.
What is the most likely location of the CVA?

A

left anterior cerebral artery

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

A patient presents with spastic paraparesis. He has been emotionally disturbed with apathy, confusion and mutism.
What is the likely location of the stroke?

A

bilateral anterior cerebral artery

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

A patient presents with right hemiplegia and hemianesthesia. The patient has aphasia.
The patient has monocular blindness on the left.

What is the location of the CVA?

A

Left internal carotid

  • symptoms identical to MCA
  • monocular blindness ipsilateral to the affected ICA [because the opthalmic artery is the first branch off int. carotid
  • sparing of ACA symptoms because of collateral from circle of Willis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What structures are supplied by branches of the posterior cerebral artery?

A
  1. mesencephalon [midbrain]
  2. thalamus
  3. splenium of the corpus callosum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A patient presents with contralateral hemianopsia with macular sparing. What is the likely location of the stroke?

A

Posterior cerebral artery

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

A patient cannot perceive the visual field as a whole, can’t fixate the eyes, and cannot move his hand to a specific object by using vision. What is this syndrome called? A stoke in what area can cause this?

A

Balint syndrome - stroke in the PCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

A patient is not able to read written word but they have the ability to communicate via writing. What is this called?
A stroke in what area could cause it?

A

Alexia without agraphia [pure word blindness]

PCA

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

What is a transient ischemic attack?
What are symptoms?

How does it differ from a stroke?

A

a temporary interruption of blood flow to part of the brain [ischemia without infarction]

Symptoms would mirror those of a stroke for a particular area, but would last less that 24 hours

Stroke and TIA are parts of a continuum of occlusive vascular disease of the brain. 1/2 of patients who experience TIA will go on to have a stroke [many w/in 48hrs]

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

What is the direct cause of hemorrhagic strokes?
What risk factors/underlying lead to hemorrhagic stroke?
What percent of all strokes are hemorrhagic?

A

Hemorrhagic strokes are due to ruptured blood vessels [ICH= intracerebral, SDH = subdural]

  • hypertension
  • aneurysm
  • subdural hematomas
  • AV malformations
  • amyloid angiopathy

15-20% of all strokes are hemorrhagic

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

What age group is most likely to experience a hypertensive bleed?
What areas of the brain are most likely to be affected by a hypertensive bleed?

A

Hypertensive bleeds affect mostly people 55-75 and are due to long-standing chronic hypertension.

Small penetrating arteries cause hematoma in subcortical hemispheres, pons, and cerebellum

18
Q

What age group is most affected by subarachnoid hemorrhages due to ruptured aneurysms?
What are 2 of the biggest risk factors?

A

middle aged adults are most likely to have a ruptured aneurysm.
Risks:
1. polycystic disease [familial]
2. smoking

19
Q

A patient presents with the “worst headache of my life”.
You do a CT of the head and note the absence of dark areas [cisterns, ventricles].
CSF shows blood.
What is the likely cause of the headache?
What is treatment?

A

A subarachnoid hemorrhage - treat with surgical clipping

20
Q

What is the physiological cause of ischemic stroke?

What percent of strokes are ischemic?

A

Ischemic strokes are caused by brain blood vessels being occluded by

  1. a build-up of arterial atherosclerotic plaques
  2. an embolus from another blood vessel

Ischemic strokes are 80-85% of all strokes

21
Q

What is the MOST common substrate for ischemic stroke?
How do they form?
What are the 2 mechanisms by which they cause ischemic symptoms?

A

Cerebrovascular atherosclerosis of the large vessels [macroangiopathy]
Cholesterol-filled subintimal plaques form at/near arterial bifurcations [which are areas of turbulence that can disrupt endothelium]

Mechanism by which they cause ischemic symptoms:

  1. Flow reduction from high grade stenosis or occlusion–> distal hypoperfusion if 70% reduced luminal diameter
  2. Artery-to-artery embolism = nonstenotic plaque creates platelet plugs that can embolize
22
Q

What areas of the brain are most likely to experience lacunar strokes/penetrating artery disease/ microangiopathy?

A

Cerebral white matter
Basal ganglia
Thalamus
Brainstem

[all these areas are supplied by small penetrating arteries that come off the medium sized cerebral arteries -MCA, ACA

23
Q

A patient presents with a pure motor deficit in the face, arm and leg. What is the likely problem?

A

Lacunar strokes- occlusion of small vessels cause lacunes [subcortical infarcts]

24
Q

A patient presents with a pure sensory deficit in the face arm and leg. What is the likely problem?

A

Lacunar stroke

25
Q

What is the most preventable type of stroke?

What are the underlying conditions that predispose?

A

The most preventable stroke is cardiogenic emboli to the brain.
Underlying conditions:
1. non-rheumatic A fib
2. acute MI
3. prosthetic cardiac valves
4. rheumatic heart disease, LV thrombi from prior MI, dilated cardiomyopathy

26
Q

A patient experiences an abrupt onset of neurological/stroke-like symptoms.
The nurse notes that he had been in A. fib that morning. What is the suspected cause of the CVA?

A

Cardiogenic embolism

27
Q

What are the 3 criteria for diagnosing a cardiogenic embolism as the cause of stroke?

A
  1. abrupt onset
  2. cortical neuro deficits
  3. potential cardiac source of embolism
28
Q

What is current recommendation for A fib antithrombotic prophylaxis?

A
  1. aspirin can reduce risk of stroke
  2. warfarin is more effect to decrease the risk in people with A. fib
  3. direct thrombin inhibitors [dabigatran] is used in non-valvular AF
29
Q

A young patient without increased LDL or HTN presents with stroke like symptoms. What are causes to consider?

A
  1. hypercoaguable state [OCPs]
  2. crack/cocaine = vasoconstriction
  3. infections [neurosyphilis]
30
Q

The number 1 treatable risk factor for cerebrovascular atherosclerosis is ____________. What is this defined as?

A

HTN

140/90

31
Q

What are the 2 most important non-modifiable risk factors or stroke?

A

Age and gender [risk doubles each decade after 55]

32
Q

What are the major modifiable risk factors for ischemic stroke?

A
  1. HTN
  2. cigarette smoking - exaggerated if other risk factors are present
  3. diabetes- instate tight HbA1C <7% control to reduce risk
  4. cholesterol -simvastatin for those with coronary heart disease
33
Q

In general for diagnosing stroke, what 3 components are important?

A
  1. Blood work [glucose, RFTs, CBC, PT/PTT/INR, infections, inflammation, hypercoaguable state]
  2. Cardiac studies
    - Electrocardiogram and cardiac monitoring
    - Echocardiogram
  3. Imaging
    - CT, CTA
    - MRI/MRA
    - Angiography
34
Q

What are the 3 imaging modalities used to diagnose stroke?

What are pros/cons of each?

A
  1. CT/CTA-
    PRO: if patient has stroke symptoms, it can diagnose intracranial hemorrage, or ischemic stroke
    CON: ionizing radiation
  2. MRI/MRA-
    PROS: lack radiation and contrast; soft tissue identification; detect edema in advance of tissue destruction; MRA is best for intracranial/extracranial vessel
    CONS: MRI = longer scan, no pacemakers, dental work, defibrillators, claustrophobia, bone/low water density is not well seen; MRA= long transit time [aortic arch to brain] and large degrees of stenosis limit
  3. Angiography
    PRO: gold standard to determine etiology and treatment plan for patients with ischemic stroke, intracranial bleed, vascular malformations; interventions can be performed during angio [tPA, embolization, placement of coils into aneurysms]
35
Q

What are the 3 therapeutic choices to reduce the risk of stroke?
When should each be used?

A
  1. Antiplatelet therapy
    - aspirin [cox inhibitor that prevents PG and TXA2 formation]; clopedigril [non-comp inhibitor of ADP-induced platelet aggregation; Aspririn+dypiridamole [extended release]
    - Used in patients with TIA or prior stroke, causes less bleeding then warfarin
  2. Warfarin
    - patients with A. fib
  3. Carotid Endarterectomy [CEA] and Carotid Angioplasty and Stenting [CAS]
    - symptomatic patients of TIA/stroke within the past six months and carotid stenosis of 70% or greater
    - 50-69% blocked, CEA can be used depending on age, sex, comorbidities
36
Q

What are the criteria for ASYMPTOMATIC patients to be considered for CEA?

A
  1. stenosis >60% by angio

2. stenosis >70% by doppler

37
Q

What is the the goal of treatment in the few hours just after an acute stroke?

A

Neurons dies within a few minutes of no oxygen and do not regenerate, but there is the ischemic penumbra [area around necrosis] that is hypoperfused, hypometabolic, but there is still neurons that are alive.

The goal is to salvage the ischemic penumbra by
1. avoiding overzealous treatment of mild to moderate HTN in the hours/days after the stroke because you want the penumbra to get good flow

  1. if the stroke is ischemic, tPA in 4.5 hours can cause fibrinolysis and clot breakdown for patients whose CT does NOT show bleeding
38
Q

What is the purpose of tPA?
What is the time window for treatment with it?
What factors extend the time window?

A

tPA is tissue plasminogen activator and it does fibrinolysis and clot breakdown
It should be given w/in 3 hours [must be documented so if the person was asleep–>no go]

The time window extends to 4.5 hours if the person is:

  1. younger than 80
  2. on oral anticoagulants with INR <25
  3. no history of diabetes and stroke combined

CT cannot show bleeding or nonstroke causes for symptoms

39
Q

What are the definite contraindications for tPA therapy?

A
  1. seizure at onset of stroke
  2. recent surgery or stroke
  3. extreme elevation in BP that cannot be controlled
  4. coagulopathies, active bleed ICH
40
Q

What is given within the first 48 hours after a stroke to reduce the risk of early recurrent stroke, death and dependence?

A

aspirin

Nervous System (32 decks)

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