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Joeli lectures > CVA, ICH, Cerebral Flow > Flashcards

CVA, ICH, Cerebral Flow Flashcards

1
Q

Vertebral artery

A

posterior circulation
joins basilar artery
supplies brainstem, cerebellum, posterior cerebrum

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2
Q

Internal carotid artery

A

supplies middle cerebral artery, anterior cerebral artery, ophthalmic artery
supplies cortex

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3
Q

Communicating vessels

A

anterior communicating
posterior communicating

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4
Q

Anterior cerebral artery

A

mostly leg
cognitive/personality changes (frontal lobe supply)

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5
Q

Middle cerebral artery

A

mostly arm and face
homonymous hemianopsia
left MCA –> aphasia

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6
Q

Posterior cerebral artery

A

vision and hearing

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7
Q

posterior inferior cerebral artery (PICA)

A

cerebellar signs

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8
Q

Basilar artery

A

goes to brain stem and cerebellum – depending on the location can be catastrophic

large artery - permanent disability, coma, death
small artery - dizziness, ataxia, cerebellar signs, vertigo, etc

can also cause bulbar symptoms - facial weakness, dysphonia, dysarthria, dysphagia, limited jaw movement, oculomotor symptoms

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9
Q

Extracranial vertebral artery (ECVA)

A

most common symptom dizziness
bilateral leg weakness, hemiparesis, numbness can lead to ataxia
atherosclerosis or compression near upper cervical vertebra in elderly

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10
Q

Epidural space

A

contains meningeal arteries (middle meningeal artery)
sight of epidural hematoma –> arterial bleed, skull fractures or skull trauma usually at pterion

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11
Q

Subdural space

A

cerebral veins penetrate subdural space to enter dural sinus (also called bridging veins)

sight of subdural hematoma –> caused by shearing force; consider atrophy of brain in elderly/AD or shaken baby

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12
Q

Subarachnoid space

A

cerebral vessels (aneurysm)
CSF (blood within CSF on lumbar puncture should have same amount with each)

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13
Q

Ischemic stroke

A

sudden decrease in cerebral blood flow
most common type of stroke (80-85%)

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14
Q

Ischemic stroke caused by thrombosis

A

local obstruction of artery caused by arteriosclerosis

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15
Q

Ischemic stroke caused by embolism

A

debris originating elsewhere and moving to cerebral vasculature

EX: clot caused by a-fib

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16
Q

Ischemic stroke caused by systemic hypoperfusion

A

general circulatory problem which can be due to cardiac failure leading to widespread hypoperfusion

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17
Q

Hemorrhagic stroke

A

ruptured vessel causes blood to seep into surrounding tissue and causes compression of surrounding brain tissue
less common (15-20%)

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18
Q

Hemorrhagic stroke - intracerebral

A

bleed within the brain
HTN, trauma, drug use (cocaine, meth)
gradually worsens over time!!!

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19
Q

Hemorrhagic stroke - subarachnoid

A

bleeding surrounding the brain to CSF
vascular malformations near pial surface, ruptured arterial aneurysm at base of brain
sudden onset of symptoms

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20
Q

Where does lacunar infra most commonly occur

A

in basal ganglia, subcortical white matter, and pons

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21
Q

What is lacunar infarct primarily caused by

A

lipohyalinosis – degeneration of small vessels caused by lipid accumulation in vessel wall

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22
Q

Biggest risk factor of lacunar infarct

A

HTN

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23
Q

People with lacunar infarct lack –

A

aphasia
agnosia
apraxia
hemianopsia

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24
Q

TIA

A

transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction

indicates high risk of recurrent and more severe CVA

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25
Q

Ischemic core

A

area directly affected by ischemia –> cell death within minutes

ischemic core cannot be saved

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26
Q

Ischemic penumbra

A

area surrounding ischemic core –> receiving some collateral circulation –> ischemic but viable tissue –> cell death within hours

goal of repercussion is to save the penumbra

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27
Q

Treatment for ischemic stroke

A

alteplase within 4.5 hours ideally within 3

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28
Q

door to needle time

A

less than or equal to 60 min

29
Q

first imaging performed for ischemic stroke

A

non contrast CT

helps distinguish ischemic stroke mimics like tumor, infection, hemorrhage

30
Q

CT should be performed and interpreted within

A

< 45 min

31
Q

CTA/CTP for ischemic stroke

A

may be used to determine collateral flow, size of penumbra
studies are determining if this could help guide treatment selection

bigger penumbra = better candidate for therapy

32
Q

Contraindications for tPA

A

-current intracranial hemorrhage
-signs or symptoms of subarachnoid hemorrhage (sudden -severe headache, stiff neck, nausea, light sensitivity, decreased vision, altered LOC)
-active internal bleed
-recent (w/in 3 mos) intracranial or intraspinal surgery, stroke, or serious head trauma
-CT confirmation of multi lobar infarction
-intracranial neoplasm, aneurysm, or arteriovenous malformation
-bleeding disorders
-current anticoagulant therapy
-elevated BP (systolic > 185 or diastolic > 110)

33
Q

Praxis

A

the performance of movement
neurology: the performance of learned, skilled movement or planned movement

34
Q

Apraxia

A

the loss of the skilled movements
inability to correctly perform learned, skilled movements
not due to weakness

35
Q

Disorder of voluntary movement

A

a cognitive disorder - not a primary motor disorder
the proper use of an object cannot be carried out

36
Q

Apraxia and neuroanatomy —

A

disconnect between thinking and carrying out the movement
not a problem in the primary motor cortex - strength is fine, coordination is fine; usually involves injury to the PARIETAL LOBE

37
Q

ideomotor apraxia

A

knows what a comb is but cannot use it

38
Q

ideational apraxia

A

unable to carry out a sequence of action (fold paper in half, put in envelope, set on floor)

39
Q

Aphasia

A

the loss of the ability to produce or understand language
most often occurs due to the LEFT HEMISPHERE damage 00 language centers of the brain

40
Q

Broca’s aphasia

A

affecting frontal lobe
comprehension spared, writing and speech impaired
may have right hemiparesis bc close to motor area

41
Q

Wernicke’s aphasia

A

affecting posterior superior temporal gyrus
comprehension defect, fluent with words but they are nonsensical - “word salad”
may have right superior visual field defect bc close to optic radiations
motor function is spared

42
Q

Blood brain barrier formed by

A

tight junctions between endothelial cells (filter)
pericytes (cerebral blood flow regulation)
astrocytes

43
Q

diffusion of BBB according to concentration gradient

A

lipophilic molecules
H20

44
Q

Efflux channels BBB

A

ATP dependent
keep toxins, medications, etc out of brain

45
Q

Transported via proteins (BBB)

A

glucose
amino acids and nucleosides

46
Q

where does communicating hydrocephalus occur

A

occurs at arachnoid space

47
Q

non-communicating hydrocephalus is due to

A

tumor
mass
stenosis

*fluid is unable to pass around

48
Q

over-production hydrocephalus

A

tumor
papilloma

49
Q

Decreased absorption - hydrocephalus

A

arachnoid space

50
Q

Hydrocephalus in infant

A

sutures are not closed –> enlarged head
sunsetting eye sign

51
Q

Causes of hydrocephalus in infant

A

congenital stenosis of cerebral aqueduct
infection
tumor
etc —

52
Q

other symptoms of hydrocephalus in patient

A

decreased LOC
irritability
poor feeding
bulging fontanelle
enlarged scalp veins

53
Q

Normal pressure ICP

A

5-15 mmHg

54
Q

Elevated ICP

A

> 15 mmHg
caused by inflammation, edema, hydrocephalus, mass lesions

55
Q

Early response for ICP

A

CSF displaced into lumbar cistern and decreased cerebral blood flow

56
Q

Later response of ICP

A

reduced production of CSF, increased CSF absorption

57
Q

When body is unable to compensate for ICP

A

brain herniation

focal mass effect (tumor, bleed, abscess)
diffuse mass effect (generalized cerebral edema –> CVA, meningitis)

58
Q

Uncal herniation

A

temporal lobe herniates downward toward brainstem (herniates under tentorium)
Pressure on CN3 –> ipsilateral dilation
compression of PCA –> occipital CVA –> homonymous hemianopia
compression of basilar artery or break branches –> decreased supply to brainstem
compression of brain stem –> indirect pressure to opposite side of brainstem –> ipsilateral weakness

59
Q

Transcalvarial herniation

A

external herniation
brain through skull generally due to fracture or surgery

60
Q

cingulate herniation

A

cingulate gyrus herniates under faux cerebri
common type of herniation
compresses ACA leading to CVA
often precedes other supratentorial herniations

61
Q

Central herniation

A

diencephalon slipped under tentorium
responsible for processing sensory info and emotions
regulates hormone production
CN6 palsy

62
Q

Infratentorial herniation

A

upward herniation
tonsillar herniation – part of cerebellum pushed into foramen magnum
compression of brainstem
alterations in breathing and cardiac function
decreases LOC
may present with headache and neck stiffness

63
Q

Physical findings of herniation

A

decreased LOC
focal neurological signs
papilledema
Cushing’s triad
AVOID LUMBAR PUNCTURE

64
Q

Cushing’s triad

A

increased blood pressure - cerebral auto regulation attempt to maintain cerebral perfusion pressure in presence of increased ICP
irregular breathing - compression of brainstem/respiratory centers
bradycardia - activation of PNS due to baroreceptors signaling elevated systemic BP

65
Q

Subclavian steal

A

subclavian artery supplies axillary and brachial arteries

blockage = decreased supply to arm = decreased blood pressure in arm

if there is increased arm usage –> more blood supply needed –> subclavian steals blood supply from vertebral artery

vertebral artery supplies posterior brain

causes retrograde flow in vertebral artery back to subclavian

66
Q

Why do lacunar infarcts occur there…

A

Basal ganglia, subcortical white matter, and pons are supplied by small branches from the anterior, middle and posterior cerebral artery as well as basilar artery – very few areas of anastomosis –> decreased collateral circulation –> predisposition to infarction

67
Q

What can communicating hydrocephalus lead to

A

Normal pressure hydrocephalus

68
Q

What can cause normal pressure hydrocephalus/communicating

A

subarachnoid hemorrhage
infection
meningitis

69
Q

On PE, what might a patient with over-production hydrocephalus have

A

Papilledema

Joeli lectures (18 decks)

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