Brainscape's Knowledge GenomeTM

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


See full index

Neurology > CVA/TIA > Flashcards

CVA/TIA Flashcards

1
Q

Anterior Circulation

A
  • Internal Carotid
  • anterior cerebral
  • middle cerebral
  • anterior choroidal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Posterior circulation

A
  • Vertebrals
  • Basilar artery
  • posterior cerebral
  • cerebellar arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the risk factors for a stroke? (6)

A
  • HTN
  • Obesity
  • Smoking
  • Hyperlipidemia
  • Diabetes
  • Diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are 3 ways a stroke can happen?

A
  • Ischemic (thromboembolic)
  • Hemorrhage
  • Systemic hypotension (very rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does a stroke result from?

A

Occlusion of a vessel, hemorrhage, or systemic hypotension causes ischemia from hypoperfusion

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

What are the 3 types of ischemic stroke?

A
  • Carotid circulation obstruction
  • Vertebrobasilar obstruction
  • Lacunar infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Carotid Artery Occlusion Obstruction

A
  • occlusion of a major vessel, cerebral infarction
  • Higher risk of early mortality and reinfarction than lacunar infarcts
  • Not much progression of symptoms besides brain swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the cardiac causes of carotid artery circulation obstruction? (7)

A
  • afib
  • rheumatic heart dz
  • mitral valve dz
  • infective endocarditis
  • atrial myxoma
  • mural thrombi
  • ASD/patent foramen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are vascular causes of carotid artery circulation obstruction? (9)

A
  • Carotid arter plaque/dissection
  • AIDS
  • fibromuscular dysplasia
  • atherosclerosis of aortic arch
  • giant cell arteritis
  • polyarteritis
  • granulomatous angitis
  • meningovascular syphilis
  • SLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

S/S of CACO (2)

A
  • onset usually sudden

- symptoms depend on the vessel blocked and where it is blocked

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

What are the S/S of CACO of the anterior cerebral artery distal to the communicating artery? (7)

A
  • contralateral weakness (leg>arm)
  • contralateral grasp reflex
  • Paratonic rigidity
  • Abulia (lack of initiative)
  • Confusion
  • Urinary incontinence
  • Behavioral disturbances/memory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are S/S of CACO of the middle cerebral artery? (5)

A
  • contralateral hemiplegia
  • contralateral hemisensory loss
  • contralateral homonomous hemianopia
  • drowsiness, stupor, coma
  • blockage of one carotid artery looks similar
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

S/S of CACO of anterior main division of the middle cerebral artery (2)

A
  • expressive aphasia

- weakness and sensory loss in the contralateral arm/face>leg

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

S/S of CACO of posterior main division of the middle cerebral artery (2)

A
  • Sensory aphasia (wernicke’s)

- contralateral homonomous visual field defect

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

CACO on the non-dominant side of the brain (4)

A
  • speech and comprehension may be preserved
  • confusional state
  • dressing apraxia
  • constructional and spatial defects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Vertebrobasilar Obstruction in the Post. Cerebral Artery (8)

A
  • contralateral hemisensory disturbance +/- paresis
  • Pain in the effected area of the body
  • syncope
  • involuntary movements
  • alexia
  • tinnitus
  • mild, transient hemiparesis
  • macular sparing contralateral homonomous hemianopia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Vertebrobasilar Obstruction in the vertebral artery (3)

A
  • inferior convergence, may not manifest
  • bilateral vertebral artery occlusion acts like a basilar artery occlusion
  • vertebrobasilar insufficiency (pass out from looking up)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Vertebrobasilar obstruction in the basilar artery (5)

A
  • coma
  • pinpoint pupils
  • flaccid quadriplegia
  • sensory loss
  • variable cranial nerve abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Vertebrobasilar Occlusion- partial basilar obstruction (7)

A
  • diplopia
  • visual loss
  • vertigo
  • dysarthria
  • ataxia
  • weakness or sensory disturbances in limbs
  • discrete cranial nerve palsies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Vertebrobasilar Occlusion in the superior cerebellar artery (6)

A
  • contralateral spinothalmic sensory loss
  • contralateral facial sensory loss
  • vertigo
  • N/V
  • nystagmus
  • ipsilateral limb ataxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Vertebrobasilar occlusion in the posterior inferios cerebellar artery (5)

A
  • ipsilateral sensory loss in the face
  • CN IX &X
  • ipsilateral limb ataxia
  • Horner’s syndrome
  • contralateral spinothalamic sensory loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Vertebrobasilar occlusion in the anterior inferior cerebellar artery (6)

A
  • ipsilateral facial sensory loss
  • ipsilateral facial weakness
  • vertigo
  • N/V
  • nystagmus
  • ipsilateral limb ataxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Vertebrobasilar obstruction in the cerebellar arteries

A
  • massive infarction leads to coma, tonsillar herniation, and death
24
Q

Lacunar Infract (7)

A
  • SMall lesions in the distribution of the short penetrating arterioles in the:
  • basal ganglia
  • pons
  • cerebellum
  • anterior limb of the internal capsule
  • deep cerebral white matter
  • a/w HTN and diabetes
25
Q

S/S of Lacunar Infarct (6)

A
  • contralateral pure motor or sensory loss
  • ipsilateral ataxia with crural paresis
  • dysarthria with clumsiness of the hand
  • *deficit may progress over 24-36 hrs
  • good prognosis
  • CT may see it, may not
26
Q

What are the 3 main risk factors for hemorrhagic stroke?

A
  • HTN- intraparenchymal
  • AV malformation- subarachnoid
  • Aneurysm- subarachnoid
27
Q

Other risk factors for hemorrhagic stroke (5)

A
  • bleeding disorders
  • anticoagulant therapy
  • liver dz
  • high alcohol intake
  • cerebral amyloid angiopathy
28
Q

Common S/S of Hemorrhagic Stroke (4)

A
  • initial decrease in LOC
  • Vomiting
  • headache if the meninges are involved
  • focal signs according to location
29
Q

Intraparenchymal Hemorrhage (5)

A
  • HTN
  • May extend into the ventricular system or subarachnoid space
  • meningeal irritation
  • basal ganglia (common for micro aneurysm)
  • pons, thalamus, cerebellum, cerebral white matter can all of micro aneurysms as well
30
Q

Subarachnoid Hemorrhage (3)

A
  • AVMs and aneurysms
  • very painful
  • “worst headache of my life”
31
Q

AVM

A
  • congenital abnormality

- tortuous vessels connect the arterioles and veins in a delicate network that is prone to hemorrhage

32
Q

What are the 4 types of aneurysms?

A
  • saccular (berry)
  • fusiform
  • charcot bouchard aneurysm
  • mycotic
33
Q

What is the definition of a saccular aneurysm?

A

Failure of circular smooth muscle to interdigitate leading to weakening of the muscle

34
Q

What is used to classify saccular aneurysms?

A

Hunt and Hess scale, manifestations of rupture

35
Q

Saccular aneurysm Diagnosis (2)

A
  • CT no contrast

- appears as a subarachnoid hemorrhage

36
Q

Tx of Saccular Aneurysms (3)

A
  • coiling
  • clipping
  • medication to prevent vasospasms
37
Q

CVA Diagnosis Overview (3)

A
  • Hard to tell the different btw hemorrhagic/ischemic based on presentation
    • CT without contrast
  • CBC, bleed time/coags, LFT
38
Q

What should you do if CT shows a hemorrhage?

A

Conservative management and supportive care

39
Q

What should you do if CT does not show hemorrhage?

A

Proceed with thrombolytics, assume ischemic stroke, start tap if you are within the time range

40
Q

Hemorrhagic Stroke Tx Overview (3)

A
  • Generally supportive
  • angiography used to check for aneurysm
  • blood in the ventricles with increased ICP, is indicative of ventriculostomy
41
Q

Hemorrhagic Stroke Sx Indications

A
  • Decompression
  • superficial hemorrhage in the cerebral white matter (decreases likelihood of herniation and damage from mass effect)
  • cerebellar hemorrhage (pt deteriorates and dies w/out it, deficits are generally minimal afterwards)
42
Q

Ischemic Stroke Tx Overview

A
  • Does not appear right away on CT
  • TPA, windo 3-4.5 hrs
  • MRI picks up ischemic stroke but it takes a long time
43
Q

CVA Supportive Care

A

Increased ICP

  • elevate head
  • mannitol
44
Q

CVA CPP TX (6)

A
  • maintain CPP
  • prevents further ischemia
  • Do not lower BP to normal within the first two wks of stroke
  • loss of auto regulation
  • Systolic BP>220 brought down with IV labetolol or nicardipine
  • the bigger the MAP the easier it is to maintain cerebral pressure
45
Q

When should ICP be treated?

A

When it is over 20-25mmHg

46
Q

CVA Anticoagulation (2)

A
  • used for most ischemic strokes

- Warfarin, INR should be 2-3

47
Q

Other CVA Tx (2)

A
  • PT/OT

- Speech therapy

48
Q

CVA prognosis (4)

A
  • ischemic infarct is better for survival than hemorrhagic
  • TPA improves chance for recovery
  • LOC poor prognostic indicator
  • Increased risk for stroke and MI
49
Q

TIA (3)

A
  • Focal neurological deficit of acute onset which resolves in 24 hours
  • Some patients with stroke have a TIA hx
  • Risk of stroke is highest in 48 hrs after TIA
50
Q

TIA Causes (2)

A
  • Emboli (cardiac or vascular)

- Multiple TIAs can manifest differently in some patients but it is usually not the case

51
Q

TIA S/S in the Carotid Distribution (4)

A
  • weakness/heaviness in contralateral arm, leg, face
  • sensory deficits on the contralateral side
  • Amaruosis fugax (shade pulled over eye) if opthalmic artery involved
  • Dysphasia
52
Q

TIA S/S in the Vertibrobasilar distribution (6)

A
  • vertigo
  • ataxia
  • diplopia
  • visual disturbances
  • perioral numbness
  • weakness or numbness on one, both or alternating sides
53
Q

TIA Diagnostic Work up (6)

A
  • CT/MRI to r/o stroke and tumor
  • Carotid ultrasound
  • Standard arteriography is gold standard
  • CBC, glucose, cholesterol, sed rate, syphilis serology
  • EKG/CXR
  • Echo
54
Q

Hospitalize TIA if? (6)

A
  • W/in 48 hrs of first attack
  • If attacks crescendo
  • Symptoms last more than an hr
  • Symptomatic Carotid stenosis
  • known cardiac source
  • hypercoagulable state
55
Q

What is the single most helpful lifestyle modification a patient can make for TIA?

A

STOP SMOKING

56
Q

TIA Surgery

A
  • Surgery or stent for high grade stenosis
57
Q

TIA Tx

A
  • If surgery cannot be done, then medical tx
  • for a cardiac source, warfarin (or aspirin)
  • non- cardiac event, aspirin

Neurology (12 decks)

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