CVA TIA, Pales I

Question 1

incidence of strokes

Answer 1

1 every 40 seconds

Question 2

leading cause long-term disability in US

Answer 2

stroke

Question 3

CVA

Answer 3

cerbro vascular accident

abrupt onset neuro deficit that is attributable to focal vascular cause

Question 4

2 major types of stroke

Answer 4

hemorrhagic stroke

ischemic stroke

Question 5

What is the penumbra in ischemia

Answer 5

brain tissue around cerebral necrosis that has reversible changes

Question 6

main categories of causes of ischemic strokes

Answer 6

large artery thrombosis
embolism
lacunar

Question 7

what are the originations of embolisms that can cause ischemic strokes

Answer 7

arterial: carotid or aorta
heart: atrial, valve or ventricular
paradoxical

Question 8

what are the not common causes of stroke

Answer 8

watershed infarcts
hypercoagulable disorders
vasculitis
vasospasm
dissection of artery

Question 9

what happens in large artery thrombosis

Answer 9

activate platelets and coagulation that cause occlusion

Question 10

types of emboli that cause strokes

Answer 10

athersclerotic plaques and those from thrombi

Question 11

source for paradoxical emboli

Answer 11

lower extremity DVT

Question 12

atrial source of emboli

Answer 12

a fib, flutter
atrial septal aneurism
atrial tumors (myxoma)

Question 13

what is afib

Answer 13

fast and ineffective atrial contraction leading to stasis and thrombus formation

Question 14

atrial septal aneurysm

Answer 14

weakening and out-pouching of interatrial septum leading to stasis and thrombus formation (mural)

Question 15

most common tumor in atrium

Answer 15

atrial myxoma

Question 16

atrial myxoma

Answer 16

pieces of tumor may tear off and become emboli

associated thrombus can embolize artery down the stream

Question 17

emboli from ventricular source

Answer 17

cardiomyopathy
myocardial infarction
ventricular aneurisms

Question 18

majority of ventricular emboli are from what type

Answer 18

MI, stasis!

Question 19

how do MIs lead to emboli

Answer 19

part of wall not moving so creates stasis and leads to thrombus formation

Question 20

what can cause valvular sources of cardiac emboli

Answer 20

rheumatic mitral stenosis
prosthetic valves
infective and non-infective endocarditis
nonbacterial thrombotic endocarditis (malignancies and prothombotic states)
calcification of valves
bicuspid aortic valves
inflammatory valvulitis

Question 21

causes of inflammatory valvulitis

Answer 21

libman sacks endocarditis (assoc with lupus)
behcet disease
syphilis

Question 22

where to arterial embolic infarcts take place that affect brain

Answer 22

carotid artery atherosclerosis or stenosis

Question 23

what is defect that can lead to paradoxical embolie

Answer 23

patent foramen ovale

need Tx atrial septal defect

Question 24

lacunar infarcts occur where

Answer 24

subcortical areas of brain from small deep penetrating aa arising from big aa

Question 25

increases risk for lacunar infarcts

Answer 25

atheroemboli | or lipohyalinosis

Question 26

major factor lacunar infarct

Answer 26

HTN

Question 27

25% ischemic strokes are what type

Answer 27

lacunar infarcts

Question 28

Sx lacunar infarcts

Answer 28

frequently asymptomatic

Question 29

lipohyalinosis

Answer 29

high pressure of L arteries transmitted to small arteries hyperplasia small vessels hyalinization of vessel walls narrowing then occlusion

Question 30

Watershed infarcts

Answer 30

ischemic infarcts of areas farthest from the large aa | most sensitive is when perfusion decreases

Question 31

watershed infarcts develop in what conditions

Answer 31

sepsis severe bleeding severe dehydration

Question 32

Where are the cortical border zones

Answer 32

between ACA and MCA | between MCA and PCA

Question 33

3 parts that normally control state of homeostatic equilibrium

Answer 33

coagulation system anticoagulation system thrombolytic system

Question 34

what leads to hypercoagulable states

Answer 34

promote coagulation over anti-coagulation

Question 35

hypercoagulable states clot what type vessels

Answer 35

veins more than arteries

Question 36

what are the hypercoagulable disorders

Answer 36

``` Factor V mutation Protein C or S deficiency antithrombin deficiency plasminogen deficiency prothrombin gene mutation ```

Question 37

what disorders are more likely to cause arterial clotting

Answer 37

antiphospholipid antibody syndrome | hyperhomocysteinemia

Question 38

what do you detect in antiphospholipid Ab syndrome

Answer 38

anticardiolipin Ab | Lupus anticoagulants

Question 39

hypercoagulable states from other processes

Answer 39

cancer pregnancy hormone replacement therapy prlonged bed rest or immobility, heart attack, stroke myeloproliferative disorders such as polycythemia vera or essential thrombocytosis

Question 40

vertebral dissection seen in what sport

Answer 40

golfing from cerebral dislocation

Question 41

causes of strokes not hypercoagulation

Answer 41

vasculitis vasospasm moyamoya disease

Question 42

vasospasms causing stroke seen in

Answer 42

subarachnoid bleeding, cocaine use

Question 43

moyamoya disease

Answer 43

poorly understood occlusive disease involving large intracranial aa

Question 44

stroke presentation depends on

Answer 44

size of affected vessel | area of brain supplied by affected vessel

Question 45

hemiparesis

Answer 45

weakness of one side of body

Question 46

hemiplegia

Answer 46

complete paralysis of one side of body

Question 47

homonymous hemianopsia

Answer 47

loss of vision in same visual field of both eyes

Question 48

acalculia

Answer 48

difficulty to perform simple math tasks

Question 49

agnosia

Answer 49

inability to recognize objects, persons, sounds, shapes or smells