CVD Flashcards
1
Q
A
2
Q
What does MCA supply?
A
Lateral aspect of anterior 3/5th of
cerebral hemisphere.
3
Q
What does ACA supply?
A
Medial aspect of anterior 3/5th of cerebral hemisphere & upper edge of lateral surface.
4
Q
What does PCA supply?
A
Supply posterior 2/5th of the cerebral hemisphere (Whole occipital lobe and the Posterior part of the temporal lobe).
5
Q
Circle of Willis
A
6
Q
Def of Stroke
A
- Rapidly developing clinical symptoms and/or signs of focal loss of brain function lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin.
7
Q
Causes of Ischemic Stroke
A
8
Q
Thrombotic Causes of Ischemic Stroke
A
9
Q
Embolic Causes of Ischemic Stroke
A
10
Q
Hematological Causes of Ischemic Stroke
A
11
Q
Clinical Features of Ischemic Stroke
A
- Focal loss of neurological function
- Negative in quality
- Rapidly developing
- Maximal at onset
12
Q
Clinical Features of Ischemic Stroke
- Focal Loss of neurological Function
A
13
Q
Clinical Features of Ischemic Stroke
- Focal Loss of neurological Function (In Carotid System)
A
Unilateral signs e.g.
a. Hemiplegia,
b. Hemi-hypoesthesia,
c. Hemianopia
d. Aphasia (if the left hemisphere is involved).
14
Q
Clinical Features of Ischemic Stroke
- Focal Loss of neurological Function (In Veretbrobasilar System)
A
Bilateral signs
a. Motor and sensory signs (hemiplegia may also be found)
b. Disturbance of cranial nerves and cerebellum.
15
Q
The commonest involved artery is the ……. which supply the internal capsule
A
MCA & its central branches
16
Q
The MCA supplies: …….
A
- Lateral portions of frontal and parietal lobes
- Superior part of the temporal lobe
17
Q
So, its blockage May damage the following structures: …….
A
So, its blockage May damage the following structures:
1) Primary Motor Cortex
2) Primary somatosensory cortex
3) Broca’s area
4) Optic radiations
18
Q
Occlusion of PICA →
A
Lateral medullary syndrome
19
Q
Clinical Features of Ischemic Stroke
- Negative in Quality
A
20
Q
Clinical Features of Ischemic Stroke
- Rapidly Developing
A
The onset of the focal neurological symptoms and signs is sudden or acute
21
Q
Clinical Features of Ischemic Stroke
- Maximal at Onset
A
- The focal neurological symptoms and signs are maximal at onset (i.e. evolving over minutes to hours in all of the affected body parts) rather than progressive (evolving over days to weeks and migrating from one body part to another).
22
Q
INVx in Ischemic Stroke
A
- 1st Line INVx
- Urgent Plain CT
- Duplex Carotid US
- ECG & Echo
- Specialized INVx
23
Q
INVx in Ischemic Stroke
- 1st Line INVx
A
- Full blood count & ESR
- PT, INR and PTT
- Plasma glucose
- Plasma urea & electrolytes
- Plasma cholesterol
- Urine analysis
24
Q
INVx in Ischemic Stroke
- 1st Line INVx (Significance)
A
- These investigations may reveal important modifiable risk factors & may suggest the cause of stroke (e.g. polycythemia, thrombocythemia, infective endocarditis
25
INVx in **Ischemic Stroke**
- Urgent plain CT
26
INVx in **Ischemic Stroke**
- Duplex Carotid US
When a carotid ischemic event is suspected.
27
INVx in **Ischemic Stroke**
- ECG & Echo
When a potential Cardioembolic source is suspected
28
INVx in **Ischemic Stroke**
- Specialized INVx
When the cause of stroke remains uncertain e.g.:
1. MRI and MRA of the brain.
2. Transcranial Doppler.
3. Tests for collagen vascular disease.
4. Angiography, etc.
29
Acute TTT of **Ischemic Stroke**
- Emergency Care
- Throbolytic TTT
- Neuroprotective TTT
- Prevention of Complications
30
Def of **Ischemic Penumbra**
- Zone of reversible ischemia around core of irreversible infarction
- Salvageable in first few hours after ischemic stroke onset.
31
**Penumbra** is damaged by ......
1. Hypoperfusion
2. Hyperglycemia
3. Fever
4. Seizure
32
TTT of **Ischemic Stroke**
Modern therapy for ischemic stroke includes:
1. Acute treatment: to reduce morbidity and mortality.
2. Rehabilitation: to reduce disability and dependence.
3. Prevention: to reduce stroke recurrence.
33
Emergency Care of **Ischemic Stroke**
- Airway
- Breating
- Circulation
34
Emergency Care of **Ischemic Stroke**
- Airway
To protect against air way obstruction
- Suction of Nasal and pharyngeal secretions may be needed.
- Endotracheal intubation may be needed.
35
Emergency Care of **Ischemic Stroke**
- Breathing
To protect against air way hypoventilation, and aspiration.
- Pulse oximetry or arterial blood gases
- Supplemental oxygen & ventilatory assistance.
- A feeding tube is placed if there is oropharyngeal dysfunction
36
- Mild hypothermia ...... the brain
- Mild hyperthermia ...... the outcome.
- protects
- Worsens
37
Emergency Care of **Ischemic Stroke**
- Circulation
38
Emergency Care of **Ischemic Stroke**
- Circulation (Blood Pressure Monitoring)
39
Emergency Care of **Ischemic Stroke**
- Circulation (cardiac Monitoring)
To guard against MI & arrhythmia.
40
- If the patient was taking hypotensive drugs before the stroke → .......
- If BP does not fall after a 1-2w → ......
- Continue them in the same dose.
- use ACE inhibitors. (gradual & permanent lowering to <140/85 (target))
41
- If systolic BP was >220 mmHg or diastolic BP was >120 mmHg → ......
use LV. labetalol or sodium nitroprusside (urgent but slow lowering of BP is indicated)
42
Thrombolytic Therapy of **Ischemic Stroke**
Recombinant Tissue Plasminogen Activator (Actilyse)
43
Thrombolytic Therapy of **Ischemic Stroke**
- Aim
To recanalize the occluded artery and re-perfuse the ischemic brain tissue
44
Thrombolytic Therapy of **Ischemic Stroke**
- Dose
0.9 mg/kg I.V.
45
Thrombolytic Therapy of **Ischemic Stroke**
- Precautions
- It carries the risk of major bleeding, hence should be used carefully and only in the presence of facilities to handle bleeding complication
46
Thrombolytic Therapy of **Ischemic Stroke**
- Indications
47
Thrombolytic Therapy of **Ischemic Stroke**
- CI
48
Neuroprotective Therapy of **Ischemic Stroke**
- Aim
Preventing or limiting the brain tissue damage that occurs in the area of reduced cerebral blood flow.
49
Neuroprotective Therapy of **Ischemic Stroke**
- Examples
50
Prevention of Complications in **Ischemic Stroke**
51
Prevention of Complications in **Ischemic Stroke**
- Brain Edema
1. Fluid restriction for 24-48 hours.
2. Mannitol 20% solution 0.25 - 1 gm / kg over 30-60 minutes
52
Prevention of Complications in **Ischemic Stroke**
- Pneumonia
1. Prevention of aspiration.
2. Chest exercise & early mobilization.
53
Prevention of Complications in **Ischemic Stroke**
- DVT
Low doses of unfractionated or LMW heparin for Bed ridden patients.
54
Prevention of Complications in **Ischemic Stroke**
- depression
Antidepressants
55
Prevention of Complications in **Ischemic Stroke**
- Electrolyte Disturbance & Nutritional Deficiency
1. Adequate LV. fluids.
2. Tube feeding (after 3 days).
56
Prevention of Complications in **Ischemic Stroke**
- Prssurte Sores
1. Skin cleaning.
2. Frequent positional changes.
3. Frequent change of bed sheets.
4. Special mattress.
57
Prevention of Complications in **Ischemic Stroke**
- Seizures
Anticonvulsant medications
58
Prevention of Complications in **Ischemic Stroke**
- Urosepsis
Indwelling catheters are used only when absolutely indicated and for the shortest possible time
59
Rehab in **Ischemic Stroke**
Should start as soon as the diagnosis of stroke is established and includes:
1. Physiotherapy.
2. Speech therapy.
3. Occupational therapy.
60
Prevention of 2ry **Ischemic Stroke**
61
Prevention of 2ry **Ischemic Stroke**
- Aggresive Control of RF
Avoid smoking.
Lipid lowering.
Control of diabetes.
Treatment of hypertension.
62
Prevention of 2ry **Ischemic Stroke**
- Antiplatlet Therapy
For thromboembolic ischemic strokes. e.g.
Aspirin 75-150 mg daily
Clopidogrel 75 mg daily.
63
Prevention of 2ry **Ischemic Stroke**
- Anticoagulant Therapy
64
Prevention of 2ry **Ischemic Stroke**
- Carotid endarterectomy
For patients with severe carotid stenosis (>70%) and non-disabling ischemic symptoms
65
Types of **Hemorrhagic Stroke**
- ICH
- SAH
66
Causes of **Intracerebral Hemorrhage**
67
Most common Causes of **Intracerebral Hemorrhage**
Hypertension
68
Hematological Disorders Causing **Intracerebral Hemorrhage**
69
Vascular Malformations Causing **Intracerebral Hemorrhage**
Saccular or Mycotic aneurysms.
Arteriovenous malformations.
Cavernous angiomas.
70
Inflammatory Vessel Diseases Causing **Intracerebral Hemorrhage**
Granulomatous Angitis.
Polyarteritis Nodosa.
71
Sites of ****1ry (Hypertensive) Intracerebral Hemorrhage****
72
Most common Site of **1ry (Hypertensive) Intracerebral Hemorrhage**
Putamen
“The most common type of ICH” lenticulostriate artery"
73
Most Dangerous Site for **1ry (Hypertensive) Intracerebral Hemorrhage**
Thalamus
74
CP of **ICH**
..
75
CP of **ICH**
- Time of Symptoms
In the majority of cases, the hemorrhage has its onset while the patient is up and active.
76
CP of **ICH**
- Onset
Abrupt onset of symptoms over minutes, hours or a day or Depending on the size of the ruptured artery
77
CP of **ICH**
- General
- Specific
78
General CP of **ICH**
Clinical manifestations of increased intracranial pressure
- Headache
- Vomiting
- Depressed level of consciousness and
- Seizures (in some cases)
79
Specifc CP of **ICH**
clinical manifestations which are related to the site of the hematoma
- Putaminal
- Lobar
- Thalamus
- Cerebellar
- Pontine
80
CP of **Putaminal Hemorrhage**
81
CP of **Lobar Hemorrhage**
82
CP of **Thalamic Hemorrhage**
83
CP of **Cerebellar Hemorrhage**
84
CP of **Pontine Hemorrhage**
85
Dx of **ICH**
86
Dx of **ICH**
- Clinically
87
Dx of **ICH**
- Brain CT
- CT is reliable and superior to MRI in early detection of intracerebral hemorrhage (white mass).
- The surrounding edema is hypodense.
88
Dx of **ICH**
- Brain MRI
MRI is particularly useful for brainstem hemorrhages.
89
Dx of **ICH**
- Others
As PT, PPT, Platelet count, Liver functions etc.
90
TTT of **ICH**
91
TTT of **ICH**
- Emergency Care
to protect against Airway obstruction, Hypoventilation, & Aspiration (ABC)
92
TTT of **ICH**
- Control of BP
Carried out cautiously & slowly (see before).
93
TTT of **ICH**
- Control of ICP
**Rapid treatment of intracranial HTN improves the outcome of patients with ICH.**
- Controlled hyperventilation to PCO2 (25-30 mmHg).
- IV mannitol (0.25-1 gm/kg).
- Dexamethasone.
94
TTT of **ICH**
- Prevention & TTT of Comp
as seizures, pneumonia etc. (see before).
95
TTT of **ICH**
- Surgical Evacuation
Especially in patients with superficial (lobar hematomas or with cerebellar hemorrhage
96
Def of **TIA**
- Acute focal loss of brain function with symptoms lasting less than 24 hours due to inadequate cerebral blood supply
97
Duration of **TIA**
- Most TIAs last only 10 seconds to 15 minutes but occasionally as long as 24 hours (followed by complete recovery).
- Episodes that last longer than 1 hour are usually caused by small infarctions.
98
**TIA** & Stroke
- TIA is an important predictor of stroke risk.
99
Pathogenesis of **TIA**
100
Symptoms of Carotid **TIA**
101
Symptoms of Vertebrobasilar **TIA**
102
INVx for **TIA**
103
TTT of **TIA**
