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Neurology > CVD > Flashcards

CVD Flashcards

0
Q

If cerebral ischemia is short lived?

A

Syncope

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1
Q

What is cerebral ischemia?

A

Inadequate blood flow/O2 to the brain

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2
Q

What is syncope?

A

no air for temp time –> faint –> come back to life

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3
Q

If cerebral ischemia is long?

A

hypoxic-ischemia encephalopathy

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4
Q

What is cerebral vascular accident?

A

FOCAL vascular (blood) cause affecting PORTION OF THE BRAIN

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5
Q

What is the main difference between cerebral ISCHEMIA and cerebral VASCULAR ACCIDENT?

A

ischemia: NO BLOOD/O2 TO THE BRAIN

vascular accident: BLEEDING TO ONE POINT IN THE BRAIN

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6
Q

What is intraparenchymal damage?

A

damage w/in the brain

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7
Q

What is the most important thing to distinguish when patient comes in with a “stroke”?

A

is it: 1) ischemic or 2) hemorrhagic

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8
Q

Which stroke is more common?

A

ischemic (85%)

hemorrhagic (15%)

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9
Q

Cx of ischemic stroke?

A

1) thrombosis

2) embolic

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10
Q

What is thrombosis?

A

clotting of bv d/t a large amount of platelets

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11
Q

What is embolic?

A

can be from a thromobus but also includes air bubbles, FB

occurs in a fib pts, patent foramen, R->L shunt

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12
Q

What is TIA?

A

transient ischemic attack

  • short time when brain does not receive O2/blood but quickly resolves –> usually when pt is brought into ER they are asymptomatic
  • MUST COMPLETELY RESOLVE IN 24 HRS OR ELSE CONSIDERED STROKE
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13
Q

What links ischemic and hemorrhagic strokes?

A

ischemic can turn into hemorrhagic stroke

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14
Q

Cx for TIA?

A

many cxs!

  • a fib
  • carotid artery
  • foreman ovale
  • carotid stenosis
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15
Q

What is a hallmark of TIA?

A

resolves in 24 hours

-usually short (<1hr)

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16
Q

What can happen in the next 48 hrs of a TIA?

A

STROKE (15%)

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17
Q

What are some sx of TIA?

A
  • suddenly not able to talk: ischemia to broca’s

- transient blindness: AMAUROSIS FUGAX

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18
Q

Tx TIA?

A

ASPIRIN

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19
Q

What is the diff between aspirin and heparin?

A

Aspirin prevents platelet aggregation

heparin is a coag that helps blood keep moving (pts who are stasis/bedridden

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20
Q

TIA - imaging?

A

CT

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21
Q

What is small vessel stroke-lacunar stroke?

A

occlusion of the small vessel (pons)

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22
Q

Cx of small vessel stroke?

A

thrombosis 3mm to 2cm

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23
Q

Small vessel stroke - sx?

A

pure motor hemiparesis (internal capsule)
pure sensory stroke (ventral thalamus)
ataxic hemiparesis (ventral pons)
dysarthria and clumsy hand

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24
Q

Small vessel stroke - prognosis?

A

fast and complete

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25
Q

Small vessel stroke - hallmark?

A

clumsy hand

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26
Q

Pt cannot talk suddenly?

A

TIA

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27
Q

Pt suddenly has blindness?

A

TIA

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28
Q

Pt has clumsy hand?

A

small vessel stroke

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29
Q

Middle cerebral artery - sx?

A 
contralateral hemianesthesia (paralysis)
ipsilateral gaze preference (looks to the side of the stroke)
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30
Q

What is PCA? What arteries are included?

A

Posterior Cerebral Arteries

  • vertebral
  • basilar
  • posterior
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31
Q

PCA - what parts of the brain is affected?

A

mid brain
subthalamic
thalamic
cerebellum

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32
Q

PCA - PE?

A

third nerve palsy
ataxia
coma

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33
Q

What is third nerve palsy?

A

eye is closed
cannot move eyeball up
eyeball does not react to light

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34
Q

Distal PCA affect which part of the brain?

A

occipital

temporal lobes

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35
Q

Distal PCA - sx?

A

cortical blindness (blind but has reactive pupils to light)
hemianopia (vertical blindness)
acute memory disturbances

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36
Q

Ischemic stroke RF?

A

ASCVD - thrombosis (w/in the CNS), embolism (rusty pipes from thrombosis)
older age, fam hx, DM, HTN, smoking, lipids
A fib (emoblic form clot in atria)
MI
valvula dz (emoblic vegetation)
patent foramen ovale
vascular dz (gient cell arteritis, lupus, sarcoidosis, syphilis)
cancer, thrombocytosis, factor V leiden, oral contraceptives
HIV/AIDs

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37
Q

Acute Ischemic stroke -tx?

A

1) ABC
2) tPA w/in 4.5 hrs of sx - usual contradictions still stand (MI, surgery, pregnancy, trauma)
3) antithrombotic (ASA) - clopidogrel if allergic to ASA
* anticoagulation (heparin) is USELESS (b/c there is a prob w/ the platelets, NOT blood)

38
Q

Cerebral hemorrhage - cx?

A

HTN (preventable)
trauma
cerebral amyloid angiopathy (age related arteriolar degeneration)

39
Q

Hemorrhagic stroke - RF?

A

age
drinking
anticoagulation
cocaine (young)

40
Q

What are types of hemorrhagic stroke?

A

1) basal ganglia hemorrhage
2) thalamic hemorrhage
3) cerbellar hemorrhage
4) lobar hemorrhage

41
Q

What are the types of ischemic strokes?

A

1) TIA
2) small vessel
3) middle artery
4) posterior artery

42
Q

Which ischemic stroke goes away quickly - self resolves?

A

TIA and small vessel artery

43
Q

If pt has high HTN comes in w/ “stroke” - what are you suspecting?

A

1) CT - differeniate between ischemic and hemorragic
2) look for sx of: face sag, slurred speech, arm/leg weakness
* if severe: flaccid paralysis, coma, deep irregular breathing, dilated fixed ipsilateral pupil

44
Q

Thalamic hemorrhage - sx?

A

sensory defect

contralateral hemiplegia/hemiparesis

45
Q

Why is there dilated fixed ipsilateral pupil in hemorrhagic strokes?

A

increased ICP: parasympathetic is not working –> sympathetic overrides cxing the widening of the pupil and “stuck”

46
Q

Pontine hemorrhage - sx?

A 
coma w/ quadriplegia over minutes
decerebrate rigidity 
pinpoint pupils w/ reactive to light
dolls eye phenomena 
hyperapnea, severe HTN, hyperhidrosis
47
Q

Cerebellar hemorrhage - sx?

A 
occipital headache
N&V
ataxia gait
dizziness/vertigo 
HOURS (can intervene)
48
Q

Lobar hemorrhage - sx?

A

depends on which part of the lobe is hemorrhaging
focal headache
VOMITTING

49
Q

Lobar hemorrhage - occipital?

A

hemianopia (vertical visual loss)

50
Q

Lobar hemorrhage - left temporal?

A

aphasia

51
Q

Lobar hemorrhage - parietal?

A

sensory loss

52
Q

Lobar hemorrhage - frontal?

A

arm weakness

53
Q

How long does pontine, cerebellar, lobar hemorrhage take?

A

pontine - min
cerebellar - hours
lobar - min

54
Q

Headaches of cerebellar vs lobar hemorrhage?

A

cerebellar- occipital

lobar - focal

55
Q

Sx of intraranial hemorrhage?

A

increased ICP

56
Q

increased ICP sx?

A

headahce
pailledema
cushings triad (increasing BP, dec pulse, widening pulse pressure)

57
Q

how is intracranial hemorrhage named?

A

depending on the location of the hemorrhage

ie) subdural hemorrhage
ie) subarachnoid hemorrhage

58
Q

What is cushing triad?

A

incr BP
dec pulse
widening pulse pressure

59
Q

Subarachnoid hemorrhage occurs where most commonly?

A

between arachnoid and pia mater

60
Q

Subarachnoid hemorrhage found…?

A

circle of willis

61
Q

Subarachnoid hemorrhage - RF

A

polycystic kidney

62
Q

Subarachnoid hemorrhage prognosis?

A

not very good - mortality 50-70%; morbidly 70%

63
Q

Subarachnoid hemorrhage - hallmark

A

WORSE HEADACHE OF MY LIFE

THUNDERCLAP HEADACHE

64
Q

Subarachnoid hemorrhage - what happens in the head?

A

ICP suddenly rises –> passes out (headache, vomitting, seizures, papilledema, cushings triad)

65
Q

Subarachnoid hemorrhage - sx?

A

headache, vomitting, BP increases (trying to perfuse brain)

66
Q

Subarachnoid hemorrhage - little bleeding - sx?

A

headache
stiff neck
focal neurological deficit (loss of vision)

67
Q

Subarachnoid hemorrhage - cx?

A

trauma - check w/ manometer and give mannitol until surgery

68
Q

Subarachnoid hemorrhage - gold standard?

A

angiogram

69
Q

Subarachnoid hemorrhage - labs?

A

1) CT FIRST!!!!!! to r/o “mass lesion” (if there is a mass lesion and you LP –> brainstem herniation occurs!!)
2) LP - SF has blood (HALLMARK)

70
Q

Subarachnoid hemorrhage - tx?

A

1) ABC
BP should be ~150 (keep brain perfused)
2) elevate head
3) sedation
4) cerebral vasospasm (4-14 days after) - cx “delayed” death
5) surgical clipping/endovascular coil placement

71
Q

Subdural hemorrhage - acute vs. chronic?

A

acute: sloshing the brain around (no trauma needs to happen - accelerating/deceleration) ie) shaken baby syndrome
chronic: common in elderly ie) overtime the briding veins are stretched as brain shrinks
* BOTH: BRIDGING VEINS (venous bleed) is torn

72
Q

Subdural hemorrhage - acute RF?

A

a fib
anticoagulation
elderly that bump their head

73
Q

Subdural hemorrhage acute - sx?

A

unilateral headahce w/ slightly enlarged pupil

-stupor, coma, blow pupil

74
Q

acute subdural hemotoma - acute - dx?

A

CT scan - CRESCENT SHAPE

75
Q

Subdural hemorrhage acute - tx?

A

burr hole drainage
craniotomy
until surgery: mannitol, hyperventilation

76
Q

Subdurl hemorrhage chronic subdural hemotoma - sx?

A 
dementia
slow thinking
headache
seizure
personality changes, depression
77
Q

Subdural hemorrhage chronic - RF?

A

elderly
chronic alcoholics: they have smaller brains so the venous bridging stretches!
anticoagulation

78
Q

Subdural hemorrhage chronic -tx?

A

surgical

watchful waiting

79
Q

Subdural hemorrhage chronic - imaging?

A

CT

80
Q

Epidural hemorrhage?

A

arterial bleed between skull and dura

81
Q

Epidural hemorrhage - cx?

A

trauma that tears the middle meingeal artery w/ skull fx (pt is in coma)

82
Q

Epidural hematoma - sx? Hallmark

A

1) hit and unconscious
2) comes to life - “LUCID INTERVAL”
3) deteriorates over min to hrs –> fall into coma
CN 3 is altered –> fixed, dilated pupil

83
Q

CN III injured?

A

subdural and epidural hemorrhage

fixed, dialted pupil - if traumatic

84
Q

Epidural hemorrhage - imaging?

A

CT - NOT crescent (unlike subdural hemorrhage) –> rounded b/c the bleeding can’t expand out of the sutures in the skull

85
Q

Epidural hemorrhage - tx?

A

rapid surgery and control bleeding

86
Q

Pt comes in after a fight, was hit in the head w/ a baseball bat. He was knocked unconscious and now he is awake. What to expect?

A 
fixed dilated pupil - CN III damaged
lucid interval (patient is normal but will deteriorate overtime)
87
Q

Pt comes in w/ a headache, pulsating noise in the head. Pt is 10-30yo. What to expect?

A

arterial-venous malformation

88
Q

What is arterial-venous malformation?

A

congenital or developmental abnormality
can be surface or deep in the brain
asymptomatic until bleeding occur
can calcify overtime

89
Q

Who is most likely to get aterial - venous malformation?

A

younger patients w/ intercranial bleeding (10-30yo)

90
Q

Arterial-venous malformation - imaging

A

MRI&raquo_space;> CT

angiogram is gold standard

91
Q

Arterial venous malformation - tx?

A

surgery if accessable

stereotactic radiation

92
Q

Moyamoya dz?

A

“puff of smoke” when the collateral vasculature is weak and prone to bleeding and thrombosis - stenosis of the cerebral vessel develops (so the other collateral vasculature is useless as well!)

93
Q

Who can help pts w/ stroke?

A

PT
OT
SLP (esp those who are prone to getting pneumonia - if they can’t aspirate - pneumonia!)
RT
case manager (esp if pt is not going back home after discharge)
psychologist - watch out for depression (b/c pt feels useless after stroke)

Neurology (13 decks)

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