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neuro 2 exam 2 > DSA 26 Cerebrovascular Disease > Flashcards

DSA 26 Cerebrovascular Disease Flashcards

1
Q

stroke in MCA → lesion in motor cortex. presentation?

A

contralateral paralysis in upper limb and face

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2
Q

stroke in MCA → lesion in sensory cortex. presentation?

A

contralateral loss of sensation in upper limb and face

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3
Q

stroke in MCA → lesion in Wernicke’s area; Broca’s area. presentation?

A

aphasia if in dominant (usually left) hemisphere; hemineglect if lesion affects non dominant (usually right) side.

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4
Q

stroke in ACA → lesion in motor cortex. presentation?

A

contralateral paralysis of lower limb

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5
Q

stroke in ACA → lesion in sensory cortex. presentation?

A

contralateral loss of sensation in lower limb

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6
Q

stroke in PCA → lesion in occipital cortex, visual cortex. presentation?

A

contralateral hemianopsia with macular sparing

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7
Q

stroke in basilar artery → lesion in pons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular CN nuclei, paramedian pontine reticular formation. presentation?

A

locked-in syndrome: preserved consciousness and blinking, quadriplegia, loss of voluntary facial/mouth/tongue movements

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8
Q

identify: noises heard over vascular territories, usually over arteries

A

bruits

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9
Q

where are carotid bruits heard best?

A

at bifurcation of carotid with sound transmitted to angle of mandible

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10
Q

what is usually the initial brain imaging modality of choice when investigating patient with potential cerebrovascular disease?

A

CT scan

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11
Q

identify: focal neurological deficit due to temporary reduction in blood flow to part of the brain, usually lasting minutes

A

transient ischemic attack

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12
Q

during what time frame do TIAs ALWAYS resolve?

A

always resolve within 24 hours

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13
Q

what is normal cerebral blood flow?

A

50cc per 100 gram per min

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14
Q

what is the cerebral blood flow value defined as ischemia?

A

<25 cc per 100 gram per min

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15
Q

during _______ (ischemia/infarction) neurons become dysfunctional but may recover if blood flow returns.

A

ischemia

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16
Q

what is the cerebral blood flow value defined as infarction?

A

<13cc per 100 gram per min

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17
Q

during _____ (ischemia/infarction) cell death in the brain typically occurs.

A

infarction

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18
Q

true or false: asymptomatic carotid bruit is much riskier than TIA.

A

false, TIA is riskier

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19
Q

what are individual stroke risk factors?

A

1.) prior stroke or TIA 2.) atrial fibrillation

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20
Q

what is the most common stroke risk factor in the general population?

A

hypertension

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21
Q

where does atherosclerosis tend to occur earliest?

A

locations of greatest vascular turbulence that is around the major bifurcations

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22
Q

what is the equation for hemodynamics?

A

CPP = MAP - ICP

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23
Q

patient presents with S/S of acute ischemic stroke or any acute focal neuro deficit, mild/moderate increase in BP. what do you do?

A

perform brain imaging before lowering the BP. if patient has an increased ICP, decreasing MAP might decrease CPP critically.

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24
Q

patient presents with S/S of acute ischemic stroke or any acute focal neuro deficit, mild/moderate increase in BP. imaging doesn’t show evidence of something increasing ICP. now what?

A

if evidence of end organ damage, lower BP acutely. if not, lower BP gradually and carefully.

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25
Q

central area of infarction surrounded by area of ischemia. what is the area of ischemia?

A

penumbra. usually seen in acute ischemic stroke

26
Q

what is the clinical significance of the penumbra?

A

brain within the penumbra might be salvageable. recovery of this area is primary reason people improve following strokes.

27
Q

as a physician, how should you manage the penumbra?

A

make every effort to maintain perfusion to this area of ischemia

28
Q

what is the indication for using tPA?

A

acute ischemic stroke

29
Q

what are tPA contraindications?

A

hemorrhage on CT seizure activity at onset recent intracranial hemorrhage, trauma, or surgery active bleeding or bleeding disorder coagulation abnormality uncontrolled HT at time of tx

30
Q

identify: small atherosclerotic ischemic stroke involving the small penetrating arteries of the brain resulting in little “lakes”

A

lacunar stroke

31
Q

where do lacunar strokes typically occur?

A

deep white matter

32
Q

patient suffers stroke. what leads you to suspect cardioembolic etiology?

A

younger patient (40s or 50s), no hypertension, no hyperlipidemia, non-smoker. possible cardiovascular risk factors

33
Q

_______ (thrombotic/embolic) ischemic infarct is unlikely to have reversal of occlusion.

A

thrombotic

34
Q

_______ (thrombotic/embolic) ischemic infarct has possibility of thrombolysis occurring and re-establish blood flow.

A

embolic

35
Q

what structure is frequently damaged when ischemic infarct occurs?

A

blood-brain barrier

36
Q

what happens if blood flow is re-established to area of brain with BBB damage?

A

hemorrhagic transformation

37
Q

true or false: hemorrhagic transformation virtually never occurs in cardioembolic infarct.

A

false, this is true for atherosclerotic infarct. occurs in approx. 10-15% of cardioembolic infarcts

38
Q

a patient experiences progressive deterioration with medical management of hemorrhagic stroke. next step?

A

surgical evacuation of hematoma after craniotomy may be life-saving

39
Q

what is the second most common cause of subarachnoid hemorrhage?

A

ruptured vascular malformation

40
Q

difference between primary and secondary prevention?

A

primary prevention involves patients who have NOT experienced an event due to risk factors.

41
Q

true or false: asymptomatic carotid bruit is a modifiable risk factor.

A

false, symptomatic carotid bruit is.

42
Q

_______ antibody is a modifiable risk factor.

A

anticardiolipin

43
Q

true or false: vasculitis is a modifiable risk factor.

A

true

44
Q

what risk factors might be added for women?

A

history of eclampsia migraine hormone replacement therapy

45
Q

rank the risk factors based on relative risk from greatest to least: hyperlipidemia, alcohol abuse, hypertension, smoking, diabetes

A

hypertension smoking diabetes alcohol abuse hyperlipidemia

46
Q

how do you treat a patient that has cardiac risk factors for stroke?

A

anticoagulation or vitamin K antagonist/antithrombotics **unless contraindicated**

47
Q

patient has previous TIA or mild stroke. no cardiac or surgical vascular risk factors. treatment?

A

antiplatelet agents: aspirin, clopidogrel, ticlopidine, dipyramidole

48
Q

describe the most ominous bruit and explain siginificance.

A

the most ominous bruit possible is a very high-pitched, barely heard bruit–this indicates a very severe stenosis

49
Q

describe symptoms of right carotid artery ischemia.

A

contralateral motor or sensory symptoms

contralateral hemianopsia

ipsilateral eye visual disturbance

50
Q

if patient CDUS suggests high grade stenosis of proximal internal carotid artery, what do you do next?

A

cerebral arteriogram. then if the cerebral arteriogram reveals some flow, perform carotid endarterectomy.

51
Q

what is the very first branch off the internal carotid artery in the head?

A

ophthalmic artery

52
Q

how can you distinguish internal carotid ischemia from MCA ischemia based on patient presentation?

A

ICA ischemia will present with ipsilateral monocular visual loss.

MCA ischemia would present with contralateral hemianopsia.

53
Q

how do you treat a patient with atherosclerotic ischemic stroke?

A

modify all modifiable risk factors and initiate antiplatelet therapy

54
Q

when treating a patient, how do we distinguish a TIA from a stroke?

A

we dont. we treat the TIA as a stroke unless the patient is improving.

55
Q

what is the definition of uncontrolled hypertension in terms of tPA contraindications?

A

BP > 180/110

56
Q

what is the significance of the ophthalmic artery branching off the internal carotid artery before the MCA?

A

cannot have an ophthalmic artery occlusion resulting from a MCA lesion

57
Q

what might result from an occlusion at the tip of the basilar artery? how would this affect the pupillary light reflex?

A

might cause cortical blindness due to infarction of both occipital lobes.

pupillary light reflex would be normal–no component of this reflex is posterior to the Edinger-Westphal nucleus in the midbrain.

58
Q

how does cardioembolic stroke differ from atherosclerotic stroke?

A

blood flow may return to infarcted brain following cardioembolic stroke because we have our own endogenous thrombolytic system.

59
Q

ischemic stroke that enhances with contrast or has become secondarily hemorrhagic. suspect stroke is cardioembolic or atherosclerotic?

A

cardioembolic

60
Q

list 3 non-vascular causes of TIA.

A
  1. ) partial seizure
  2. ) migraine with aura
  3. ) MS attack

neuro 2 exam 2 (16 decks)

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