Exam 3 Cerebrovascular Dz Flashcards
2 main categories of Strokes?
Ischemic (85%)
Hemorrhagic
Arteries that supply Cerebral Arteries and Cerebellum?
Internal Carotid
Vertebral
Internal Carotids are branches of what aa?
Branches into?
Common Carotids
Anterior cerebral -> Middle cerebral
Vertebral aa are branches of what aa?
Subclavians
Vertebral aa fuse into what a?
Basilar
Basilar Artery supplies what?
Branches into?
midbrain
cerebellum
posterior cerebral a
Circle of Willis does what?
Back-up blood supply
Connects Internal Carotids and Basilar
Ischemic Strokes result from? (4)
Carotid/Large IC vessel thrombus
Lacunar dz (deep vessels)
CV embolus
Vasculitis, Vasospasm, Hyper-coag
IC Hemorrhagic Strokes result from? (4)
HTN
AV malformation
Amyloid angiopathy
Anticoag therapy
Subarach Hemorr Stroke results from? (4)
Trauma
Congenital berry aneury
Amyloid angiopathy
Inflamm dz
Thrombus is?
Occlusion from dz at site
Embolus is?
Occlusion from fragment from another site
Aneurysm is?
Balloon dilation of vessel
Arteriovenous Malformation is?
Tumor of bv
Thrombi/Emboli ischemia damages neurons which leads to?
Release of glutamate ->
↑ Ca2+ absorb in neighbor neurons ->
Kills the neighbors ->
Spreads cascade of death outward
Transient Ischemic Attacks (TIA) are?
↑ risk of what?
Sudden onset of focal neuro deficit,
resolves w/i 24 hrs
CVA (5-10% per yr)
Highest risk during 1st 3 mo
TIA presentation: Amaurosis Fugax?
Transient unilateral vision loss from blocked ophthalmic artery
“Shade being pulls across eye”
From ipsilateral carotid artery dz
CVA exam findings?
Vitals = N
Fund exam = Hollenhorst plaques
Carotid bruits
P murmur/arrhy
CVA neuro exam findings:
Mental Status?
CNs?
Motor?
Mental Status = ∆ in consciousness, speech dist
CNs =
ptosis, abn pupils, fields cut
numb face/asymm
loss of gag/tongue deviation
Motor = change in strength
R v L, U v L, pronator drift
CVA neuro exam findings:
Sensory?
Reflex?
Cerebellar?
Sensory = lost sensation (R/L, Up/Low)
Reflex = asymm, hyper in affected area
Cereb = abn finger-nose/heel-shin, + Romberg, ataxia
Review Vascular Territories/Homonculus slide 20-21
.
Anterior Circulation CVA: Internal Carotid presentation? (5)
APHASIA Ipsilat monocular vision loss Contralat homonymous hemianopsia Contralat sensorimotor deficit (prox > dist) Contralat CN VII palsy
Anterior Circulation CVA: Anterior Cerebral Artery presentation? (6)
↓ concentration Personality ∆ Sphincter incontinence Contralat sens/motor deficit extremities (dist > prox, leg > arm) Face spared
Anterior Circulation CVA: Middle Cerebral Artery presentation? (10)
Aphasia
Contralat homonymous hemianopsia
Contralat sensorimotor deficit (prox > dist)
Contralat CN VII palsy
Dominant hemisphere: Agnosia R/L disorientation Agraphia (can't write) Alexia (can't see/read words)
Non-Dominant hemisphere:
Apraxia (loss of learned actions)
Hemi-neglect (unaware of one side of body)
Expressive Aphasia/Brocca’s is?
Receptive Aphasia/Wernicke’s is?
Global Aphasia?
Understands but can’t produce words
Doesn’t understand, speaks nonsense
Both
Posterior Circulation CVA: Posterior Cerebral Artery presentation? (4)
Contralat hemisensory loss
Contralat homonymous hemianopsia
Cortical blindness
Color agnosia (can’t interpret)
Posterior Circulation CVA: Vertebrobasilar Circulation presentation? (4)
Coma Diplopia (double vision) Vertigo Weakness (corticospinal tracts) Sensory loss (spinothalamic tracts) Ataxia/imbalance
Watershed Infarct it?
Infarct b/w vascular territorities
2° to low flow from hypoTN
Lacunar Infarct is?
Seen where in brain?
a/w?
Presentation?
Small, subcortical infarcts
2° to penetrating artery occlusion
Basal ganglia (Middle cerebral artery) Pons (Basilar artery)
a/w HTN
Pure motor or sensory loss
Non-focal Symptoms are? (4)
Result of?
Caused by? (3)
HA
∆ mental status
N/V
Papilledema
↑ ICP
Intracerebral hemorr
Subarachnoid hemorr
CVA w/ edema
Complications of CVA? (7)
Aspiration PNA DVT/PE UTI Decubiti Contractures Poor nutrition/hydration Depression
