Geriatric Cerebrovascular Disease Flashcards
Possible etiologies of stroke
- Cardiogenic: AFib MC
- Vascular: carotid stenosis (antithrombotic or surgery)
- Cryptogenic: antithrombotic tx
tPA time windows?
3 and 4.5 hrs
Describe congophilic angiopathy
- Cerebral amyloid angiopathy
- Lobar hemorrhages
- Recurrent exacerbated by anti-platelet agents or anticoagulants
How is congophilic angiopathy diagnosed?
Diagnosis of exclusion
CTI or MRI w/contrast after bleed resolution is necessary
Describe cerebral white matter disease
- Microangiopathy
- Seen on CT as dark areas
- Seen on T2 MRI as white area in centrum semi ovale
What is cerebral white matter disease also called on MRI reports?
Unidentified Bright Objects (UBO) or leucoariosis
What increases the incidence of cerebral white matter disease?
Vascular risk factors
Trauma
Migraine
What is cerebral white matter disease not to be confused with?
Demyelinating plaques of MS
Describe multi-infarct dementia
- Large vessel disease
- Causes many strokes (likely in eloquent areas of brain)
- Evidence easily seen on CT and MRI
Definition of “new” stroke/TIA?
6 months (after that, it is considered chronic/old)
How is intracranial arterial stenosis diagnosed?
CTA MRA
Treatment of intracranial arterial stenosis?
- Anti-platelet agent
- NO surgical/intravascular intervention
USPSTF recommendation for asymptomatic screening of carotid disease?
NOT recommended
Describe carotid vascular disease
- Carotid stenosis at bifurcation
- Endarterectomy if symptomatic and 70% ipsilateral narrowing
Who is MC affected by carotid dissection leading to TIA/CVA?
Younger pts (but a consideration with trauma)
How is carotid dissection diagnosed?
CTA MRA
Treatment of carotid dissection?
Anti-platelets
How does subarachnoid bleed present?
- Worst HA in their life
- AMS
Likely etiology of subarachnoid bleed?
Aneurysm over 5 mm
Treatment of subarachnoid bleed?
Reversal of any anticoagulant
Treatment of cerebral hematoma?
Reversal of any anticoagulant
What is a cerebral hematoma and how does it present?
- Parenchymal bleed
- Possible HA
- Focal deficit
Treatment of subdural hematoma?
- Can observe with a neurosurgeon if stable (spontaneous resolution is likely for small ones)
- Reverse any anticoagulant
What does a large subarachnoid bleed increase risk of?
Hydrocephalus
When should surgery be performed with parenchymal brain bleeding?
If progressive bleeding OR posterior fossa with deficits