Geriatric Cerebrovascular Disease

Question 1

Possible etiologies of stroke

Answer 1

• Cardiogenic: AFib MC
• Vascular: carotid stenosis (antithrombotic or surgery)
• Cryptogenic: antithrombotic tx

Question 2

tPA time windows?

Answer 2

3 and 4.5 hrs

Question 3

Describe congophilic angiopathy

Answer 3

• Cerebral amyloid angiopathy
• Lobar hemorrhages
• Recurrent exacerbated by anti-platelet agents or anticoagulants

Question 4

How is congophilic angiopathy diagnosed?

Answer 4

Diagnosis of exclusion

CTI or MRI w/contrast after bleed resolution is necessary

Question 5

Describe cerebral white matter disease

Answer 5

• Microangiopathy
• Seen on CT as dark areas
• Seen on T2 MRI as white area in centrum semi ovale

Question 6

What is cerebral white matter disease also called on MRI reports?

Answer 6

Unidentified Bright Objects (UBO) or leucoariosis

Question 7

What increases the incidence of cerebral white matter disease?

Answer 7

Vascular risk factors
Trauma
Migraine

Question 8

What is cerebral white matter disease not to be confused with?

Answer 8

Demyelinating plaques of MS

Question 9

Describe multi-infarct dementia

Answer 9

• Large vessel disease
• Causes many strokes (likely in eloquent areas of brain)
• Evidence easily seen on CT and MRI

Question 10

Definition of “new” stroke/TIA?

Answer 10

6 months (after that, it is considered chronic/old)

Question 11

How is intracranial arterial stenosis diagnosed?

Answer 11

CTA MRA

Question 12

Treatment of intracranial arterial stenosis?

Answer 12

• Anti-platelet agent

- NO surgical/intravascular intervention

Question 13

USPSTF recommendation for asymptomatic screening of carotid disease?

Answer 13

NOT recommended

Question 14

Describe carotid vascular disease

Answer 14

• Carotid stenosis at bifurcation

- Endarterectomy if symptomatic and 70% ipsilateral narrowing

Question 15

Who is MC affected by carotid dissection leading to TIA/CVA?

Answer 15

Younger pts (but a consideration with trauma)

Question 16

How is carotid dissection diagnosed?

Answer 16

CTA MRA

Question 17

Treatment of carotid dissection?

Answer 17

Anti-platelets

Question 18

How does subarachnoid bleed present?

Answer 18

• Worst HA in their life

- AMS

Question 19

Likely etiology of subarachnoid bleed?

Answer 19

Aneurysm over 5 mm

Question 20

Treatment of subarachnoid bleed?

Answer 20

Reversal of any anticoagulant

Question 21

Treatment of cerebral hematoma?

Answer 21

Reversal of any anticoagulant

Question 22

What is a cerebral hematoma and how does it present?

Answer 22

• Parenchymal bleed
• Possible HA
• Focal deficit

Question 23

Treatment of subdural hematoma?

Answer 23

• Can observe with a neurosurgeon if stable (spontaneous resolution is likely for small ones)
• Reverse any anticoagulant

Question 24

What does a large subarachnoid bleed increase risk of?

Answer 24

Hydrocephalus

Question 25

When should surgery be performed with parenchymal brain bleeding?

Answer 25

If progressive bleeding OR posterior fossa with deficits