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Cardiovascular Block > L22 - Carotid disease / TIA / CVA > Flashcards

L22 - Carotid disease / TIA / CVA Flashcards

1
Q

Summarise key points of atherosclerotic disease of the carotid artery?

A

Atherosclerosis

  • plaque formation composed of necrotic cells, lipids, cholesterol crystals
  • plaques can cause stenosis
  • embolisation
  • thrombosis
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2
Q

Summarise pharmacotherapy used to manage atherosclerotic disease of the carotid artery? (3)

A
  • antiplatelet agents (aspirin, ticlopidine, clopidogrel)
  • statin therapy
  • anticoagulants
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3
Q

Briefly describe the bifurcation of the carotid artery and what structures are found?

A

C3-C5

  • Carotid artery enlarges in mid neck forming carotid bulb.
  • bifurcates into ICa and ECa
  • carotid sinus and carotid body are found.
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4
Q

Describe the pathophysiology behind a TIA?

4

A
  • Temporary reduction / cessation of cerebral blood flow.
  • partial / total occlusion
  • typically from acute thromboembolic event
  • stenosis of small vessel
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5
Q

What is ischaemic stroke?

A
  • Sudden loss of blood circulation to an area of the brain

- resulting in corresponding loss of neurologic function.

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6
Q

What is acute ischaemic stroke caused by?

A
  • thrombotic or embolic occlusion of cerebral artery

- more common than haemorrhagic stroke

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7
Q

Signs and symptoms of stroke

A

acute onset combination of

  • face / arm / leg weakness or sensory loss
  • loss of co-ordination
  • speech disturbance
  • visual disturbance
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8
Q

FAST

A

Facial weakness
Arm leg weakness
Speech problems
Time to call 999

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9
Q

Ischaemic stroke therapies include

A
  • fibrinolytic therapy
  • anti-platelets
  • mechanical thrombectomy
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10
Q

Stroke prevention (4)

A
  1. Platelet anti-aggregants
  2. Statins
  3. Exercise
  4. Lifestyle interventions
    - -> smoking cessation
    - -> alcohol moderation
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11
Q

Describe the 3 paired major arteries supplying the cerebral hemispheres?

A
  1. Anterior cerebral artery
  2. Middle cerebral artery
  3. Posterior cerebral artery
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12
Q

Anterior cerebral artery

A

Cortical branches
–> medial, frontal, parietal lobe

Medial lenticulostriate branches
–> caudate head, globus pallidus, anterior limb of internal capsule

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13
Q

Middle cerebral artery

A
  • dominant supply

Cortical branches

  • -> lateral, frontal and parietal lobes
  • -> lateral and anterior temporal lobe

Lateral lenticulostriate branches

  • -> globus pallidus
  • -> putamen
  • -> internal capsule
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14
Q

Posterior cerebral artery

A

Arises from basilar artery

Cortical branches

  • -> occiptal lobes
  • -> medial, posterior temporal and parietal lobes

Perforating branches

  • -> brainstem
  • -> posterior thalamus
  • -> midbrain
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15
Q

Pathophysiology behind acute ischaemic stroke

A
  • vascular occlusion, secondary to thromboembolic disease
  • ishcaemia –> cell hypoxia, depletion of ATP –> can’t maintain ionic gradients
  • influx of sodium and calcium ions, passive inflow of water into cell –> cytotoxic oedema
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16
Q

Common differentials to stroke (3)

A
  • Bell’s palsy
  • Demyelination
  • space occupying lesion
17
Q

Difference between ischaemic and haemorrhagic stroke

A

Ischaemic = blocked blood vessel

Haemorrhagic = burst blood vessel

18
Q

Describe haemorrhagic stroke

A

Bleeding directly into brain parenchyma.

  • leakage from small intracerebral arteries damaged by chronic hypertension
19
Q

Management of haemorrhagic stroke

A
  1. Anticonvulsants: prevent seizure recurrence
  2. Antihypertensive agents: reduce BP
  3. Osmotic diuretics: decrease intracranial pressure in subarachnoid space
20
Q

Difference between STROKE and TIA

A

Stroke

  • rapidly developing neurological deficit (lasting 24hrs or leading to DEATH)
  • no apparent cause other than vascular

TIA

  • rapidly developing neurological deficit, lasting under 24hrs, will not result in death
  • no apparent cause other than vascular
21
Q

Summarise stroke classifications

A
  1. Total anterior circulation stroke (TACS)
  2. Partial anterior circulating stroke (PACS)
  3. Lacunar syndrome (LACS)
  4. Posterior circulation stroke syndrome (POCS)
22
Q

TACS features (4)

Total Anterior Circulation Stroke

A
  1. Hemiparesis (face/arm/leg)
  2. homonymous hemianopia
  3. disorder of higher function (dysphasia, neglect, inattention)
  4. May also have dysarthria/ dysphagia
23
Q

PACS

Partial Anterior Circulation Stroke

A

only 2/3 components of TACI

  1. higher cerebral dysfunction alone (e.g. dysphasia)
  2. motor and/or sensory deficit affecting one limb (e.g. hand)
  3. may also have dysarthria / dysphagia
24
Q

LACS (3)

A
  • hemiparesis / hemi-sensory loss
  • face, arm, leg
  • may also have dysarthria / dysphagia

any one of:

  1. Pure motor deficit
  2. Pure sensory deficit
  3. Sensorimotor deficit
25
Q

POCS (5)

A
  • vertigo with ataxia and vomiting or
  • isolated hemianopia or
  • unilateral impaired coordination
  • lower motor neurone cranial nerve signs
  • may also have dysarthria / dysphagia
26
Q

Rule of D’s (4)

A
  1. Diplegia’s
  2. Diplopia
  3. Dysaesthesia
  4. Dysdiadochokinesis
    - inability to execute rapid alternating movements

Cardiovascular Block (16 decks)

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