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NEUROMUSCULAR > lecture 2 gold- cerebrovasculat diseases > Flashcards

lecture 2 gold- cerebrovasculat diseases Flashcards

1
Q

what is Abnormality of the brain resulting from a
pathologic process of blood vessels

A

cerebrovascular disease

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2
Q

define ischemia

A

Decreased blood flow, reversible

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3
Q

define infarction

A

death of tissue due to lack of blood flow

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4
Q

what is a Formation of clot within a vessel,
generally due to atherosclerosis

A

thrombosis

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5
Q

what is a Blood clot formed elsewhere travels
to the brain and lodges in a cerebral vessel

A

embolism

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6
Q

what is Bleeding (into the brain,
subarachnoid space, etc.)

A

hemorrhage

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7
Q

what is An acute clinical event related to
interruption of blood supply or
bleeding of a blood vessel resulting
in a change in neurologic function
(lasting more than 24 hrs) with
evidence of cerebral ischemia on
brain imaging.

A

a stroke

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8
Q

how long does a stoke last

A

more then 24 hours

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9
Q

what is a –Brief episode of focal neurologic
dysfunction from brain or retinal
ischemia w/o evidence of acute
infarction on MRI

A

transient ischemia attack

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10
Q

how long is a TIA

A

<1 hour but by definition < 24 hours

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11
Q

when is the highest risk that after a TIA you can have a stroke

A

1st 30 days

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12
Q

___ day risk of stroke after TIA is 3-17 %-

A

90

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13
Q

those with TIA have a ____ % stoke risk int he next 10 years

A

18.8

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14
Q

what tool is used for TIA evaluation

A

ABCD2

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15
Q

what is the ABCD2

A

a tool to see what is the probabaility that a stroke will happen in the next 2 days

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16
Q

what score is considered high risk from the ABCD2 score ? moderate ? low ?

A

6-7
4-5
0-3

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17
Q

what are 5 mimickers of a stroke

A

– Hypoglycemia or hypoxia
– Seizures (Todd’s paralysis)
– Migraines
– Multiple sclerosis attacks
– Brain tumor swelling

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18
Q

what is considered not an ischemic stroke (7)

A
  • Sudden loss of consciousness
  • Syncope/pre-syncope
  • Numbness in both feet
  • Waxing and waning confusion
  • Diffuse weakness
  • Numbness in one hand or foot
  • Pain
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19
Q

what is the 5th leading cause of death in the Us

A

strokes

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20
Q

in the US how many strokes are averaged every 40 seconds

A

1

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21
Q

what is the leading cause of serious disability in the US

A

stroke

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22
Q

globally what is the 2nd leading cause of death

A

stroke

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23
Q

what is considered a major risk factor for strokes

A

age

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24
Q

Hypertension
Pregnancy
Diabetes
OCPs
High cholesterol
Alcohol abuse
Heart Disease
Obesity
Smoking
Physical activity
Drug abuse
Obstructive sleep apnea

these are all examples of what

A

modifiable risk factors for stroke

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25
Q

• Older age (72% occur in people > age 65)
• Male gender
• Family history
• Race (Blacks > Whites)

these are examples of what

A

non modifiable risk factors for stroke

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26
Q

what stroke subtype is 87% of stroke

A

ischemia

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27
Q

what stroke subtype is large vessel atherosclerosis

A

ischemia

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28
Q

what are small vessel subcortical strokes called

A

lacunar

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29
Q

what stroke subtype is 13% of stoke

A

hemorrhagic

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30
Q

what are the 2 types of hemorrhagic strokes and which is most common

A

intra cerebral and subarachnoid , and intra cerebral is more common

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31
Q

what are teh 5 ischemic stroke subtypes

A

– Large vessel atherosclerosis
– Cardio-aortic-embolism
– Small vessel subcortical strokes (lacunar)
– Other Rare/Unusual Etiology
– Undetermined etiology (~25 – 30%)

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32
Q

for a thrombotic infarction what % of people have had a warning episode (TIA)

A

> 50

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33
Q

when is the onset for a thrombotic infarction

A

during sleep , awakens with deficits

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34
Q

what do the symptoms of a thrombotic infarction depend on

A

the vessel invovled

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35
Q

what are branches of the internal carotid artery

A

OPAAM

Ophthalmic Artery
Posterior Communicating
Anterior choroidal
Anterior Cerebral Artery
Middle Cerebral Artery

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36
Q

if someone has a ACA stroke what is it affecting

A

leg weakness

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37
Q

if someone has a MCA stroke what is it affecting

A

hemiparesis of face and arm on the contralateral side

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38
Q

someone with a MCA will have neglect on which side and aphasia on which side

A

neglect on the non dominant and aphasia on dominant

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39
Q

what else will be impaired with a MCA infarction

A

cortical sensory loss

homonymous hemianopsia

paralysis of conjugate gaze to opposite side (eyes look toward the lesion)

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40
Q

what is aphasia

A

disorders of language

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41
Q

where is motor aphasia/expressive aphasia

A

anterior MCA territory near broca’s area

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42
Q

what is decreased and what is intact with motor aphasia

A

decreased fluency and intact comprehension

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43
Q

where is sensory aphasia/ receptive aphasia located

A

posteior MCA territory near wenickes area

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44
Q

what is intact and poor in sensory aphasia

A

fluent is intact and poor comprehension

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45
Q

which aphasia is more common

A

motor aphasia (brocas)

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46
Q

what is it called when both motor and sensory aphasia happens

A

global aphasia

47
Q

what are the impairments with an ACA infarction *rare)

A
  • hemiparesis in the legs
  • hemisensoyr int he legs
  • urinary incontinence (usually only with bilateral infarcts )
  • slowness
  • akinetic mutism
48
Q

what is abulia

A

slowness , delay , lack of spontaneity

49
Q

what are the impairments for a PCA infarction

A

-homonymous hemianopsia
- visual hallucination
-cortical blindness
-some contra sensory deficit
-inability to read (alexia)
- top of the basilar syndrome

50
Q

what is the summary of symptoms for ACA infarct

A

contralateral leg weakness & problems with motivation and organization

51
Q

what is the summary of symptoms of a dominant MCA infarct

A

contral weakness in arm and face
neglect
gaze deviation
aphasia

52
Q

what is the summary of symptoms for non dominant MCA infaract

A

-contralateral weakness in arms and face
-neglect
-gaze deviations

53
Q

what are th summary of symptoms for a PCA infarct

A

-contra homonymous hemianopsia
- splenium of corpus callosum
-may affect thalamus

54
Q

– Sensory &/or motor abnormalities in any combo of
extremities/face
– Vertigo, clumsiness, ataxia,
– Diplopia, Dysarthria, Dysphagia
– Nausea/vomiting
– Hearing loss, hiccups

these are all symptoms of what kind of large vessel ischemic stroke

A

vertebrobasilar (brainstem)

55
Q

where do most cerebral embolism arise in

A

the heart

56
Q

what is the most common cause of a cardioembolic infarction

A

atrial fibrillation

57
Q

what is an endocarditis

A

infection of heart valves

58
Q

if someone has atrial fibrillation what is the increased risk for stroke and death

A

• 5x increased risk for stroke
• 2x increased risk of death

59
Q

what reduces the risk for stroke by 2/3 with people with a fib

A

oral anti coagulation therapy

60
Q

what are the examples for atrial fibrillation anticoagulation

A

warfarin (coumadin)
novel oral anticoagulants

• Rivaroxaban (Xarelto)
• Apixaban (Eliquis)
• Dabigatran (Pradaxa)

61
Q

what are other sites for embolism infarction

A

–aorta
–large intracranial arteries
–patent foramen ovale

62
Q

what are small infarcts of less than 1.5 cm called

A

lacunar infarction

63
Q

a lacunar infarction is an occlusion of small penetrating vessels in what 6 things

A

-pons
-putamen
-caudate
-internal capsule
- thalamus
-corona radiata

64
Q

what is a lacunar infarction usually related to

A

hypertension and DM

65
Q

what is a effected in a pure motor stroke of an lacunar infarction

A

hemiparesis of face , arm and leg

internal capsule or base of pons

66
Q

what is a effected in a pure sensory stroke of an lacunar infarction

A

face, arm and leg-
posterolateral thalamus

67
Q

what is a effected in a sensorimotor stroke of an lacunar infarction

A

thalamus and internal capsule

68
Q

what is a effected in a dysarthria , clumsy hand syndrome of an lacunar infarction

A

base of pons

69
Q

what is a effected in a ataxia hemiparesis of an lacunar infarction

A

Pons/Internal capsule or
subcortex

70
Q

what is affected in a thalamic stroke

A

contralateral sensory loss to all modalities

71
Q

what is the symptoms of a thalmic stroke

A

spontaneous pain and dysesthesias

72
Q

do people with thalamic stoke have hemiparesis ?

A

mildly

73
Q

what is affected with an ACIA stroke

A

hearing loss, facial weakness, ataxia, Horner’s
syndrome

74
Q

what artery is affected in lateral medullary syndrome or wallenberg syndrome

A

PICA/ vertebral artery

75
Q

what is affected with a superior cerebellar artery stroke

A

ipsilateral ataxia, scanning speech

76
Q

• Inherited disease
– MELAS
– CADASIL
– Fabry disease
• Inflammatory disorders
– Vasculitis
• Hematologic disorders
– Coagulation disorders
– Sickle cell
• Other
– Radiation
– Moya Moya
– Cocaine

these are all what

A

rare casues of strokes

77
Q

what does BE FAST stand for

A

-balance
-eyes

-face
-arms
-speech
-time

78
Q

the standard is door to needle time in ___ minutes but what is the goal

A

60
45 mins is the goal

79
Q

for every 30 min delay what % decline is there in a good outcome

A

10

80
Q

what is the most important thing in the history

A

time of onset

81
Q

what are the 11 NIH stroke scale items

A

1a. LOC
1b. LOC questions
1c. commands
2. best glaze
3. visual field
4. facial palsy
5. motor arm
6- motor leg
7- limb ataxia
8- sensory
9- best language
10- dysarthria
11-extinction/ neglect

82
Q

what is tPA (tissue plasminogen activator)

A

clot busting medication

83
Q

what is the only FDA approved medication from acute stroke

A

tPA ( tissue plasminogen activator)

84
Q

what are the contraindications from tPA

A

– > 4.5 hours from last known normal
– Hemorrhage (internal, intracranial)
– Head trauma or stroke in past 3 months
– Severe uncontrolled high blood pressure (<185/110)
– Endocarditis or aortic dissection
– Bleeding disorder or anticoagulated
– Glucose < 50

85
Q

how should we monitor Bp in tPA patients

A

check BP every 15 min for 2 hours and then every 30 mins for 6 hours then 1 hour for next 18 hours

86
Q

what is the BP that patients need to maintain when taking tPA

A

< 180/105

87
Q

how long is blood pressure management post stroke

A

first 3-4 days

88
Q

what is the post tPA blood pressure goal post stroke ?

A

<180/105

89
Q

what is the no tPA medication blood pressure goal post stroke

A

< 220/110

90
Q

what are secondary preventions for stroke care

A

– Quit smoking, drugs, alcohol
– Medical management (antiplatelet;
hypertension, diabetes mellitus, obesity,
hyperlipidemia)
– Anticoagulation in cardioembolic strokes
– Carotid artery surgery versus stenting

91
Q

what is the Surgical procedure to remove
atherosclerotic plaque from the carotid
artery.

A

carotid endarterectomy

92
Q

Symptomatic carotid artery stenosis”
implies a patient has had what

A

a TIA or stroke referable to the territory of the stenosis vessel

93
Q

what on the imaging is bright colored and tells u about new stroke

A

DWI

94
Q

when is the highest rate of recovery from a stroke

A

1st 3-6 months

95
Q

what deficits have better recovery rather than others

A

swallowing , facial movements , and gait

96
Q

what deficits tend to recover more slowly

A

language , spatial attention and dominant hand movements

97
Q

does recovery from a stroke tend to being proximal or distal

A

proximally

98
Q

what kind of intracerebral hemorrhagic stroke is most common caused by HTN

A

subcortical

99
Q

Aneurysms, AVMs, venous, trauma,
intracranial artery dissections,
cocaine/amphetamine

these are what kind of strokes

A

subarachnoid hemorrhagic strokes

100
Q

• Focal neurologic deficits rapid in onset
• Symptoms of increased intracranial pressure
common (headache, vomiting, decreased
consciousness)
• CT readily shows blood

these are clinical signs of what kind of strokes

A

intracranail hemorrhage

101
Q

what is the most common causes of a intracerebral hemorrhage

A

hypertension

102
Q

Intracerebral hemorrhage due to HTN are located where

A

– putamen
– pons
– cerebral
hemisphere
– cerebellum
– thalamus

103
Q

according to the glasgow coma scale what is considered severe , moderate and mild scores

A

severe.. 3-8
mod… 9-12
mild.. 13-15

104
Q

what is the management for intracerebral hemorrhage

A

treat increased intracranial pressure

105
Q

80% of subarachnoid hemorrhage is caused by what

A

rupture of intracranial aneurysm

106
Q

what % die before medial attention for a Subarachnoid hemorrhage (SAH)

A

10

107
Q

what % die within 3 months with a Subarachnoid hemorrhage (SAH)

A

40

108
Q

what % are survivors of Subarachnoid hemorrhage (SAH) that live with disabilities

A

50

109
Q

what is a Sudden explosive headache which may lead to loss of consciousness

A

aneurysm rupture

110
Q

what is the leading causes of death and disabilities for an aneurysmal subarachnoid hemorrhage

A

– Effects of initial hemorrhage
– Recurrent hemorrhage
– Vasospasm leading to ischemic

111
Q

Thrombosis of venous system: can involve both____ and ____

A

ischemia and hemorrhage

112
Q

strokes of venous origin may present with

A

– Headache
– Focal neurologic signs
– Hemorrhage- SAH or ICH
– Altered mental status, seizures

113
Q

how do you diagnose strokes of venous orgina and how do u treat it

A

diagnose with CT or MRI and treat with anticoagulation

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