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Neurology > Lecture 4: CVA > Flashcards

Lecture 4: CVA Flashcards

1
Q

Types of Strokes

A

1) Hemorrhagic: 17%, occur as a result of bleeding in the brain due to an injury to head or ruptured aneurysm of a vessel (produce more fatalities)
2) Ischemic stroke: 83%, occur because of clot formation in blood vessels

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2
Q

Types of Hemorrhagic Strokes

A

1) Intracerebral Hemorrhage (59%)- occurs when defective artery in brain ruptures and surrounding area of brain fills with blood
2) Subarachnoid Hemorrhage (41%)- occurs when b. vessel on surface of brain ruptures and bleeds into subarachnoid space btwn skull

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3
Q

Types of Ischemic Strokes:

A

1) Cerebral Embolism (20%): result of clot (embolus) that forms in another part of body and is carried to brain, becoming lodged in artery that supplies blood to brain; flow is blocked
2) Artherosclerotic Cerebrovascular Dz (20%): stroke occurs due to severe arterial stenosis or occlusion due to severe arteriosclerosis and coexisting thrombosus
3) Lacunar Infacrts (25%): results from microatheroma, lipohyalinosis and other occlusive dz.’s of the small penetrating arteries in the brain (usually basal ganglia, pons, cerebellum)
4) Cryptogenic (30%): unknown cause

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4
Q

Lacunar Strokes

A
  • small infarctions occur secondary to small vessel damage

- usually resulting from HTN or DM

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5
Q

Most common areas affected by lacunar strokes

A

Basal ganglia and internal capsule!

-other areas affected: pons, cerebellum, thalamus

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6
Q

Clinical Features of Lacunar strokes

A

1) Pure Motor Hemiplegia
2) Pure Sensory Strokes
3) Ataxic Hemiparesis
4) Secondary Motor Syndrome
5) Dysarthria CLumsy hand syndrome

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7
Q

Pure Motor Hemiparesis

A
  • contralateral weakness involving face-arm-leg
  • limbs equally affected
  • lesions occur in pons or internal capsule
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8
Q

Pure Sensory Stroke

A

parathesias in face-arm-leg

-lesions occur in thalamus

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9
Q

Ataxic Hemiparesis

A

incoordination accompanied by weakness of some limbs

-lesions usually in pons

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10
Q

Secondary Motor Syndrome

A

causes weakness and sensory deficits of face-arm-legs

-lesions in posterior limb of internal capsule

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11
Q

Dysarthria Clumsy Hand syndrome

A

slurred speech with clumsy contralateral hand

-lesions in pontine or brainstem lacunes

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12
Q

MCA Infarction

A

contralateral hemiparesis, aphasia, homonymous hemianopsia

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13
Q

MCA infacrtion: Dominant side

A

Aphasia: Broca’s, Wernicke’s or global

Gaze preference: toward side of lesion

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14
Q

MCA stroke: non dominant side

A

Neglect, spatial disorientation: do not recognize anything on dominant side (so contralateral neglect)

also have agnosia-anosognosia

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15
Q

Anterior cerebral artery stroke

A

contralateral weakness: lower extremities and face

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16
Q

posterior cerebral artery stroke

A

homonymous hemianopsia contralateral to side involved: so R sided lesion cannot see L side

17
Q

Basilar Artery Stroke

A

may present with: quadriplegia, coma, altered consciousness, pupillary abnormalities, ocular palsy

18
Q

Basilar Artery Stroke: depend on CN involved

A

but remember: have ipsilateral deficit with CN nerves

Example: CN VII involvement: ipsilateral facial weakness: upper and lower

19
Q

With Basilar Artery stroke: Locked in syndrome

A

can only move eyes vertically

20
Q

Vertebral Artery Stroke

A

-sx’s similar to basilar artery: contralateral hemiplagia and sensory deficit and ipsilateral CN palsy

21
Q

Hemorrhagic Stroke: Etiology

A
  • **HTN
  • amyloid angiopathy
  • AV malformation
  • cavernous angioma
  • intracranial aneurysm
  • dural venous sinus thrombosis
  • coagulopathy
  • hemorrhagic conversion of infarction
  • neoplasm or infxn
22
Q

Intracerebral Hemorrhage

A

most common causes HTN

Other causes: bleeding disorders, anticoag therapy, liver dz, High EtOh or primary/secondary brain tumors

23
Q

Intracerebral hemorrhage sx’s

A

LOC, N/V, evoloving hemiplaegia or hemiparesis

24
Q

Thalamic hemorrhage

A

loss of upward gaze, downward or skew deviation, pupillary inequalities

25
Q

Nonmodifiable risk factors for stroke

A

Age, Sex (male), race (AAs), prior stroke, fam hx

26
Q

Modifiable risk factors for stroke

A

HTN, Hrt. Dz, smoking, TIA, Diabetes, High cholesterol, Wt

27
Q

Specific cardiac risk factors for stroke

A

arrhythmia, valvular dz, endocarditis, aortic arch plaque, low ejection fraction, septal defect, CAD, anuerysm, atrial/ventr thrombosus

28
Q

Other Risk factors

A

Migraine, coagulopathies, hemoglobinopathies (thalassemia, Sickle cell, TTP, congenital defects); malignancy, hyper coagulable state; Vasculitis/vasculopathy (SLE, secondary sylph); Drygs/medds; Infectious dz.’s; trauma; venous sinus thrombosis

29
Q

Tx options

A
  • IV TPA
  • Intra arterial TPA
  • Endovascular tx: penumbra, MERCI, angioplasty, stenting, microwire clot disruption
  • decompressive hemcraniotomy
30
Q

IV TPA

A

-must be given in 3 hr window; window of 4.5 hrs accepted

31
Q

Specific Inclusion criteria for IV TPA

A

-NO recent surgery or procedure involving non compressible site
-INR < 1.7
-Glucose > 60, < 185/110
-platelet > 100,000
No h/o intracranial hemorrhage

32
Q

Intra-arterial TPA

A

not FDA approved; deliver TPA directly into clot they artery
-extends to a 6 hr window

33
Q

Intra arterial TPA drawbacks

A

invasive procedure; limited hospitals can do procedure; does not help lacunar strokes

34
Q

Work up of Strokes

A
  • carotid doppler
  • Echo (TEE)
  • MRI/MRA: helps differentiate btwn new and old
  • Blood tests: HgA1c, lipid, syph, toxicology
  • Carotid endarterctomy
  • Carotid artery stent replacement
35
Q

Meds for stroke

A

Anticoags/antiplatelets: ASA, plavix, aggrenox, Heparin/levanox/coumadin (reserved for embolic strokes)

Neurology (12 decks)

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