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Patho > Nervous System-Vascular disease and Cephalgia > Flashcards

Nervous System-Vascular disease and Cephalgia Flashcards

1
Q

What are the two common places that a clot can come from that goes to the brain

A

Heart
Carotids

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2
Q

What are the disorders that encompasses cerebrovascular disease?

A

ischemic and hemorrhagic stroke, aneurysmal subarachnoid hemorrhage, and arteriovenous malformations

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3
Q

85% of strokes are _______ and 15% are _________

A

thrombotic, hemorrhagic

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4
Q

What is the issue in thrombotic stroke?

A

there is a lot of inflammation

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5
Q

What can help you identify where in the brain a patient may be having problems with perfusion?

A

knowing the blood supply to different areas of the brain

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6
Q

What is the blood supply to the brain carried by?

A

two internal carotid arteries and two vertebral arteries which anastomose at the base of the brain to form the circle of willis

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7
Q

Carotids supply the _________ portion of the brain while the vertebrobasilar system suppplies the ________ of the brain

A

anterior, posterior

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8
Q

What does cerebral autoregulation allow the brain to mantain?

A

constant cerebral flow despite changes in the systemic arterial pressure

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9
Q

What is the mean arterial pressure range that autoregulation is efficient within?

A

60-140 mmHg

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10
Q

What happens if the MAP is below 60?

A

cerebral flow can be severely compromised

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11
Q

What happens if MAP rises beyond the upper limit of autoregulation?

A

cerebral flow increases rapidly and overstretches the cerebral vasculature

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12
Q

What are the three major metabolic factors affecting cerebral blood flow?

A

CO2
Hydrogen ion
Oxygen concentration

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13
Q

What does an increase in CO2 provide a stimulus for?

A

vasodilation

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14
Q

What does an increase in H ion concentration do?

A

increases cerebral blood flow, serving to wash away the neurally depressive acid material

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15
Q

A _______ oxygen concentration increases cerebral blood flow

A

decreased

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16
Q

What is a stroke?

A

the syndrome of acute focal neurologic deficit from a vascular disorder that injures brain tissue

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17
Q

What are the two main types of strokes and their definitions

A
  1. Ischemic
    -Interruption of blood flow in a cerebral vessel (87% of all strokes)
  2. Hemorrhagic
    -Bleeding into brain tissue
    -Blood vessel rupture
    -Hypertension, aneurysm, injury
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18
Q

What are the mechanisms of Ischemic CVA?

A
  1. Large artery atherosclerotic disease (thrombotic and embolic (not including cardiac) – 20%
  2. Small vessel or penetrating artery disease (lacunar) – 25%
  3. Cardiogenic embolism – 20%
  4. Cryptogenic (undetermined) – 30%
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19
Q

What are modifiable factors for stroke?

A

-HTN
-Hyperlipidemia
-smoking
-diabetes
-HD (a fib, wall motion defects)
- Carotid artery disease
-coagulation disorders
- obesity/inactivity
-heavy alcohol use
-cocaine use

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20
Q

What are unmodifiable factors for stroke?

A

-age
-gender
-race
-hereditary

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21
Q

What is cerebral ischemia caused by?

A

cerebrovascular obstruction by thrombosis or emboli

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22
Q

What are the two major types of types of ischemic cerebrovascular disease?

A

TIA and CVA

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23
Q

What is the difference between TIA and CVA?

A
  1. TIA- ischemia w/o infarction its brain angina but its not painful

CVA- infarction has occurred and the amount of infarction depends on location and collateral circulation and how quickly do we intervene.

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24
Q

Ischemic CVA may be further subdivided _____ and _____

A

etiology, location

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25
Q

In an evolving CVA, there is a central core of dead or dying cells surrounded by an ischemic band of minimally perfused cells called the _____________

A

penumbra

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26
Q

What is the goal of stroke management?

A

to save the penumbra

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27
Q

Why is the penumbra maintained in ischemia CVA?

A

because of small amounts of perfusion

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28
Q

What is the survival of cells in the penumbra dependent on?

A

timely return of adequate circulation, volume of toxic material released by dying cells and the degree of edema

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29
Q

What happens if the cells in the penumbra are affected adversely?

A

the core of ischemic tissue enlarges and the volume of surrounding ischemic tissue increases

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30
Q

What is an TIA?

A

(Transient Ischemic Attack) is a brief episode of neurologic dysfunction resulting from focal cerebral ischemia not associated with infarction

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31
Q

T/F TIA is infarction

A

False, not infarction

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32
Q

What is TIA secondary to?

A

thrombus or embolus

33
Q

TIA is analogous to brain angina in that there is a temporary disturbance in ______ which reverses before infarction occurs

A

focal perfusion

34
Q

“A zone of penumbra without central infarction”
is this CVA or TIA?

A

TIA

35
Q

Ischemia CVA results there is ______ of the brain tissue. cell death occurs.

A

infarction

36
Q

Ischemic CVA may be divided into categories:

A

Large vessel and small vessel, and can be thrombotic or embolic

37
Q

What is the most common type of CVA?

A

Large vessel

38
Q

What is the most common cause of large vessel CVA?

A

Atherosclerotic disease
Plaques found frequently at arterial bifurcation

39
Q

Large vessel CVA often affects the ________ and may result in _______, _______,_____ and _______

A

cortex, aphasia, visual field deficits, motor and sensory changes

40
Q

T/F in large vessel TIA, symptoms usually develop gradually over minutes to hours and may wax and wane in severity

A

True

41
Q

In which population is large vessel TIA most often seen in?

A

older individuals with evidence of atherosclerotic heart or peripheral arterial disease

42
Q

A patient presents with small vessel TIA. Where would these infarcts be located?

A

in deeper, non-cortical portions of the brain or in brainstem

43
Q

What does small vessel TIA result from?

A

occlusion of the smaller penetrating branches of the large cerebral arteries

44
Q

Small vessel TIA commonly occurs in the setting of which two diseases?

A

chornic HTN, DM

45
Q

Does small vessel TIA usually cause cortical defects?

A

no, instead it result in motor or sensory hemiplegia, or dysarthria

46
Q

What imaging is ordered if a patient has small vessel TIA?

A

MRI because it cannot be seen on a CT scan

47
Q

What does Embolic CVA usually affect?

A

the larger proximal cerebral vessels and often lodges at bifurcations (most frequent is middle cerebral artery)

48
Q

Where do most cerebral emboli originate from?

A

thrombus in the left heart but they may also come from a plaque in the carotid arteries

49
Q

In contrast to thrombotic stroke, in embolic CVA there is no ______________ disease in the occluded vessel

A

intrinsic vascular

50
Q

T/F Embolic CVA typically does not have a a sudden onset with immediate maximum deficit

A

False, it DOES

51
Q

What are the various cardiac conditions predispose to emboli formation?

A

Atrial fibrillation
Rheumatic heart disease
Recent MI
Ventricular aneurysm
Bacterial endocarditis

52
Q

What is hemorrhagic CVA caused by?

A

spontaneous rupture of an intracerebral vessel

53
Q

T/F Hemorrhagic CVA occurs suddenly and is not as common

A

True

54
Q

What does Hemorrhagic CVA cause ?

A

focal hematoma, edema, compression of the brain contents

55
Q

What are the two types of Hemorrhagic CVA?

A
  1. intracerebral (directly into the brain parenchyma)
  2. subarachnoid (bleeding into the space between the pia mater and the arachnoid mater) depending on which artery ruptured and where it was located
56
Q

What are the most common predisposing factor of Hemorrhagic CVA?

A

advancing age and HTN

57
Q

What does the symptoms of Hemorrhagic CVA depend upon?

A

which vessel is involved

58
Q

The manifestations of a CVA are determined by:

A
  1. cerebral artery affected
  2. the area of brain tissue that is supplied by the vessel
  3. adequacy of collateral circulation
59
Q

In CVA, everything ______ to the thrombus is at risk for infarction

A

distal

60
Q

With cephalgia(headache), brain ________ and most ______ tissue is ________ to pain. What are the two types of cephalgia pains?

A

Brain parenchyma, meningeal tissue, insensitive

  1. Infratentorial pain (occipital) is carried by cervical nerve roots
  2. Supratentorial pain (frontal, temporal, parietal) is carried by the trigeminal nerve
61
Q

What are cephalgia classifications?

A

Migraine
Cluster
Tension
Chronic Daily Headache
-15 days or more per month
-?transformed migraine, ?evolved tension

62
Q

What is cephalgia related to ?

A

overuse of symptomatic medications, psychiatric disorders

63
Q

Which population are migraine most common in?

A

women

64
Q

Etiology of migraines

A
  1. fam hx/genetic
  2. hormonal etiology
65
Q

What are the two types of migraines?

A

Without aura (85%)
With aura
(can be anything, visual, auditory, any type of sensory changes)

66
Q

What are the S/S of migraines?

A

Severe unilateral head pain (throbbing/pulsating)
Photophobia
Phonophobia
Nausea/vomiting

67
Q

What are the 4 stages of migraines?

A

– pro-drome, aura, headache, post-drome
Aura stops and then the headache starts but not the case for everyone
Postdrome- fatigue not feeling good

68
Q

What is the patho for migraines?

A

-poorly understood
-theory: activation of the trigeminal nerve

-Activation of the trigeminal sensory fibers may lead to the release of neuropeptides, which in turn cause painful neurogenic inflammation within the meningeal vasculature characterized by vasodilation

-Estrogen is thought to play a major role in the pattern of migraine attacks

69
Q

What population is cluster headaches typically seen in?

A

males

70
Q

_______ occur in clusters over weeks or months with long period of remission between. Episodes may last from 15 minutes to 3 hours

A

cluster headahces

71
Q

What is the patho for cluster headhaces?

A

-Activation of the trigeminal nerve and the cranial autonomic parasympathetic reflexes are thought to explain the pain and autonomic symptoms

-The hypothalamus is also believed to play a key role

-MRI imaging has demonstrated dilated intracranial arteries on the affected side

72
Q

T/F a cluster headache is common

A

False, it is uncommon

73
Q

A cluster headahce is typically seen in ______

A

males

74
Q

Cluster headaches occur over weeks or months with long periods of _______ in between. Episodes may last from ______ minutes to _____ hours.

A

remission
15, 3

75
Q

What is thought to explain the pain and autonomic symptoms of cluster headaches? and which area of the brain is thought the play a key role?

A

-activation of trigeminal nerve and cranial autonomic parasympathetic reflexes
-hypothalamus

76
Q

In a cluster headache, MRI imaging has demonstrated _____________ on the affected side

A

dilated intracranial arteries

77
Q

What is a cluster headache frequently associated with?

A
  1. Restlessness or agitation
  2. Ipsilateral conjunctival injection or lacrimation
  3. Ipsilateral nasal congestion or rhinorrhea
  4. Ipsilateral eyelid edema, facial swelling
78
Q

What is the most commonly occurring headache with a hatband distribution?

A

tension-type headache

79
Q

Newer theories suggest that tension type headaches are a form of ________. These are _________ or ________ withdrawal headaches

A

migraine
analgesic, caffeine

Patho (16 decks)

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