Neurology Flashcards
Intracranial Arteries
***** **Internal Carotid Artery (ICA ) **
* Supplies the Front area of brain
*
**Middle Cerebral Artery (MCA ) **
Largest Branch of ICA
**Vertebral Arteriies **
Posterior Areas of Brain
**Basilar Artery
**Formed where Rt and Lt verterral arteries join in Skull **
Extracranial Arteries
Outside of skull such as Carotid Arteries and Vastibular Arteries
Trasient Ischemic Attack (TIA )
**” Mini-Stroke “
Brief episode of neurologic dysfunction without **permanent demage **
Precursor to stroke 1/3 people will have Acute Stroke
Mechanisms of TIA
Embolic TIA
Lacunar or Smal Vessel TIA
Low -flow TIA
Tracient Ishcemic Attack Definition
Tissue based definition TIA
- TIA is a trascient episode of neurologic dysfunction
- Caused by focal brain, Spine cord, retinal Ishcemia
- **No acute infarction Identified
- Brief ishcemia can cause permanent brain injury
Embolic Etiology
Mechanisms of TIA // Etiology
**Etiology **
* Pathologic process in an artery
* Usually from **Extracranial ( Carotid ) , Heart (Afib ) , or Aorta **
* Emboli are subject to natural thrombolysis and migration
Embolic Etiology Clinical Manifestation
**Clinical Manifestation **
* Discreate , usually single
* Prolonged episodes ( HRS not Mints )
**Sight and Symptoms **
* Depends of size of artery occuluded
*
*** Anterior : **:
* Contraleteral Hemiplegia ,
* Aphagia
Posterior :
* Transient ataxia ,
* Dizziness
* diploxia
* dysarthria
Lacunar Etiology/Small Vessel TIA :
Mechanism TIA
Etiology
* **Stenosis to an intracerebral penerating vessel
* **Middle **cerebral artery stem, **Basilar **artery, or Vertebral artery
* Induced Ischemia ( Reduced blood flow )
**Clinical Manifastation **
* **Brief and repetitive Episodes **
* Steretytypes S and S
* Traditional numbness /weakness to face , arm, leg
Low Flow Etiology
- **Tighly Stenotic atheroscletic Lesions **
- **ICA origin or Intacranial Portion of ICA
- **Short Lived But Reoccuring ( few per day , month ) **
-
Anterior: Stereotyped Findings
* - Posterior : Disorginized Dizzness , Spinnin or Vertigo, Numbness of one side of body or face or Diplopia
TIA Assessment and Dx
- H and P
- is the pt back to baseline
- Head CT and MRI
- Diffrentials
Labs
- CBC, BMP, UA
- TSH
- PT/INR
- Lipid panel
- ESR
Imaging
- Head CT
- CTA head /Neck
- MRI/MRA
- Carotid US
- 2 D Echo (transthorasic examing PFO )
- PFO ( openng of RT and LT atrium )
TIA Tx Plan
- Control HTN ( permisive HTN ) 140/80 start meds
- Hyperlipidemia ldl < 100( Atorvastatin 80 mg QD )
* - Smoking Cessatin
- DM control
- Exercie ( moderate to intermittent break sweat or increase HR
- Diet ( meditarania ) low fat more vagid
Antiplatelet Agenets STroke Prevent
TX plan
- **Risk for TIA **
- 10 to 15 % for 3 month
- Most event occuring in first 2 days
- Risk Assessment ABCD 2
___________________________________________
**Most Common Antiplatlent Agent
**ASA, Plavix, ASA and Plavix + ER Dipyridamole - Plavix and ASA: for Long Term use NOT Recommentded stoke prevention
- Short Term use show useful
- Aggrenox : Dipyridanole /ASA 200mg ER /25 mg IR
FIY
ASA higter Dose not effective
Plavix along not effective increase bleed
Plavix marginally more effective than ASA
Brilinta not effective
