Neurology Flashcards
what is carotid disease caused by?
atherosclerosis
what’s a major cause of stroke?
carotid disease
what’s the most common location of emboli causing CVA?
carotid bifurcation
what’s the RFs for carotid disease?
h/o TIA, HTN, high cholesterol, DM, age, obesity, sleep apnea, lack of exercise
what are sx’s of carotid disease?
maybe TIAs & CVAs
carotid bruits (“cervical bruit), Hollenhorst plaques (small, yellow particles on retinal vessel)
can be asx
what is the classic finding in a pt with carotid stenosis?
cervical bruit (high-pitched systolic murmur)
what’s the GOLD STANDARD dx for carotid artery disease?
CTA
what imaging can you do to dx carotid artery disease?
Doppler U/S to evaluate blood flow
CTA = definitive study & gold standard
what’s the tx for carotid artery disease?
Meds: low dose ASA & statin
Surgery: Carotid endarterectomy OR Carotid angioplasty & stenting
when is Carotid endarterectomy indicated for tx?
if pt has 70-99% occlusion & if peri-op morbidity & mortality risk is <6% & easily surgical
when is carotid stenting done?
for pts w/ carotid lesion w/ poor surgical accessibility, previous endarterectomy, or other concerning comorbidities
what kind of bleed is a subarachnoid hemorrhage and what’s the location? what’d it due to?
arterial bleed b/w arachnoid & Pia mater in subarachnoid space
d/t rupture of an intracranial aneurysm (MC saccular “berry” aneurysms)
what are the MC causes of subarachnoid hemorrhage?
MCC = berry aneurysm rupture, AVM
what are risk factors for subarachnoid hemorrhage?
fam hx, smoking, HTN, heavy drinking, h/o AVM
what are the s/s of a subarachnoid hemorrhage
SUDDEN THUNDERCLAP HEADACHE “WORST HA OF MY LIFE”
Meningeal sx’s: stiff neck, photophobia, delirium
No focal neurologic deficits (usu.)
how do you dx a subarachnoid hemorrhage?
CT performed first
-If CT negative -> LP: xanthochromia (RBC’s), incr. CSF pressure
CTA (performed after initial dx w/CT)
-if negative then do MRA
what’s the first dx imaging test for subarachnoid hemorrhage?
CT scan
what does LP for subarachnoid hemorrhage show?
xanthochromia (Hgb breakdown), increased CSF pressure
what’s the tx for subarachnoid hemorrhage?
surgical clipping or endovascular coiling of rupture aneurysm
Supportive: bed rest, lower ICP
Admin Nicardipine*, Nimodipine -> lower BP gradually
***ALWAYS RE-IMAGE HEAD AFTER TX
what should be done after tx of subarachnoid hemorrhage?
re-imaging of head
what’s the MC arterial bleed?
epidural hematoma (hemorrhage)
where does epidural hematoma occur?
b/w skull & dura
what’s the MC mechanism of an epidural hematoma?
Temporal bone fracture -> middle meningeal artery lacerated
what artery is MC ruptured in epidural hematoma?
middle meningeal artery
what are the s/s of epidural hematoma?
brief loss of consciousness at the time of injury, followed by a normal mental status that progressively decreases over time as the hematoma expands
how do you dx epidural hematoma?
CT -> CONVEX (LENS-SHAPED) BLEED (the separation of the dura mater from the skull)
Does NOT cross suture lines and usu. in TEMPORAL AREA
what is seen on CT for dx of epidural hematoma?
CONVEX (LENS-SHAPED) BLEED usu. in temporal area
what area is epidural hematoma usually in?
temporal area (b/c that’s where middle meningeal artery is located)
what’s the tx for an epidural hematoma?
observation if small
Limit incr. ICP
- keep HOB elevated and pt in neural position
- sedation
- removal of CSF
IVFs, monitor for seizures
surgical evacuation of hematoma
what’s the MC venous bleed?
subdural hematoma (hemorrhage)
what’s the location of a subdural hematoma? d/t what?
b/w dura mater and brain d/t tearing of cortical bridging veins
who is subdural hematoma MC in?
elderly or alcohol abuse
what’s the MC cause of subdural hematoma?
blunt trauma (often causes bleeding on other side of injury “contra-coup”)
what type of bleed is subdural hematoma?
MC venous bleed
what’s the s/s of subdural hematoma?
varies, may have focal neuro sx
how do you dx subdural hematoma?
CT: concave (crescent-shaped) bleed
***Bleeding CAN cross suture lines (vs epidural can’t)
what is seen on CT for dx of subdural hematoma?
concave (crescent-shaped) bleed
what’s the tx of subdural hematoma?
hematoma evacuation vs supportive
evacuation if massive or >/= 5mm midline shift
what’s Amaurosis fugax?
transient monocular blindness d/t emboli in the ophthalmic artery
