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NMF: Neurology > NEUROVASCULAR > Flashcards

NEUROVASCULAR Flashcards

1
Q

Where does blood accumulate if a bridging vein ruptures?

A

This would be a subdural haemorhage so between the dura and the arachnoid

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2
Q

Where does blood accumulate if the posterior communicating artery ruptures?

A

This would be a subarachnoid haemorhage so between the arachnoid and pia

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3
Q

Where does blood accumulate if the middle meningeal artery ruptures?

A

This would be an extra dural haemorrhage so between the dura and pterion (bone)

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4
Q

Acute onset numbness of left arm and leg, with decreased sensation to the left side of his body.

A

This is entirely sensory so it is a lacunar stroke

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5
Q

Stroke patient with hx of AF, presents with dysphasia and left hemiparesis

A

they have 2/3 so it is a partial anterior circulation infarct

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6
Q

Stroke presenting as a left homonymous hemianopia

A

Posterior circulation infarct as the occipital love is damaged

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7
Q

Investigate a mass in the temporal lobe causing progressive headaches, nausea and loss of sensation in the right arm.

A

Biopsy

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8
Q

Investigate a boxer who was punched in the head and started to lose consciousness after.

A

this is an extradural haemorrhage needing a CT

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9
Q

Investigate a sudden onset ‘worst ever’ headache

A

this is a subarachnoid haemorrhage needing a CT angiogram

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10
Q

Compare epidural to subdural haematoma

A

EPIDURAL: rapidly expands with arterial blood, pushes away the dura

SUBDURAL: slowly expands with venous blood, doesn’t cross the falx tentorium

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11
Q

Where does the anterior brain circulation arise from?

A

The paired internal carotid arteries

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12
Q

Where does the posterior brain circulation arise from?

A

The paired vertebral arteries which join to form the basilar artery

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13
Q

Where do the anterior and posterior circulations of the brain join?

A

The circle of Willis

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14
Q

Name the 2 parts of the brain’s venous system

A
  • cerebral veins

- dural venous sinuses

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15
Q

What is contained within the dural venous sinuses?

A

Arachnoid granulations - allow CSF to be absorbed from subarachnoid space

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16
Q

Where do the dural venous sinuses drain into?

A

superior sagittal sinus –> straight sinus –> left and right transverse sinuses –> internal jugular vein

17
Q

What is an arteriovenous malformation (AVM) ?

A

A tangle of arteries and veins connected by fistulae creating an arteriovenous shunt

18
Q

Give the clinical features of AVM

A
  • mostly asymptomatic
  • present with haemorrhage or seizure
  • may cause progressive neurological deficit
  • unilateral, throbbing headache
19
Q

How are AVM investigated?

A

catheter angiography showing tangle of vessels, large feeding artery and large draining veins

20
Q

What is the treatment for AVM?

A
  • surgery

- if surgery too risky then radiosurgery or endovascular coiling

21
Q

Which circulation is at higher risk of rupturing with SAH?

A

posterior> anterior

22
Q

What are the complications of SAH?

A
  • vasospasm
  • re bleed
  • hydrocephalus
  • seizure
  • hyponatraemia
23
Q

What is a cavernous malformation?

A

well-circumscribed, benign vascular lesions of the sinusoidal spaces

lined with endothelium and separated by elastin

24
Q

Give the clinical features of cavernous malformation

A
  • seizure
  • progressive neurological deficit
  • haemorrhage
25
Q

Investigate cavernous malformation

A

CT in acute

MRI gold-standard

26
Q

give 2 factors that contribute to saccular aneurysm formation

A

muscle defect

discontinuity of underlying internal elastic membrane

27
Q

What diseases are associated with aneurysm?

A

polycystic kidney disease, fibromuscular dysplasia, EHlers-Dalos

28
Q

Where are aneurysms commonly found?

A

90% are anterior circulation

most commonly at circle of willis branching points

29
Q

Which type of aneurysm are due to diffuse atheromatous degeneration of the arterial wall?

A

Fusiform anuerysm

- ass with hypertension

30
Q

Which type of aneurysm results from septic emboli?

A

mycotic

31
Q

Which type of aneurysm causes dilated pupil?

A

posterior communicating artery aneursym compressing CNIII

32
Q

Which aneurysm can compress the optic chiasm?

A

anterior communicating artery

33
Q

What can an unruptured basilar aneurysm cause?

A

headache, third nerve palsy, confusion, hemiparesis…

34
Q

How do you treat a symptomatic anuerysm?

A

endovascular coiling or neurosurgical craniotomy + clipping of the aneurysmal neck

35
Q

Treat ischaemic stroke

A

within 4.5hrs –> IV thrombolysis + thrombectomy

aspirin 300mg fo 2 weeks then life-long clopidogrel

36
Q

? SAH with negative CT

A

lumbar puncture

NMF: Neurology (9 decks)

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