NEUROVASCULAR Flashcards
Where does blood accumulate if a bridging vein ruptures?
This would be a subdural haemorhage so between the dura and the arachnoid
Where does blood accumulate if the posterior communicating artery ruptures?
This would be a subarachnoid haemorhage so between the arachnoid and pia
Where does blood accumulate if the middle meningeal artery ruptures?
This would be an extra dural haemorrhage so between the dura and pterion (bone)
Acute onset numbness of left arm and leg, with decreased sensation to the left side of his body.
This is entirely sensory so it is a lacunar stroke
Stroke patient with hx of AF, presents with dysphasia and left hemiparesis
they have 2/3 so it is a partial anterior circulation infarct
Stroke presenting as a left homonymous hemianopia
Posterior circulation infarct as the occipital love is damaged
Investigate a mass in the temporal lobe causing progressive headaches, nausea and loss of sensation in the right arm.
Biopsy
Investigate a boxer who was punched in the head and started to lose consciousness after.
this is an extradural haemorrhage needing a CT
Investigate a sudden onset ‘worst ever’ headache
this is a subarachnoid haemorrhage needing a CT angiogram
Compare epidural to subdural haematoma
EPIDURAL: rapidly expands with arterial blood, pushes away the dura
SUBDURAL: slowly expands with venous blood, doesn’t cross the falx tentorium
Where does the anterior brain circulation arise from?
The paired internal carotid arteries
Where does the posterior brain circulation arise from?
The paired vertebral arteries which join to form the basilar artery
Where do the anterior and posterior circulations of the brain join?
The circle of Willis
Name the 2 parts of the brain’s venous system
- cerebral veins
- dural venous sinuses
What is contained within the dural venous sinuses?
Arachnoid granulations - allow CSF to be absorbed from subarachnoid space
Where do the dural venous sinuses drain into?
superior sagittal sinus –> straight sinus –> left and right transverse sinuses –> internal jugular vein
What is an arteriovenous malformation (AVM) ?
A tangle of arteries and veins connected by fistulae creating an arteriovenous shunt
Give the clinical features of AVM
- mostly asymptomatic
- present with haemorrhage or seizure
- may cause progressive neurological deficit
- unilateral, throbbing headache
How are AVM investigated?
catheter angiography showing tangle of vessels, large feeding artery and large draining veins
What is the treatment for AVM?
- surgery
- if surgery too risky then radiosurgery or endovascular coiling
Which circulation is at higher risk of rupturing with SAH?
posterior> anterior
What are the complications of SAH?
- vasospasm
- re bleed
- hydrocephalus
- seizure
- hyponatraemia
What is a cavernous malformation?
well-circumscribed, benign vascular lesions of the sinusoidal spaces
lined with endothelium and separated by elastin
Give the clinical features of cavernous malformation
- seizure
- progressive neurological deficit
- haemorrhage
Investigate cavernous malformation
CT in acute
MRI gold-standard
give 2 factors that contribute to saccular aneurysm formation
muscle defect
discontinuity of underlying internal elastic membrane
What diseases are associated with aneurysm?
polycystic kidney disease, fibromuscular dysplasia, EHlers-Dalos
Where are aneurysms commonly found?
90% are anterior circulation
most commonly at circle of willis branching points
Which type of aneurysm are due to diffuse atheromatous degeneration of the arterial wall?
Fusiform anuerysm
- ass with hypertension
Which type of aneurysm results from septic emboli?
mycotic
Which type of aneurysm causes dilated pupil?
posterior communicating artery aneursym compressing CNIII
Which aneurysm can compress the optic chiasm?
anterior communicating artery
What can an unruptured basilar aneurysm cause?
headache, third nerve palsy, confusion, hemiparesis…
How do you treat a symptomatic anuerysm?
endovascular coiling or neurosurgical craniotomy + clipping of the aneurysmal neck
Treat ischaemic stroke
within 4.5hrs –> IV thrombolysis + thrombectomy
aspirin 300mg fo 2 weeks then life-long clopidogrel
? SAH with negative CT
lumbar puncture
