Neurovascular - Conditions

Question 1

In what age group do arteriovenous malformations (AVM) normally occur?

Answer 1

Young adults

Question 2

Symptoms of AVMs?

Answer 2

Haemorrhages (most common)
Seizures
Progressive neurological deficits

Question 3

Ix AVM?

Answer 3

Angiography

Question 4

If the AVM is deep, how would you treat?

Answer 4

Endovascular coiling

Question 5

Main cause of a subarachnoid haemorrhage? (SAH)

Answer 5

Rupture of a berry aneurysm

Question 6

Symptoms of a SAH?

Answer 6

Sudden onset severe headache with N&V

Neck stiffness

Question 7

Ix SAH?

Answer 7

CT scan
If you can’t see anything on the CT scan, do a lumbar puncture
Angiography

Question 8

Tx SAH?

Answer 8

Craniotomy and microsurgical clipping

Question 9

If patient develops a neurological deficit soon after the SAH, what would you do to treat?

Answer 9

This common complication is called a vasospasm

Give nimodipine to treat

Question 10

Main symptom of a cavernous malformation?

Answer 10

Seizure

Question 11

Gold standard Ix for cavernous malformation

Answer 11

MRI

in acute setting, do a CT

Question 12

What conditions are associated with aneurysms?

Answer 12

Polycystic Kidney Disease
Fibromuscular dysplasia
Ehlers-Danlos

Question 13

Where, most commonly, would you find brain aneurysms?

Answer 13

Anterior circulation

Question 14

What is the type of aneurysm called which occurs in the vertebrobasilar arteries?

Answer 14

Fusiform aneurysms

Question 15

What 2 locations would an unruptured aneurysm cause compression on the 3rd nerve causing a palsy?

Answer 15

Posterior communicating artery

Basilar artery

Question 16

You can either coil or clip an aneurysm as treatment - in what circumstances would you do them?

Answer 16

Coil:
Elderly pts
Posterior circulation located

Clip:
Wide necked aneurysms
Co-existing haematoma

Question 17

How does the time frame with a TIA vs Stroke compare

Answer 17

TIA: 1-24 hrs
Stroke: Over 24hrs

Question 18

What system is used to determine if a TIA pt is likely to have a proper stroke?

Answer 18

ABCD2

Age, BP, Clinical feature, Duration, Diabetes

Question 19

A score of 3 and above in the ABCD2 system should be referred to a stroke specialist? T/F

Answer 19

FALSE

Score of 4+

Question 20

What specific Ix should you do on a patient with a TIA?

Answer 20

MRI and Carotid doppler

Question 21

What are the 2 types of stroke?

Answer 21

Ischaemic (more common)

Haemorrhagic

Question 22

Describe the acute pathophysiology of an ischaemic stroke

Answer 22

Glucose and oxygen transport to neurones of the affected area decreases
Glutamate and proteolytic enzymes are released which causes cerebral oedema formation and inflammation

Question 23

Why can a pt who has had a stroke raise their eyebrows but can’t smile?

Answer 23

Upper motor neurone of CN7 is affected
Bilateral innervation to upper part of face (so unaffected side will compensate)
But the CN7 innervates the contralateral side of the lower face so pt won’t be able to smile on the opposite side of where the stroke is occurring

Question 24

Within how long of symptom onset can you treat a stroke patient with thrombolysis?

Answer 24

4.5 hrs

Question 25

When can a hemicraniectomy be performed on a stroke pt?

Answer 25

When the pt has had an MCA infarct + cerebral oedema

Within 48 hrs

Question 26

What drug treatment(s) can be given to stroke pts? (include timescale)

Answer 26

Aspirin commenced within hours of symptoms
Continued for 2 weeks
After 2 weeks, transferred to clopidogrel