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BOARD PREP > Neurovascular Disorders > Flashcards

Neurovascular Disorders Flashcards

1
Q

What type of stroke usually has a gradual onset? Which has a sudden onset?

Which is more common?

Best first test?

A

Gradual: ischemic (80%)

Sudden: hemorrhagic (20%)

non-contrast CT of the head (lets you know if there is bleeding)

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2
Q

MC affected structures for MCA, ACA & PCA stroke?

A

MCA: upper limb/face

ACA: lower limb

PCA: vision

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3
Q

What is the most common site of stroke?

A

MCA

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4
Q

What are the unique symptoms seen in MCA stroke if it occurs on the left side? Right side?

A

Left side: aphasia (speech center is left side in most patients)

Right side: hemineglect

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5
Q

What is thalamic syndrome? Stroke in what artery can lead to thalamic syndrome?

A

contralateral sensory loss (face, arms, legs)

proprioception deficit

no motor deficits

PCA (ischemia in lateral thalamus)

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6
Q

Major causes of hypoxic encephalopathy?

A

shock

anemia

repeated hypoglycemia

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7
Q

What is the classic scenario that leads to damage of watershed areas?

A

after massive MI

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8
Q

What are the symptoms of a watershed stroke?

A

weakness of the shoulders & thigs

sparing of the face hands & feet

“man-in-barrel”

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9
Q

Lacunar strokes are associated with what risk factors?

A

hypertension (arteriolar sclerosis), diabetes, smoking

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10
Q

Lacunar strokes commonly cause what symptoms?

A

hemiparesis (commonly affect internal capsule)

sensory loss to arms, legs, face (thalamus)

basal ganglia

pons

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11
Q

Lacunar strokes commonly arise from what arteries?

A

leticulostriate branches of the MCA

anterior choroidal areters from ICA

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12
Q

Damage to what portion of the basal ganglia causes hemibalism?

A

subthalamic nucleus

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13
Q

Draw the blood supply to brainstem “rule of 4s”

A
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14
Q

Sympoms of a SCA stroke?

A

all cerebellar symptoms

ipsilateral cerebellar ataxia + nausea & vomiting

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15
Q

What condition can occur if you raise sodium levels too quickly?

A

central pontine myelinolysis

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16
Q

What is central pontine myelinolysis?

symptoms?

A

demyelination of central pontine axis

loss of corticospinal & corticobulbar tracts - quadreplegia

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17
Q

Lateral pontine syndrome is due to a stroke in what artery?

Symptoms?

A

AICA

nystagmus, vertigo, nausea/vomiting

contralateral pain/temp

ipsilateral face pain/temp

Horner’s syndrome

ipsilateral facial droop/loss of corneal reflex

deafness

taste on anterior tongue

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18
Q

Lateral medullary syndrome is due to a stroke in what artery?

Symptoms?

A

PICA stroke

nystagmus, vertigo, nausea & vomiting

Horner’s syndrome

contralateral pain/temp

ipsilateral face pain/temp

hoarseness, dysphagia, decreased gag reflex

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19
Q

Symptoms of anterior spinal artery syndrome?

A

loss of all but posterior columns - only vibration & proprioception in tact

paralysis below lesion

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20
Q

Medial medullary syndrome is due to a stroke in what artery?

Symptoms?

A

ASA stroke

contralateal hemiparesis

contralateral loss of proprioception & vibration

flaccid paralysis of the tongue (deviation to side of lesion)

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21
Q

Exercise-induced arm ischemia is indicative of what condition?

A

subclavian steal syndrome

(BP discrepancy >15mmHg SBP)

(flow reversal in vertebral artery)

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22
Q

What are the conditions associated with berry aneurysms?

A

Adult Polycystic Kidney Disease (ADPKD)

Ehlers-Danlos Syndrome

Aortic coarctation

older age

hypertension

smoking

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23
Q

What happens when a berry aneurysms ruptures vs whena microaneurysm ruptures?

A

berry: subarachnoid hemorrhage (headache)
micro: hemorrhagic stroke

24
Q

Where does a subarachnoid hemorrhage take place?

A

btw arachnoid & pia mater

25
Q

What do you see upon spinal tap in a patient with a subarachnoid hemorrhage?

A

xanthochromia (yellowish discoloration)

26
Q

Where do berry aneurysms most commonly occur?

A

anterior communicating artery

27
Q

Symptoms of AComm aneurysms?

A

headache

visual field defects (bitemporal hemianopsia)

28
Q

What lesion causes bitemporal hemianopsia?

This can be caused by what conditions?

A

optic chiasm compression

pituitary tumor/AComm aneurysm

29
Q

Symptoms of a PComm aneurysm?

A

unilateral headache/eye pain

CNIII palsy (eye is “down & out”, ptosis, dilation)

30
Q

What are the causes of CNIII palsy is the pupil is & isn’t spared?

A

Pupil is spared: Diabetes/hypertension

not spared: aneurysm

31
Q

What is Cushing’s triad?

Caused by?

A

hypertension

bradycardia

irregular respiration

caused by very high intracranial hypertension

32
Q

Difference between decorticate & decerebate posture?

Each posture is seen in what conditions?

A

decordicate - arms flexed - cerebral hemisphere damage

decerebate - arms extended - brainstem damage

33
Q

What is tested by the glasgow coma scale?

A

eye (4), verbal (5), motor(6)

low score - 3

high score - 15

34
Q

What structure herniates in a subfalcine herniation?

Why is this a problem? Symptoms?

A

cingulate gyrus

drags ACA with it - contralateral leg paresis

35
Q

Signs & symptosm of uncal herniation?

A

Ipsilateral CNIII compression (dilated pupil)

collapses ipsilateral PCA (visual loss, homonymous hemianopsia)

cerebral peduncle compression (contra or ipsilateral paresis)

36
Q

What structures are impacted by a transtentorial herniation?

Symptoms?

A

thalamus, hypothalamus & meidal part of temporal lobes forced through tentorium cerebelli

somnolence, LOC

initially- small, reactivep pupils

later- nonreactive

37
Q

Why is tonsillar herniation often fatal?

A

causes compression of hte medulla, which results in depression of the respiratory & cardiac centers

cardiorespiratory failure

38
Q

Common cause of epidural hematoma?

Usually d/t?

Shape on CT?

A

middle meningeal artery (branch of maxillary)

traumatic

convex - can can’t cross suture lines

39
Q

Common cause of subdural hematoma?

Usually d/t?

Shape on CT?

A

bridging veins

traumatic - slow bleeding

concave & crosses suture lines

40
Q

Symptoms of an epidural hematoma?

A

headache, drowsiness, LOC

lucid interval

41
Q

Risk factors for subdural hematoma?

Classic presentation?

A

old age, alcoholics, blood thinners, shaken baby syndrome

confusion weeks after head injury

42
Q

Symptoms of subarachnoid hemorrhage?

A

sudden onset, worst headache of life, nuchal rigidity, fever, xanthochromia on spinal tap

no focal deficits

43
Q

Most common location of hemorrhagic stroke?

A

putamen & subcortex

44
Q

Symptoms of putamen hemorrhagic stroke?

A

left paralysis, sensory loss, eyes deviated right

(contralateral hemiparesis, ipsilateral gaze deviation)

45
Q

Symptoms of cerebral amyloid angiopathy?

Causes?

A

recurrent hemorrhagic strokes - typically lobar

causes beta-amyloid deposits in artery walls

46
Q

What demographic is most at risk for intraventricular hemorrhage?

Symptoms?

Complication?

A

premature babies

LOC, hypotonia, loss of spontaneous movement - massive bleed can cause coma/seizure

the clot can block the foramen of monro, leading to enlargement of lateral ventricles

47
Q

Why do premature babies get intraventricular hemorrhages?

A

problem with germinal matrix

(highly vascular area near ventricles)

premature infants have poor autoregulation of bloodflow here

48
Q

Difference between TIA & stroke?

A

TIA - symptoms < 24hr

Stroke - symptoms > 24 hr or persist

49
Q

What are the main difference in treatment of an MI vs. stroke?

A

For stroke - NO benefit to warfarin, anti-platelet drugs

50
Q

Initial treatment of a patietn with ischemic stroke? Hemorrhagic stroke?

A

Ischemic: thrombolytics

Hemorrhagic: t_hrombolytic CI_ - reduce BP, reverse anti-coagulation, surgery

51
Q

What is the timeframe of benefit for TPA in ischemic strokes?

A

3 hrs

52
Q

post-stroke management?

A

aspirin for prophylaxis (if allergic, clopidogrel)

EKG - look for afib (if yes, give warfarin)

echocardiogram (source of embolism/PFO)

carotid ultrasound (surgery considered if >70% stenosis)

53
Q

What are the variables in CHAD score?

What CHAD score indicates aspirin? Warfarin?

A

for patients with afib

all 1pt: CHF, HTN, >75yrs, diabetes, stroke

score >2 = warfarin

score 0-1 = aspirin

54
Q

What type of drug is dabigatran?

A

direct thrombin inhibitor (anticoagulants)

55
Q

What type of drugs are Rivaroxaban & Apixaban?

A

Factor X inhibitors (anticoagulants)

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