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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
What do you see upon spinal tap in a patient with a subarachnoid hemorrhage?
xanthochromia (yellowish discoloration)
26
Where do berry aneurysms most commonly occur?
anterior communicating artery
27
Symptoms of AComm aneurysms?
headache visual field defects (bitemporal hemianopsia)
28
What lesion causes bitemporal hemianopsia? This can be caused by what conditions?
optic chiasm compression pituitary tumor/AComm aneurysm
29
Symptoms of a PComm aneurysm?
unilateral headache/eye pain CNIII palsy (eye is "down & out", ptosis, dilation)
30
What are the causes of CNIII palsy is the pupil is & isn't spared?
Pupil is spared: Diabetes/hypertension not spared: aneurysm
31
What is Cushing's triad? Caused by?
hypertension bradycardia irregular respiration caused by very high intracranial hypertension
32
Difference between decorticate & decerebate posture? Each posture is seen in what conditions?
decordicate - arms flexed - cerebral hemisphere damage decerebate - arms extended - brainstem damage
33
What is tested by the glasgow coma scale?
eye (4), verbal (5), motor(6) low score - 3 high score - 15
34
What structure herniates in a subfalcine herniation? Why is this a problem? Symptoms?
cingulate gyrus drags ACA with it - contralateral leg paresis
35
Signs & symptosm of uncal herniation?
Ipsilateral CNIII compression (dilated pupil) collapses ipsilateral PCA (visual loss, homonymous hemianopsia) cerebral peduncle compression (contra or ipsilateral paresis)
36
What structures are impacted by a transtentorial herniation? Symptoms?
thalamus, hypothalamus & meidal part of temporal lobes forced through tentorium cerebelli somnolence, LOC initially- small, reactivep pupils later- nonreactive
37
Why is tonsillar herniation often fatal?
causes compression of hte medulla, which results in depression of the respiratory & cardiac centers cardiorespiratory failure
38
Common cause of epidural hematoma? Usually d/t? Shape on CT?
middle meningeal artery (branch of maxillary) traumatic convex - can can't cross suture lines
39
Common cause of subdural hematoma? Usually d/t? Shape on CT?
bridging veins traumatic - slow bleeding concave & crosses suture lines
40
Symptoms of an epidural hematoma?
headache, drowsiness, LOC ## Footnote **lucid interval**
41
Risk factors for subdural hematoma? Classic presentation?
old age, alcoholics, blood thinners, shaken baby syndrome confusion weeks after head injury
42
Symptoms of subarachnoid hemorrhage?
sudden onset, worst headache of life, nuchal rigidity, fever, xanthochromia on spinal tap no focal deficits
43
Most common location of hemorrhagic stroke?
putamen & subcortex
44
Symptoms of putamen hemorrhagic stroke?
left paralysis, sensory loss, eyes deviated right (contralateral hemiparesis, ipsilateral gaze deviation)
45
Symptoms of cerebral amyloid angiopathy? Causes?
recurrent hemorrhagic strokes - typically lobar causes beta-amyloid deposits in artery walls
46
What demographic is most at risk for intraventricular hemorrhage? Symptoms? Complication?
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
Why do premature babies get intraventricular hemorrhages?
problem with germinal matrix (highly vascular area near ventricles) premature infants have poor autoregulation of bloodflow here
48
Difference between TIA & stroke?
TIA - symptoms \< 24hr Stroke - symptoms \> 24 hr or persist
49
What are the main difference in treatment of an MI vs. stroke?
For stroke - NO benefit to warfarin, anti-platelet drugs
50
Initial treatment of a patietn with ischemic stroke? Hemorrhagic stroke?
Ischemic: thrombolytics Hemorrhagic: t_hrombolytic CI_ - reduce BP, reverse anti-coagulation, surgery
51
What is the timeframe of benefit for TPA in ischemic strokes?
3 hrs
52
post-stroke management?
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
What are the variables in CHAD score? What CHAD score indicates aspirin? Warfarin?
for patients with afib all 1pt: CHF, HTN, \>75yrs, diabetes, stroke score \>2 = warfarin score 0-1 = aspirin
54
What type of drug is dabigatran?
direct thrombin inhibitor (anticoagulants)
55
What type of drugs are Rivaroxaban & Apixaban?
Factor X inhibitors (anticoagulants)

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