NRSRGRY - CVD Flashcards
What is the most frequent cause of new, rapid onset, non-traumatic neurologic deficit
CVD
Risk factors of CVD (4)
DHHS Diabetes High Cholesterol High BP Smoking
Mechanisms of CVD (3)
Atheroma
Endothelial damage
Weakening of vessel wall
Hypodensity on CT
a. Ischemic
b. Hemorrhagic
Ischemic
Hemorrhagic is hyperdensity
Clot forms in the vessel wall and occludes a vessel. What type of CVD is this?
Thrombotic Ischemic disease
Clot is elsewhere, thrown distally and lodges into vessel and occludes. What type of CVD?
Embolic Ischemic disease
Hemorrhagic diseases (4)
CHAA
Cerebral aneurysm
Hypertension
Amyloid Angiopathy
Ateriovenous malformation
Ischemic disease accounts for what percentage of acute CVD?
85%
T about stroke EXCEPT
a. symptoms will vary based on the functions of the neural tissues supplied by the occluded vessel and the presence of collateral circulation
b. occlusion proximal to the circle of willis will generally result in a stroke.
c. Neurologic deficit is always permanent
d. A and B
e. B and C
E
ACA stroke lobe involvement
medial frontal and parietal lobes
ACA stroke neuro deficits
contralateral leg weakness
MCA lobe involvement
lateral, frontal, temporal and parietal lobes
MCA stroke neuro deficits
contralateral face and arm weakness, language deficits
Other effects of proximal MCA stroke (aside from neurodeficits)
intracranial mass effect and midline shift
PCA stroke lobe involvement
occipital lobe
Effect of R PCA stroke
L homonymous hemianopia
PICA stroke lobe involvement
lateral medulla, inferior half of the cerebellar hemispheres
Effect of PICA stroke
nausea vomiting nystagmus dysphagia ipsilateral Horner's syndrome Ipsilateral limb ataxia
Horner’s syndrome
Miosis
Ptosis
Anhidrosis
infarction, or stroke, occurs in the lateral medulla.
Symptoms:
hoarseness nausea vomiting hiccups rapid eye movements, or nystagmus a decrease in sweating problems with body temperature sensation dizziness difficulty walking difficulty maintaining balance
Wallenburg syndrome
Management of embolic disease: reopening of occluded vessel via what drug?
rTPA
Life-saving surgery for patients with embolic disease who had stroke?
Decompressive hemicraniectomy or suboccipital hemicraniectomy
L hemiplegia, what artery affected?
R MCA
Causes of hemorrhagic CVD
Hypertension Amyloid angiopathy AVM ANeurysm Venous thrombosis Hemorrhagic conversion of ischemic infarct fungal infections
Where does hemorrhagic stroke typically occur?
Basal ganglia or cerebellum
Most hypertensive hemorrhages are medically managed EXCEPT for
patients with clot <1cm from the cortical surface
R sided weakness, headache, vomiting a few hours PTA,
L Basal ganglia hemorrhage
amyloid deposition in the media of small cortical vessels.
Amyloid angiopathy
Focal dilatation of the vessel wall (balloon-like outpouching/fusiform)
Cerebral aneurysm
Where does cerebral aneurysm usually occur
branch points of major bessels
Thin-walled rupture of cerebral aneurysm cause
subarachnoid hemorrhage
Describe the headache of cerebral aneurysm
Thunderclap headache, worst headache of my life
Management of Cerebral aneurysm
Cranial CT Four-vessel cerebral angiography Early aneurysm occlusion Craniotomy, clipping Endovascular, coiling
Approximate mortality rate of cerebral aneurysm
50% in the first month
Approximately ___ of survivors return to pre-SAH function
1/3
____ of survivors have moderate to severe disability
2/3
Abnormal dilated arteries and veins without an intervening capillary bed
AVM
AVM presents with (3)
SAH
intraparenchymal hemorrhage
seizures
Hemorrhage rate of AVM
2-4% in a year
treatment of AVM
microsurgical excision endovascular embolization stereotactic radiosurgery (<3cm diameter)
