Obj. 13: Cerebrovascular - aa/LL Flashcards
Weakness, numbness, speech impairment, visual changes, or gait problem of acute onset that resolves within 24 hours, often within a few minutes.
What is it?
What 2 diagnostic procedures will you perform?
Transient ischemic attack.
CT within 24 hours, carotid U/S to check for stenosis
What is the purpose of the ABCD2 scoring system?
What are its elements?
To assess TIA recurrence risk. Score of 3+ = admit for observation.
A - age 60+ : 1 point
B - BP > 140/90 : 1 point
C - Clinical features : weakness 2 points, speech prob 1 point
D - Duration : > 60 min, 2 points; < 60 min, 1 point
D - Diabetes : 1 point
TIA with atrial fibrillation: what medication?
TIA without cardioembolic cause: what medication?
if afib: immediately initiate warfarin or dabigatran
if non cardioembolic: aspirin 81mg
Intracranial aneurysms are usually asymptomatic.
T/F
TRUE.
May cause focal neurologic deficits if compress adjacent structures.
What is the main treatment goal for intracranial aneurysm?
to prevent subarachnoid hemorrhage
What is the most useful diagnostic study for suspected intracranial aneurysm?
Angiography
NOT CT/MRI - can’t see little lesions
What is the treatment for intracranial aneurysm?
The major aim of treatment is to prevent hemorrhages. Symptomatic but unruptured aneurysms merit prompt treatment, either surgically or by endovascular techniques, whereas small asymptomatic ones discovered incidentally are often monitored arteriographically and corrected only if they increase in size to over 10 mm.
Supratentorial congenital AV malformation could present how?
~hemorrhage
~recurrent seizures
~headache
What auscultation sign may you find when examining a patient with suspected AV malformation or aneurysm?
bruit heard over the eye or mastoid region
Small arteriovenous malformations are more likely to bleed than large ones.
T/F
TRUE
Brainstem AV malformations are often clinically silent.
T/F
TRUE
Name 3 treatment options for AV malformations and when each one would be used.
- Surgical excision - in patients who have had bleeding
- Embolization - for lesions in surgically inaccessible locations
- Anticonvulsants - in patients presenting solely with seizures
Your patient is complaining of ulcerations on the fingers of his left hand, and slurring speech. Upon exam you find a clavicular bruit, unequal radial pulses, and a systolic BP difference of 25 mm Hg between his right and left arms.
What do you suspect?
subclavian steal syndrome
What is the time frame for tPA administration?
< 4.5 hours of when they were last “observed to be normal”. (New guidelines say 3 hours, but CURRENT says 4.5)
What do you administer if patient has signs of elevated intracranial pressure?
Mannitol and head elevation
