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Patho- Vascular disease Flashcards

1
Q

What are the four main sites a blood can accumulate in the skull?

A

Extradural- Between bone and dura
Subdural- Separated dura from arachnoid
Subarachnoid- SA space
In brain itself

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2
Q

What can cause an extradural hemorrhage?

A

Skull fracture etc

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3
Q

What can cause a subdural hemorrhage?

A

Torn cerebral veins- more common in the elderly

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4
Q

What can cause a SA hemorrhage?

A

Ruptured CoW- Berry aneurysm etc

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5
Q

What are the two broad categories of intracranial hemorrhage?

A

Spontaneous

Traumatic

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6
Q

What are some forms of spontaneous hemorrhage?

A

Intracerebral hemorrhage
Cerebellar hemorrhage
SA hemorrhage
Hemorrhagic infarct

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7
Q

How does an intracerebral hemorrhage tend to present?

A

Stroke

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8
Q

How does a hemorrhagic infarct tend to present?

A

Stroke

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9
Q

What are some symptoms of a cerebellar hemorrhage?

A

Headache
Loss of consciousness/coma
Nystagmus/ocular palsy
Acute hydrocephalus

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10
Q

What are some risk factors for a SAH?

A

Smoking
Hypertension
Kidney Disease
Men aged 30-40

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11
Q

What causes SAH?

A

Berry aneurysm rupture

Arteriovenous malformation

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12
Q

Where are Berry aneurysms found?

A

Branching of CoW

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13
Q

What does a AVM look like on imaging?

A

Storm cloud

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14
Q

What are some symptoms of a SAH?

A 
Sudden devastating headache
Loss of consciousness
Vomiting
Neck stiffness/pain
Photophobia
Positive Kernig's sign
Papilloedema
Bloody CSF
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15
Q

What is Kernig’s sign?

A

Knee + hip at 90 degrees then extend knee. Get pain/stiffness

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16
Q

What is the differential for a SAH?

A

Migraine

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17
Q

How do you diagnose a SAH?

A

Immediate CT- bright white in SA space/ventricles

LP for blood if CT equivocal

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18
Q

What will you see in the CSF with SAH?

A

Yellow colour

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19
Q

What must you not be/have to have a LP done in SAH?

A

No focal deficits or papilloedema

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20
Q

How do you treat a SAH?

A 
Bed rest and support
Treat hypertension
Nimodipine
Dexamethasone- for oedema
Surgery to treat aneurysm
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21
Q

What are some complications of a SAH?

A

Obstructive hydrocephalus- Shunt or LP drain
Cerebral ischemia- develops 3-12 days after
Arterial spasm
Rebleeding- doesn’t stop
Hyponatremia- transient, give Na, don’t fluid restrict
Seizures

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22
Q

What are some forms of traumatic hemorrhage?

A 
Extradural hematoma
Subdural hematoma
SAH
Intracerebral hemorrhage 
Contusions
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23
Q

Where does a extradural hematoma occur?

A

Between the dura mater and the skull

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24
Q

What is the most common cause of an extradural hematoma?

A

Trauma to the pterion damaging the middle cerebral artery.

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25
What are some symptoms of an extradural hematoma?
Rapid onset of symptoms over minutes of hours Brief unconsciousness followed by lucid interval then coma. Ipsilateral dilated pupil Contralateral hemiparesis Brain herniation/coning- Resp arrest
26
What does an extradural hematoma look like on imaging?
Biconvex
27
What is a subdural hematoma?
Collection of blood in the subdural space (between mater and arachnoid) due to ruptured bridging veins
28
What group usually gets subdural hematomas?
Elderly
29
What tends to cause subdural hematomas?
Mild trauma damaging bridging veins in the elderly.
30
What are some symptoms of a subdural hematoma?
``` Can take weeks to develop Fluctuating symptoms Headache Drowsiness COnfusion Hemiparesis Epilepsy Coninc ```
31
How do you treat a subdural hematoma?
Immediate CT | Monitor carefully
32
What condition can brain bleeds cause?
Stroke
33
What is a stroke?
Sudden disturbance of cerebral function of vascular origin that causes death or lasts over 24h. Rapid (minutes to hours) development of clinical symptoms and/or focal (1 area) loss of brain function with symptoms lasting >24h or death that is vascular in origin.
34
What are the two broad types of stroke?
Infarct | Hemorrhage
35
What can cause an infarct stroke?
Thrombosis | Embolism
36
Where do embolisms arise from?
Carotids Heart Aorta
37
What are some risk factors for an infarct stroke?
``` Atheroma Hypertension Obesity DM Neck artery disease Smoking ```
38
Where can a bleed occuring cause a stroke?
Cerebral hemispheres | SAH
39
What two kinds of cerebral hemisphere bleed can cause a stroke?
Primary intracerebral hemorrhage | Secondary intracerebral hemorrhage
40
What can cause a primary intracerebral hemorrhage?
Hypertension
41
What can cause secondary intracerebral hemorrhage?
AV malformation Aneurysm Tumour
42
What are the three severities of stroke?
TIA Minor COmplete
43
What is a minor stroke?
Patient recovers without major deficit in ~week.
44
What is a complete stroke?
Maximum deficits occur within 6 hours.
45
What is a TIA?
Sudden focal deficit taking seconds to hours to recover. | Often reoccur and herald an ischemic stroke
46
What are some signs of a TIA?
Preserved consciousness Focal losses: Amaurosis fugax- transient loss of vision in one eye Transient global amnesia
47
How do you diagnose a TIA?
ABCD2- score out of 7
48
Describe ABCD2
``` Age >60 +1 BP >140/90 +1 Clinical features: Unilateral features +2 or Speech disturbances without weakness +1 Duration: 10-59min +1 or >60min +2 Diabetes +1 ```
49
How does a right side stroke general present?
Side neglect Artistic loss Affects left side of body
50
How does a left side stroke generally present?
Often affects language | Affects right side of the body
51
What are the five major places for a stroke to occur?
Total anterior circulation syndrome (TACS) Partial anterior circulation syndrome (PACS) Lacunar syndrome (LACS) Posterior circulation (vertebrobasilar) syndromes (POCS) Large medullary syndrome
52
WHat are some symptoms of a Total anterior circulation syndrome (TACS)?
``` Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss • Homonymous hemianopia • Cortical signs (dysphasia, neglect) • Drowsiness/unconsciousness • Complete hemiparesis • Hemisensory loss • Incontinence • Forced deviation of eye towards the side of the stroke ```
53
What are some symptoms of a Partial anterior circulation syndrome (PACS)?
2/3 of: Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss Homonymous hemianopia Cortical signs (dysphasia, neglect)
54
What is lacunar syndrome (LACS)?
Small, discrete infarcts around the internal capsule, thalamus and basal ganglia. Often multiple. Occlusion of single deep penetrating artery.
55
What are some symptoms of Posterior circulation (vertebrobasilar) syndromes (POCS)?
Signs and symptoms of brainstem damage: • Severe truncal ataxia (midline vermis lesion) • Limb clumsiness (signs ipsilateral to cerebellar hemisphere damage) • Gaze palsies • Respiratory rhythm disturbance • Hemiparesis (contralateral)
56
What are some signs of large medullary syndrome?
``` Ipsilateral face paralysis or pain Severe vertigo Vomiting Dysphagia Dysphonia Ataxia Contralateral limb sensory loss Horner's syndrome ```
57
How do you diagnose a stroke?
Rosier score
58
Describe the rosier score
``` Loss of consciousness or syncope -1 Seizures -1 Asymmetrical facial weakness +1 Asymmetrical arm weakness +1 Asymmetrical leg weakness +1 Speech disturbance +1 Visual field defect +1 ```
59
What does a Rosier score of =0 suggest?
Stroke is unlikely but don't rule out
60
What does a Rosier score of >0 suggest?
Stroke is likely
61
What are some risk factors for stroke?
``` Hypertension Smoking Obesity Alcohol High cholesterol Raised heamatocrit Diabetes Carotid stenosis ```
62
What are some differentials for a stroke?
``` Seizure Sepsis Metabolic SOL Functional- symptoms but no patho ```
63
How do you treat a stroke?
CT to differentiate infarct or hemorrhage | Infarct- give thrombolysis
64
What thrombolysis should be used for stroke?
Alteplase 10% IV bolus over 2 minutes
65
How would a stroke present on CT?
Hyperacute ischemia- Loss of grey/white differentiation
66
What is the long term treatment for a stroke?
Antihypertensive Antiplatelets- unless thrombolysed Anticoag is have AF
67
What antiplatelets should be used in stroke?
Aspirin 300mg for 14 days then Clopidogrel 75mg and Aspirin 75mg

Neurology (30 decks)

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