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Neurology > Patho- Vascular disease > Flashcards

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
Q

What are some symptoms of an extradural hematoma?

A

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

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26
Q

What does an extradural hematoma look like on imaging?

A

Biconvex

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27
Q

What is a subdural hematoma?

A

Collection of blood in the subdural space (between mater and arachnoid) due to ruptured bridging veins

28
Q

What group usually gets subdural hematomas?

A

Elderly

29
Q

What tends to cause subdural hematomas?

A

Mild trauma damaging bridging veins in the elderly.

30
Q

What are some symptoms of a subdural hematoma?

A 
Can take weeks to develop
Fluctuating symptoms
Headache
Drowsiness
COnfusion
Hemiparesis
Epilepsy
Coninc
31
Q

How do you treat a subdural hematoma?

A

Immediate CT

Monitor carefully

32
Q

What condition can brain bleeds cause?

A

Stroke

33
Q

What is a stroke?

A

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
Q

What are the two broad types of stroke?

A

Infarct

Hemorrhage

35
Q

What can cause an infarct stroke?

A

Thrombosis

Embolism

36
Q

Where do embolisms arise from?

A

Carotids
Heart
Aorta

37
Q

What are some risk factors for an infarct stroke?

A 
Atheroma
Hypertension
Obesity
DM
Neck artery disease
Smoking
38
Q

Where can a bleed occuring cause a stroke?

A

Cerebral hemispheres

SAH

39
Q

What two kinds of cerebral hemisphere bleed can cause a stroke?

A

Primary intracerebral hemorrhage

Secondary intracerebral hemorrhage

40
Q

What can cause a primary intracerebral hemorrhage?

A

Hypertension

41
Q

What can cause secondary intracerebral hemorrhage?

A

AV malformation
Aneurysm
Tumour

42
Q

What are the three severities of stroke?

A

TIA
Minor
COmplete

43
Q

What is a minor stroke?

A

Patient recovers without major deficit in ~week.

44
Q

What is a complete stroke?

A

Maximum deficits occur within 6 hours.

45
Q

What is a TIA?

A

Sudden focal deficit taking seconds to hours to recover.

Often reoccur and herald an ischemic stroke

46
Q

What are some signs of a TIA?

A

Preserved consciousness
Focal losses: Amaurosis fugax- transient loss of vision in one eye
Transient global amnesia

47
Q

How do you diagnose a TIA?

A

ABCD2- score out of 7

48
Q

Describe ABCD2

A 
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
Q

How does a right side stroke general present?

A

Side neglect
Artistic loss
Affects left side of body

50
Q

How does a left side stroke generally present?

A

Often affects language

Affects right side of the body

51
Q

What are the five major places for a stroke to occur?

A

Total anterior circulation syndrome (TACS)
Partial anterior circulation syndrome (PACS)
Lacunar syndrome (LACS)
Posterior circulation (vertebrobasilar) syndromes (POCS)
Large medullary syndrome

52
Q

WHat are some symptoms of a Total anterior circulation syndrome (TACS)?

A 
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
Q

What are some symptoms of a Partial anterior circulation syndrome (PACS)?

A

2/3 of:
Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss
Homonymous hemianopia
Cortical signs (dysphasia, neglect)

54
Q

What is lacunar syndrome (LACS)?

A

Small, discrete infarcts around the internal capsule, thalamus and basal ganglia. Often multiple. Occlusion of single deep penetrating artery.

55
Q

What are some symptoms of Posterior circulation (vertebrobasilar) syndromes (POCS)?

A

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
Q

What are some signs of large medullary syndrome?

A 
Ipsilateral face paralysis or pain
Severe vertigo
Vomiting
Dysphagia
Dysphonia
Ataxia
Contralateral limb sensory loss
Horner's syndrome
57
Q

How do you diagnose a stroke?

A

Rosier score

58
Q

Describe the rosier score

A 
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
Q

What does a Rosier score of =0 suggest?

A

Stroke is unlikely but don’t rule out

60
Q

What does a Rosier score of >0 suggest?

A

Stroke is likely

61
Q

What are some risk factors for stroke?

A 
Hypertension
Smoking
Obesity
Alcohol
High cholesterol
Raised heamatocrit
Diabetes
Carotid stenosis
62
Q

What are some differentials for a stroke?

A 
Seizure
Sepsis
Metabolic
SOL
Functional- symptoms but no patho
63
Q

How do you treat a stroke?

A

CT to differentiate infarct or hemorrhage

Infarct- give thrombolysis

64
Q

What thrombolysis should be used for stroke?

A

Alteplase 10% IV bolus over 2 minutes

65
Q

How would a stroke present on CT?

A

Hyperacute ischemia- Loss of grey/white differentiation

66
Q

What is the long term treatment for a stroke?

A

Antihypertensive
Antiplatelets- unless thrombolysed
Anticoag is have AF

67
Q

What antiplatelets should be used in stroke?

A

Aspirin 300mg for 14 days then Clopidogrel 75mg and Aspirin 75mg

Neurology (30 decks)

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