post midterm 5:cerebro Flashcards
what are the 3 Major Types of Ischemic Cerebrovascular Events?
1) Thrombosis-clot in blood vessel
2) Embolism-from somewhere else, can be clot or fat infectious air etc
3) Hemorrhage
what is TIA? will it show up on MRI?
people with TIA are more prone to what?
Time-limited episodes of neurologic dysfunction
Up to 50% with TIA have MRI evidence of brain ischemia
Longer events (> 2 hours) increase the likelihood for tissue ischemia (even if there is full clinical recovery)
A potent predictor of stroke (10-15% in next 90 days)
50% of strokes within 2 days
Risk of cardiac event ~ 2.5% in 90 days
Risk of death ~ 2.5% in 90 days
what is a stroke? what are some risk factors?
Persistent neurological deficit due to cerebrovascular disease 3d most common cause of death in US Traditional risk factors: -Hypertension -Hyperlipidemia -Smoking -Diabetes -Alcohol (heavy use) -Pro-thrombotic medications (eg estrogens)
what happens if the vertebrobasilar system is affected?
"the D's" Diplopia, visual loss Dizziness, vertigo Dysarthria Dysphagia Ataxia Weakness (one or both sides) Corticospinal tracts Crossed numbness Spinothalamic tracts
what can you get with Bilateral Occipital Infarction
- Cortical blindness
- Korsakoff’s amnesia
- Memory defecits
- Confabulation
what are Small-Vessel (Lacunar) Strokes? what are they assoc with?
- Strongly associated with hypertension
- Good prognosis for recovery
- **Pure motor stroke
- Pure sensory stroke
- Dysarthria/clumsy hand
- Ataxic hemiparesis (weak lower extrem; arm and leg incoordination)
what are some possible causes of stroke?
> Embolism
-Clot from a proximal atherosclerotic vessel
-Cardiogenic embolism (atrial fibrillation, post-MI, endocarditis)
Local vessel thrombus formation
Low flow in a diseased vessel due to hypotension, vasospasm, hyperviscosity, vasculitis
Arterial dissection
Consider other causes including non-ischemic events (e.g. seizure) in the differential diagnosis (TIA)
what are some characteristics found in embolic stroke? what is typically the source of emboli?
Abrupt onset of maximal deficit
-Associated headache
In a Younger patient:
Atrial fibrillation (may be presenting finding), may not know they have heart issues
*Source of emboli most often is the heart
when is it beneficial to give thrombolytics during stroke?
within 3 hours
*higher risk of Intracranial hemorrhage
how do you treat a stroke?
-Rule out hemorrhage
-Heparin anticoagulation if not contraindicated
Long term:
*Anti-platelet
*Anticoagulation
what is the tx protocol for stenosed carotids when symptomatic vs asymptomatic pts?
High grade (≥ 70%) stenosis with symptoms (stroke/TIA) studies favor surgery -otherwise, even if stenosed, if no symptoms, benefits may outweigh risks...
what are the current USPTF screening rec for carotid stenosis?
The US Preventive Services Task Force recommends AGAINST screening for asymptomatic carotid artery stenosis in the general adult population.
what is carotid stenting vs Endarterectomy and what are the risks and benefits?
stenting=higher risk for stroke, lower risk of heart attack
endarterectomy= higher risk of heart attack, lower risk of stroke
T/F: Potential for recovery of neurologic function exists in Intracerebral Hemorrhage
true because blood flow often preserved
what are some clinical signs you see with Hemorrhagic Stroke?
-Gradual onset of deficit (hypertensive bleeds) or maximal at onset (subarachnoid hemorrhage) Onset often during activity *Headache (50%) Meningeal signs *Change in level of consciousness Nausea, vomiting (>50%) **Photophobia, painful eye movements *Seizures (1/3 in 3 days)
what are some risk factors Hemorrhagic Stroke?
-Underlying HTN (longstanding)
-Older age
-Tumor
-Brain AVM
-High alcohol intake
-Stimulant drug use (amphetamines, cocaine)
Consider in young patient
what are some favorable factors for good prognosis of Hemorrhagic Stroke?
Level of consciousness at presentation
Size of bleed
Age
what side effects will someone have with Thalamic Hemorrhage (Hypertensive Intracerebral Hemorrhage)
Contralateral motor/sensory deficits
Paralysis of vertical gaze
Eyes deviated towards affected side
Pupils unequal, light reflex absent
what side effects will someone have with cerebellar Hemorrhage (Hypertensive Intracerebral Hemorrhage)
Vertigo, ataxia Occipital headache Lateral gaze paralysis Facial weakness Late, abrupt deterioration/death Surgical decompression possible
what is the Most common cause of spontaneous subarachnoid bleed?
Intracranial Aneurysms, majority near circle of willis
intracranial aneurysms are associated with what other inherited tissue disorders?
connective tissue disorders
Autosomal dominant polycystic kidney disease
Ehlers-Danlos Type IV
Neurofibromatosis
Marfan’s syndrome
**Family history of intracranial aneurysm inc risk
what clinical symptoms do you see in cavernous sinus syndrome
Unilateral ophthalmoplegia (III nerve) Unreactive pupil (III nerve) Facial pain (V nerve) Chiasmal syndrome (medial extension) With rupture: Pulsating exophthalmos Orbital venous congestion
T/F: Small intracranial aneurysms are relatively common and rarely rupture
true
list some Clinical Features of Ruptured Aneurysm:
Sudden, violent headache
Nausea, vomiting are common
Collapse, but usually retain consciousness
- Death may occur within minutes
- 12% die before reaching medical attention
*Lateralizing neurologic findings unusual=unlike in strokes
