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Neuro 2 Mine > Stroke > Flashcards

Stroke Flashcards

1
Q

Types of Hemorrhage

A
  • epidural (lemon)
  • subdural (banana)
  • subarachnoid (spider legs)
  • intraparenchymal/intracerebral (inside brain)
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2
Q

Intracerebral Hemorrhage Morbidity/Mortality

A
  • Same as intraparenchymal hemorrhage
  • high morbidity and mortality
  • no medical or surgical tx of proven benefit in improving mortality or functional outcome
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3
Q

Intracerebral Hemorrhage Clinical Presentation

A
  • acute focal neurologic deficit
  • dec. LOC
  • vomiting
  • headache
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4
Q

Deep Intracerebral Hemorrhage (ICH)

  • common locations
  • common risk factors
  • outcome
A
  • located where small perforating arteries are: basal ganglia, thalamus, pons, cerebrum
  • common risk factors: HTN, age
  • poor outcome: none white higher risk
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5
Q

Lobar Intracerebral Hemorrhage

  • location
  • risk factors
  • outcome
A
  • location: frontal > parietal > occipital > temporal
  • risk factors: age, dementia, coagulopathy, HTN, amyloid angiopathy
  • outcome: well tolerated, white & asian at higher risk
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6
Q

Subarachnoid Hemorrhage

  • cause
  • definition
A
  • hemorrhage into space between arachnoid mater and brain
  • most common cause: traums
  • non traumatic causes: aneurysm, arteriovenous malformation, unknown
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7
Q

What is an aneurysm?

A

-weak bulging spot on wall of brain artery

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8
Q

Which aneurysms are at greatest risk of rupture?

A

-large, poster (P-com) aneurysms are at greatest risk of rupture

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9
Q

Aneurysmal Subarachnoid Hemorrhage

  • clinical presentation
  • outcome
A

Clinical Presentation

  • sudden severe headache
  • sometimes focal deficit
  • altered LOC
  • sudden death about 1/3 cases
  • sympathetic surge
  • cardiac arrhythmia
  • hydrocephalus

Outcomes:

  • 50-60% mortality
  • 15-20% moderate disability
  • 15-20% prior level of functioning
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10
Q

Hunt and Hess Classification of Subarachnoid Hemorrhage

A
  • grade 1 is best outcome

- grade 5 is worst outcome

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11
Q

Subarachnoid Hemorrhage Risk Factors

A
  • smoking
  • women>men
  • family hx
  • other medical conditions: polycystic kidney disease, ehlers-danlos, marfan
  • HTN may be risk factor for aneurysm formation but not rupture
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12
Q

Aneurysm Tx Options

A
  • clipping- craniotomy
  • coiling
  • pipeline- novel technique
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13
Q

Subarachnoid Hemorrhage Complications

A
  • rebleed
  • hydrocephalus
  • vasospasm (4-14 days) (risk of ischemic stroke)
  • cerebral salt wasting
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14
Q

Arteriovenous Malformation

A
  • abnormal connection between artery and vein without capillary risk
  • thought to be congenital
  • presentation: hemorrhage, incidental, seizure
  • inc. risk for hemorrhage
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15
Q

Ischemic Stroke Definition

A

-fixed focal neurological deficit lasting > 24 hrs w/ evidence of acute infarction

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16
Q

Transient Ischemic Attack Definition

A

-brief episode of neurological dysfunction

17
Q

Lipohyalinosis

A

-small vessel disease of the brain

18
Q

Causes of Stroke in Young Patients

A
  • hematological causes
  • malignancies
  • oral contraceptives
  • post partum
  • anti-phospholipid antibody syndrome
19
Q

Treatment of Ischemic Stroke

A
  • anti-platelet drugs (ASA, clopidogrel)

- anticoagulants (warfarin)

20
Q

Carotid Edarterectomy

A
  • successful surgery reduces risk of stroke and TIA

- short term risks of procedure vs. long term benefit of surgery

21
Q

Tissue Plasminogen Activator (TPA)

A
  • used in acute stroke setting up to three or 4.5 hours later
  • earlier intervention greater benefit
22
Q

Berry Aneurysm

A
  • result of vessel weakening
  • commonly between ant. cerebral and ant. communicating arteries
  • occur at bifurcations
23
Q

Areas Perfused by Middle Cerebral Artery

A
  • speech
  • sensory
  • motor
24
Q

Areas Perfused by Middle Cerebral Artery

A

-medial aspect of brain

25
Q

Areas Perfused by Posterior Cerebral Artery

A
  • visual cortex

- some hippocampus

26
Q

Etiology of Ischemic Stroke

A
  • artery to artery (carotid, vertebral, aortic arch, intracranial stenosis)
  • cardiac source (A fib, dilated cardiomyopathy, endocarditis/valvular diseases)
27
Q

Penumbra

A

-brain at risk during stroke

28
Q

Imaging Modalities That Provide Good Anatomic Definition of Cerebrovasculature and Lesion

A
  • MRA (Magnetic Resonance Angiography)

- CTA (CT Angiography) (more sensitive)

29
Q

Imaging Modalities That Distinguish Between Penumbra and Dead Tissue

A
  • MR

- CT perfusion (more sensitive)

30
Q

Stroke Imaging Protocol

A
  • Noncontrast head CT
  • perfusion CT
  • CT angiogram of head and neck
31
Q

Non-contrast Brain CT Contraindications

A

-look for contraindication for antithrombolytic therapy (hematoma, hemorrhage, neoplasm, large infarct)

32
Q

Perfusion CT

A
  • intravenous contrast bolus determines amount of blood flow, blood volume, and timing
    • inc. time to start, inc. time to peak, dec. blood volume = completed infarct
    • inc. time to start, inc. time to peak, normal or inc. blood volume = brain at risk
  • high radiation dose
  • continuous imaging at 2-4 locations
33
Q

CT Angiogram

A

-use intravenous contrast bolus and thin sections moving through anatomy to depict vascular anatomy

34
Q

Timeline for CT of Infarcts

A
  • 1-6 hrs: loss of grey matter density
  • 6 hrs - 4 days: progressive swelling and hypodensity
  • 4 days-14days: return towards normal density and volume
  • > 14 days: varying degree of hypodensity and volume loss
35
Q

Timeline for MR Imaging of Infarcts

A
  • 1 hr- 10days: bright on diffusion weighted imaging
  • swelling and inc. signal on FLAIR and T2 weighted scans follows same pattern as swelling and low density on CT
  • Diffusion weighted imaging (DWI) great for small infarcts and telling new from old
36
Q

Intracranial Embolectomy

A
  • MERCI device

- Penumbra devise

Neuro 2 Mine (9 decks)

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