Vascular Flashcards
What areas are affected by Pure Motor Hemiparesis (Lacunar Syndrome)?
Contralateral arm, face, and leg; intact sensory, intact cognition.
A patient had a sudden onset of contralateral weakness in their arm, face, and leg. They did not seem to have any cognitive dysfunction and had no issues with feeling. What kind of stroke did they likely have?
Lacunar syndrome:
- Lenticulostriate artery or other MCA branch
- PCA branch
- Anterior choroidal artery
A patient suddenly experienced significant hemiparesis in her R face and R hand. She also demonstrated some expressive language difficulties, including problems repeating words. What stroke did she likely have?
Likely a L MCA superior stroke.
A patient suddenly experienced significant hemisensory loss in her L face and L arm. She also demonstrate severe hemineglect on the left and a right gaze preference. What stroke did she likely have?
R MCA inferior stroke
A patient suffered from a stroke and started experiencing weakness and some sensory loss in his L leg with accompanying nonfluent aphasia with intact repetition. What stroke did he likely have?
R ACA.
Thrombus:
think ‘BUS’
clot form, impedes blood flow; mnemonic - BUS, stuck in traffic, impede traffic flow
Embolus:
think ‘BALL’, or em-BALL-us
clot, air bubble, fatty deposit, or other object which has been carried in the bloodstream to lodge in a vessel and cause an embolism
Atrial Fibrillation (AFib)
irregular heart rate; two upper chambers of the heart experience chaotic electrical signals; increased risk of developing blood clots within the upper chambers of the heart, which then can cause an embolism
Pulmonary Embolism (PE)
a blood clot has formed elsewhere (usually the leg), and travels to the lungs, where it gets caught in a pulmonary artery, causing ischemia
(deep vein thrombosis)
Deep Vein Thrombosis (DVT)
clots form in the veins in the legs, which can cause reduced blood flow in the veins, causing leg edema, or it can cause an embolism elsewhere (e.g., PE)
The majority of strokes occur in the (anterior or posterior) circulations
The other area is generally affected by the anterior or posterior) circulations
anterior circulation (ACA, MCA, anterior choroidal) 80%
posterior circulation (vertebrobasilar, PCA) 20%
Atherosclerosis
Buildup of fatty deposits within the walls of arteries
Vasculitis
inflammation of blood vessels; swelling can cause the vessels to constrict, restricting blood flow
Cerebral Amyloid Angiopathy (CAA)
buildup of amyloid protein in the walls of arteries in the brain, causing weakened walls, increases risk for hemorrhagic stroke
Congestive Heart Failure (CHF)
heart failure; when the heart does not pump blood as well as it should; can cause fluid buildup around the lungs
Tissue Plasminogen Activator (tPA)
FDA-approved treatment for ischemic or thromboembolic stroke (thrombolytic), pulmonary embolism, or myocardial infarction; increases the enzyme of plasmin, which breaks down clots; should be administered within 4.5 hours of symptoms (after CT scan to rule out contraindications, such as hemorrhage)
Warfarin
anticoagulant; rat poison
helps prevent stroke (reduces risk by 60-70%)
Transient Ischemic Attack (TIA)
brief episodes (0-24 hours) of neurologic dysfunction resulting from focal cerebral ischemia; may not be seen on imaging; usually a warning sign before a full stroke
Aneurysm
localized enlargement of an artery, usually due to weak arteries
Arteriovenous malformation (AVM)
group of blood vessels that form incorrectly
How long does it take to cause neuronal damage from ischemia?
6-8 minutes
A patient had a L MCA Superior stroke. What are some of the signs that they might have?
- Broca’s nonfluent aphasia, R face and arm weakness (sometimes sensory loss), impaired working memory and executive function, R and/or L limb apraxia
A patient had a L MCA Inferior stroke. What are some of the signs that they might have?
- Wernicke’s fluent aphasia, R visual field deficit, R face and arm sensory loss (maybe weakness), limb apraxia, parts of Gertsmann’s syndrome
A patient had a R MCA Superior stroke. What are some of the signs they might have?
- L hemineglect, L arm and face weakness (maybe sensory loss), impaired working memory and executive functions
A patient had a R MCA Inferior stroke. What are some of the signs they might have?
- L hemineglect (profound), L visual field and somatosensory deficits, decreased voluntary or spontaneous initiation of movements on the L side, R gaze preference, anosognosia, impaired visuospatial skills (dressing, drawing), writing, reading, arithmetic problems (due to spatial difficulties)
A patient had a L MCA Deep Territory stroke. What are the signs?
- R pure motor hemiparesis, larger infarcts may produce cortical deficits (aphasia)
A patient had a L MCA Stem stroke. What are the signs?
- R hemiplegia and hemianesthesia, right homonymous hemianopia, global aphasia, L gaze preference
A patient presents with R hemiplegia and hemianesthesia, loss of R field of vision, and global aphasia. What stroke did they have?
L MCA stem stroke
A patient presents with R pure motor hemiparesis. What stroke did they have?
L MCA Deep Territory
A patient had a R MCA Deep Territory stroke. What are the signs?
L pure motor hemiparesis, larger infarcts may cause “cortical” deficits, such as L hemineglect and visuospatial deficits
A patient had a R MCA Stem stroke. What are the signs?
L hemiplegia and hemianesthesia, L homonymous hemianopia, profound L neglect, visuospatial deficits, anosognosia
A patient had a L PCA stroke. What are the signs?
R homonymous hemianopia, alexia without agraphia, maybe transcortical sensory aphasia, R hemisensory loss, R hemiparesis
A patient had a R PCA stroke. What are the signs?
L homonymous hemianopia, L hemisensory loss and L hemiparesis, memory (if hippocampus is involved)
Endarectomy
surgical procedure to remove atheroscleritic plaques
Endovascular embolization
non-invasive procedure to block blood flow (used for aneurysms)
What strokes are associated with the worst cognitive outcomes? (cortical vs. subcortical)
Combination of cortical and subcortical strokes are associated with worse cognitive outcomes.
Leukoaraiosis
benign white matter abnormalities commonly observed in the aged and not associated with dementia; periventricular white matter disease
Multi-Infarct Dementia
involves stepwise progression due to multiple cerebral infarctions with subsequent volume loss; involves cerebrum, white matter, and deep gray matter structures
Strategic Infarct
single infarct associated with a particular constellation of neuropsychological deficits
Strategic infarct in the L Angular Gyrus
Gertsmann syndrome - acalculia, right-left disorientation, finger agnosia, agraphia
and visuospatial constructional problems
Strategic infarct in the caudate nucleus, globus pallidus, and thalamus
interruption of prefrontal-subcortical circuits, resulting in executive and motor dysfunction
Strategic infarct in the thalamus
broad range of cognitive and behavioral disturbances: executive dysfunction, language impairment, memory dysfunction, and/or disorders of initiation, inhibition, and emotional regulation
Strategic infarct in PCA brances
Memory deficits are common
Strategic infarct in the ACA
Neurobehavioral syndromes are common
Cerebral amyloid angiopathy (CAA)
amyloid deposition in blood vessels resulting in hemorrhage, ischemic infarction, and cognitive loss; can be both sporadic and hereditary, usually onset after age 55
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)
hereditary nonatherosclerotic arteriopathy affecting the cerebral small vessels, resulting in diffuse white matter disease and small lacunar infarctions
A 60yo patient presents to the ER with seizures, a migraine, and depression. They have a history of multiple TIAs and strokes. What is their most likely diagnosis?
CADASIL
