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vascular Flashcards

1
Q

Epidural Hematoma -TX

A

_immediate evacuation

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2
Q

Epidural hematoma

A
  • Middle meningeal artery, lucid interval, often associated with bone break -Herniation->CNIII compression (ipsilateral pupillary dilation/ “down and out” ; PCA-> ipsilateral visual cortex/ contraletral VF ; Duret-> compression of contraleteral cerebral peduncle-_ipsilateral hemiparesis ( false localizing sign)
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3
Q

Subdural Hematoma

A

-Bridging veins -Can be fatal -Midline shift -

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4
Q

Supratentorial herniation

A

-Uncal -Central (transtentorial) -Cingulate (subfalcine) -Transcervical

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5
Q

Infratentorial herniation

A

-Upward ( cerebellar or transtentorial) -Tonsillar ( downward cerebellar)

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6
Q

Cingulate Herniation

A

-ACA -LEG WEAKNESS

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7
Q

Transtentorial Herniation

A

-Reticular-altered level of consciousness -Corticospinal tract- decorticate posturing; rostral-caudal deterioration

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8
Q

Uncal Herniation

A

-Cerebral peduncle-hemiparesis ( ipsi) -CNIII-pupil dilation; down and out; ipsi -PCA- visual field loss contra

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9
Q

Subarachnoid Hemorrhage- cause and risk factors

A
  • Ruptured berry aneurysm -ACOM>MCA>PCOM>basilar - for non-traumatic cases, the pathology is rupture of a berry aneurysm. risk factors drug use (cocaine, amphetamines, cigarettes, alcohol) polycystic kidney disease and fibromuscular dysplasia.
  • “worst headache of my life”
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10
Q

Subarachnoid Hemorrhage-complications

A
  • Vasospasm -TX with nimodipine (CCB)
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11
Q

diagnosis of SAH

A

-95% CT will show; Sometimes need LP and this shows xonthochromia and persistent bleeding…not to be confused with a traumatic tap!

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12
Q

SAH-TX

A

-clipping or endovascular coiling -CLinical depends on level of consciousness; want to treat earlier

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13
Q

Parenchymal/ Intracerebral

A

-putamen, pons, cerebellum, and thalamus -cerebellum needs surgical intervention (occlusion of the 4th ventricle, hydrocephalus) -RF: HTN! ASTAB/ASTAB; old-cerebral amyloidosis bleeding into ischemia, tumor, AVM, cavernomas,trauma

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14
Q

Ischemic Stroke

A

-Strokes of Large, named arteries -Lacunar Stroke Syndrome -BStem stroke syndromes -Cerebellar stroke syndromes -Cerebellar strokes - Watershed and embolic strokes -Venous infarcts

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15
Q

Named Arteries: ACA

A

-contra motor/sensory;leg>face/arm - Frontal lobe, behavior, akinetic mutism - trans motor aphasia (L) /neglect (r) -urinary incontinence

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16
Q

Named Arteries: MCA

A

-Contra motor/sensory ; face/arm>Leg -Aphasia (L);neglect (R) -Eyes deviate towards lesion -b/l homonymous hemianopsia

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17
Q

Named Arteries: PCA

A

-contra hemianopsia, alexia w/o agraphia for L sided. pts may be unaware of loss -Large- contra motor/sensory

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18
Q

Lacunar Strokes

A
  • Small vessels -Subcortical white matter, BG/Internal capsule,Thalamus, Pons, Cerebellum -HTN! -Changes in small arteries-hyalonosis
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19
Q

Lacunar Strokes-Clinical

A

-Pure Motor:internal capsule -Pure Sensory: thalamus Ataxic hemiparesis Clumsy-hand/dysarthria * not so much higher cortical function

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20
Q

Brainstem Strokes

A

-Crossed findings -CN ipsi & M +S contra -Brainstem disease include dizziness/vertigo, ataxia, nausea, imbalance, double vision, nystagmus, dysarthria, and dysphagia. - reticular problems can cause comatose

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21
Q

WALLENBERGSyndrome

A
  • Occlusion of vertebral artery or PICA -lateral medullary syndrome - Clinical 1.dysphagia, hoarseness, dizziness, nausea, and vomiting,nystagmus, problem with gait/balance. Hiccups ( tx-thorazine) 2. Pain & temp loss in contra body, ipsi face 3. Horner’s syndrome
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22
Q

Cerebellar Strokes

A

-ipsi ataxia -n/v, vertigo,dysarthria,and nystagmus. -lateral-ataxia of ipsi arm/leg; medial= axial muscle/gait /balance -Usually ok; unless swells ( day 3-5) and then need to drain if 4th ventricle occlusion

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23
Q

Waterhshed/ Embolic Strokes

A

-hypoperfusion(hypotension, CHF, carotid stenosis) -ACA/MCA weakness of proximal arm/leg muscles but ok distal strength. (“man in barrel”) -From other arteries or other areas

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24
Q

Venous Infarcts- what? RF? treatment? radiologic signs?

A

-Depends on part of brain effected -Signs of ^ICP-HA/seizures -RF: hyper-coagulable states ( genetic, postpartum, infections, and meds) -Tx-heparin -Cord sign/empty delta

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25
Q

Amaurosis fugax

A

temporary monocular blindness bc of temporary occlusion of the retinal artery

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26
Q

Locked-In syndrome

A

-Aware and awake can only move eyes. lesion of ventral pons -Tip of basilar

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27
Q

Vertebral Artery dissection

A

-Tear into wall from chiropractic procedure (other neck trauma, RF of connective tissue disorder) -Clot into wall layers not lumen -String sign

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28
Q

Dense MCA sign

A

-Clot in MCA; early stroke

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29
Q

tPA

A

-within 3 (4.5 hrs) -CI:minor/resolving deficits, pts w/ glucose <50mg/dL, recent trauma/surgery, hemorrhage, BP > 185/110, INR >1.7, Platelet count less than 100,000

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30
Q

Tx- Lupus anticoagulant

A

Warfarin

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31
Q

Acute Stroke Workup

A
  • DWI and ADC map -Post stroke Mana usually R sided stroke
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32
Q

MRI & contrast

A
  • T1 -Indicates breakdown of BBB
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33
Q

Psychiatric symptoms of ischemic stroke

A

-Depression

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34
Q

CADASIL

A

Cerebral Autosomal Dominate Ateriopathy with Subcortical Infarcts and Leukoencephalopathy= pt with migraines, dementia, and multiple lacunar strokes

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35
Q

MELAS

A
  • mitochondrial encephalopathy with lactic acidoses and stroke -A mitochondrial disorder (maternal inheritance) with stroke-like episodes often in the occipital region. Presents with seizures and dementia in adolescence.
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36
Q

Sickle Cell

A

-An autosomal recessive disease of caused by a mutation of hemoglobin found in people of African ancestry. - Predisposes to stroke

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37
Q

2ndary stroke prevention

A
  • high dose statin regardless f lipid profile -BP 120/80*** -HgBA1c-DM?treat - Smoking cessation, dietary modification, exercise
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38
Q

Anticogulation or antiplatelet?

A

Transesophageal chocardiogram  Is there a clot in the heart?  If yes, start anticoagulation EKG, cardiac monitoring  Is there atrial fibrillation?  If yes, start anticoagulation. If there is no indication for anticoagulation, use an antiplatelet agent (ASA, ASA/dipyridamole (Aggrenox), Clopidogrel (Plavix). Clopidogrel is more effective in preventing heart attacks than ASA. Anticoagulants are Dabigatran (Pradaxa) or Warfarin.

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39
Q

TIA

A

Patients with TIAs should be treated as per stroke patients. In high-risk patients with certain clinical features of the TIA (unilateral weakness or speech disturbance), the 90-day stroke risk is nearly 20%.

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40
Q

Carotid Endarectomy

A

Carotid Doppler/MRA  Is there carotid stenosis (usually >70%)  If yes, carotid endarectomy (preferably within two weeks).

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41
Q

Global cerebral anoxia

A

From cardiac arrest There is diffuse edema with sulcal effacement, bilateral uncal herniation, diffuse compression of the entire ventricular system. “reversal sign on CT”

42
Q

Young stroke patients

A

Hypercoag/rheum work-up antithrombin III deficiency, protein C and S deficiency, activated protein C resistance/factor V Leiden mutation, and prothrombin gene mutation. Most of these present with strokes before the age of 30, and they usually cause venous infarctions.

43
Q

Antiphospholipid syndrome

A

can be screened for by testing lupus anticoagulant and anticardiolipin antibodies. Patients are often women, and may report spontaneous abortions. The treatment is with warfarin.

44
Q

ASA -Distribution

A

Lateral costicospinal tract; Medial leminiscus Caudal medulla -hypoglossal nerve

45
Q

ASA-stroke

A

Contra hemiparesis- lower limbs Dec contralateral propioception Ipsilateral hypoglossal dysfunction ( tongue deviates ipsilaterally)

46
Q

PICA-distribution

A

Lateral medulla- vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguous, sympathetic fibers, inferior cerebellar peduncle

47
Q

PICA-Stroke

A

-Vomiting, vertigo, nystagmus -Limbs/face- decreased pain, temp, sensation -Dysphagia, hoarseness, Dec gag reflex -Ipsi Horner’s -Ataxia, dysmetria

48
Q

AICA-distribution

A

-Lateral pons-vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers -MIddle and inferior cerebellar peduncles

49
Q

AICA stroke

A

-Vomiting, vertigo, nystagmus -Paralysis face -Dec lacrimation/salivation -Dec taste from anterior 2/3 tongue -Dec corneal reflex FACe-dec pain, temp; ipsi dec hearing, ipsi horner’s

50
Q

PCA-distribution

A

-Occipital cortex, visual cortex

51
Q

PCA-stroke

A

-Contra hemianopsia w/macular sparing

52
Q

reversed

_immediate evacuation

A

Epidural Hematoma -TX

53
Q

reversed

  • MCA, lucid interval, often associated with bone break -Herniation->CNIII compression (ipsilateral pupillary dilation/ “down and out” ; PCA-> ipsilateral visual cortex/ contraletral VF ; Duret-> compression of contraleteral cerebral peduncle-_ipsilateral hemiparesis ( false localizing sign)
A

Epidural hematoma

54
Q

reversed

-Bridging veins -Can be fatal -Midline shift -

A

Subdural Hematoma

55
Q

reversed

-Uncal -Central (transtentorial) -Cingulate (subfalcine) -Transcervical

A

Supratentorial herniation

56
Q

reversed

-Upward ( cerebellar or transtentorial) -Tonsillar ( downward cerebellar)

A

Infratentorial herniation

57
Q

reversed

-ACA -LEG WEAKNESS

A

Cingulate Herniation

58
Q

reversed

-Reticular-altered level of consciousness -Corticospinal tract- decorticate posturing; rostral-caudal deterioration

A

Transtentorial Herniation

59
Q

reversed

-Cerebral peduncle-hemiparesis ( ipsi) -CNIII-pupil dilation; down and out; ipsi -PCA- visual field loss contra

A

Uncal Herniation

60
Q

reversed

-Ruptured berry aneurysm -ACOM>MCA>PCOM>basilar -80% in anterior circ -Esp alcoholics, old -May need intervention -Can be incidental finding

A

Subarachnoid Hemorrhage

61
Q

reversed

  • Vasospasm -TX with nimodipine (CCB)
A

Subarachnoid Hemorrhage-complications

62
Q

reversed

-drugs, polycystic kidney disease, fibromuscular dysplasia. -95% CT will show; Sometimes need LP and this shows xonthochromia

A

RF SAH

63
Q

reversed

-clipping or endovascular coiling -CLinical depends on level of consciousness; want to treat earlier

A

SAH-TX

64
Q

reversed

-putamen, pons, cerebellum, and thalamus -cerebellum needs surgical intervention (occlusion of the 4th ventricle, hydrocephalus) -RF: HTN! ASTAB/ASTAB; old-cerebral amyloidosis bleeding into ischemia, tumor, AVM, cavernomas,trauma

A

Parenchymal/ Intracerebral

65
Q

reversed

-Strokes of Large, named arteries -Lacunar Stroke Syndrome -BStem stroke syndromes -Cerebellar stroke syndromes -Cerebellar strokes - Watershed and embolic strokes -Venous infarcts

A

Ischemic Stroke

66
Q

reversed

-contra motor/sensory;leg>face/arm - Frontal lobe, behavior, akinetic mutism - trans motor aphasia (L) /neglect (r) -urinary incontinence

A

Named Arteries: ACA

67
Q

reversed

-Contra motor/sensory ; face/arm>Leg -Aphasia (L);neglect (R) -Eyes deviate towards lesion -Contra hemianopsia

A

Named Arteries: MCA

68
Q

reversed

-contra hemianopsia, alexia w/o agraphia for L sided. pts may be unaware of loss -Large- contra motor/sensory

A

Named Arteries: PCA

69
Q

reversed

  • Small vessels -Subcortical white matter, BG/Internal capsule,Thalamus, Pons, Cerebellum -HTN! -Changes in small arteries-hyalonosis
A

Lacunar Strokes

70
Q

reversed

-Pure Motor:internal capsule -Pure Sensory: thalamus Ataxic hemiparesis Clumsy-hand/dysarthria * not so much higher cortical function

A

Lacunar Strokes-Clinical

71
Q

reversed

-Crossed findings -CN ipsi & M +S contra -Brainstem disease include dizziness/vertigo, ataxia, nausea, imbalance, double vision, nystagmus, dysarthria, and dysphagia. - reticular problems can cause comatose

A

Brainstem Strokes

72
Q

reversed

  • Occlusion of vertebral artery or PICA -lateral medullary syndrome - Clinical 1.dysphagia, hoarseness, dizziness, nausea, and vomiting,nystagmus, problem with gait/balance. Hiccups ( tx-thorazine) 2. Pain & temp loss in contra body, ipsi face 3. Horner’s syndrome
A

WALLENBERGSyndrome

73
Q

reversed

-ipsi ataxia -n/v, vertigo,dysarthria,and nystagmus. -lateral-ataxia of ipsi arm/leg; medial= axial muscle/gait /balance -Usually ok; unless swells ( day 3-5) and then need to drain if 4th ventricle occlusion

A

Cerebellar Strokes

74
Q

reversed

-hypoperfusion(hypotension, CHF, carotid stenosis) -ACA/MCA weakness of proximal arm/leg muscles but ok distal strength. (“man in barrel”) -From other arteries or other areas

A

Waterhshed/ Embolic Strokes

75
Q

reversed

-Depends on part of brain effected -Signs of ^ICP-HA/seizures -RF: hyper-coagulable states ( genetic, postpartum, infections, and meds) -Tx-heparin -Cord sign/empty delta

A

Venous Infarcts

76
Q

reversed

temporary monocular blindness bc of temporary occlusion of the retinal artery

A

Amaurosis fugax

77
Q

reversed

-Aware and awake can only move eyes. lesion of ventral pons -Tip of basilar

A

Locked-In syndrome

78
Q

reversed

-Tear into wall from chiropractic procedure (other neck trauma, RF of connective tissue disorder) -Clot into wall layers not lumen -String sign

A

Vertebral Artery dissection

79
Q

reversed

-Clot in MCA; early stroke

A

Dense MCA sign

80
Q

reversed

-within 3 (4.5 hrs) -CI:minor/resolving deficits, pts w/ glucose 185/110, INR >1.7, Platelet

A

tPA

81
Q

reversed

Warfarin

A

Tx- Lupus anticoagulant

82
Q

reversed

  • DWI and ADC map -Post stroke Mana usually R sided stroke
A

Acute Stroke Workup

83
Q

reversed

  • T1 -Indicates breakdown of BBB
A

MRI & contrast

84
Q

reversed

-Depression

A

Psychiatric symptoms of ischemic stroke

85
Q

reversed

AD disease -pt with migraines, dementia, and multiple lacunar strokes

A

CADASIL

86
Q

reversed

  • mitochondrial encephalopathy with lactic acidoses and stroke -A mitochondrial disorder (maternal inheritance) with stroke-like episodes often in the occipital region. Presents with seizures and dementia in adolescence.
A

MELAS

87
Q

reversed

-An autosomal recessive disease of caused by a mutation of hemoglobin found in people of African ancestry. - Predisposes to stroke

A

Sickle Cell

88
Q

reversed

  • high dose statin regardless f lipid profile -BP 120/80*** -HgBA1c-DM?treat - Smoking cessation, dietary modification, exercise
A

2ndary stroke prevention

89
Q

reversed

Transesophageal chocardiogram  Is there a clot in the heart?  If yes, start anticoagulation EKG, cardiac monitoring  Is there atrial fibrillation?  If yes, start anticoagulation. If there is no indication for anticoagulation, use an antiplatelet agent (ASA, ASA/dipyridamole (Aggrenox), Clopidogrel (Plavix). Clopidogrel is more effective in preventing heart attacks than ASA. Anticoagulants are Dabigatran (Pradaxa) or Warfarin.

A

Anticogulation or antiplatelet?

90
Q

reversed

Patients with TIAs should be treated as per stroke patients. In high-risk patients with certain clinical features of the TIA (unilateral weakness or speech disturbance), the 90-day stroke risk is nearly 20%.

A

TIA

91
Q

reversed

Carotid Doppler/MRA  Is there carotid stenosis (usually >70%)  If yes, carotid endarectomy (preferably within two weeks).

A

Carotid Endarectomy

92
Q

reversed

From cardiac arrest There is diffuse edema with sulcal effacement, bilateral uncal herniation, diffuse compression of the entire ventricular system. “reversal sign on CT”

A

Global cerebral anoxia

93
Q

reversed

Hypercoag/rheum work-up antithrombin III deficiency, protein C and S deficiency, activated protein C resistance/factor V Leiden mutation, and prothrombin gene mutation. Most of these present with strokes before the age of 30, and they usually cause venous infarctions.

A

Young stroke patients

94
Q

reversed

can be screened for by testing lupus anticoagulant and anticardiolipin antibodies. Patients are often women, and may report spontaneous abortions. The treatment is with warfarin.

A

Antiphospholipid syndrome

95
Q

reversed

Lateral costicospinal tract; Medial leminiscus Caudal medulla -hypoglossal nerve

A

ASA -Distribution

96
Q

reversed

Contra hemiparesis- lower limbs Dec contralateral propioception Ipsilateral hypoglossal dysfunction ( tongue deviates ipsilaterally)

A

ASA-stroke

97
Q

reversed

Lateral medulla- vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguous, sympathetic fibers, inferior cerebellar peduncle

A

PICA-distribution

98
Q

reversed

-Vomiting, vertigo, nystagmus -Limbs/face- decreased pain, temp, sensation -Dysphagia, hoarseness, Dec gag reflex -Ipsi Horner’s -Ataxia, dysmetria

A

PICA-Stroke

99
Q

reversed

-Lateral pons-vestibular nuclei, facial nucleus, spinal trigeminal nucleus, cochlear nuclei, sympathetic fibers -MIddle and inferior cerebellar peduncles

A

AICA-distribution

100
Q

reversed

-Vomiting, vertigo, nystagmus -Paralysis face -Dec lacrimation/salivation -Dec taste from anterior 2/3 tongue -Dec corneal reflex FACe-dec pain, temp; ipsi dec hearing, ipsi horner’s

A

AICA stroke

101
Q

reversed

-Occipital cortex, visual cortex

A

PCA-distribution

102
Q

reversed

-Contra hemianopsia w/macular sparing

A

PCA-stroke

Neuro (12 decks)

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