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DIT topics > vascular brain events > Flashcards

vascular brain events Flashcards

1
Q

most common site of berry aneurysm

A

anterior communicating artery (occurs at bifurcations)

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2
Q

rupture of berry aneurysm classically causes

A

subarachnoid hemorrhage: “worst headache of life”,
blood in CSF irritates brain → headache
other consequences: hemorrhagic stroke, compression of optic chiasm

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3
Q

conditions associated with berry aneurysm

A 
ADPKD - cysts in kidneys + berry aneurysms
Ehlers-Danlos 
advanced age
hypertension
smoking
african american
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4
Q

lenticulostriate arteries supply the basal ganglia and thalamus and are at risk for

A

charcot-bouchard microaneurysms if chronic HTN

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5
Q

non-traumatic causes of subarachnoid hemorrhage

A

rupture of berry aneurysm (EDS, ADPKD, HTN, age) or

AVM

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6
Q

most common cause of subarachnoid hemorrhage overall

A

trauma

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7
Q

what is normally present in subarachnoid space

A

CSF

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8
Q

how to diagnose subarachnoid hemorrhage

A

1) CT scan of brain - look for blood
2) lumbar puncture (even if negative CT) - look for blood in 3rd/4th tube or xanthochromia (waited to go to ER, Hb has broken down to bilirubin → yellow CSF)

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9
Q

treatment of subarachnoid hemorrhage

A

surgical clip
nimodipine (dihydropyridine CCB, -dipine): dilates arteries - doesn’t prevent vasospasm that can occur 2-3 days after but improves outcomes

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10
Q

where to enter for lumbar puncture

A

L3-L5: keeps spinal cord alive!
spinal cord ends between L1-L2
L4 = iliac crest

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11
Q

layers of tissue before entering subarachnoid space

A

skin
superficial fascia
3 ligaments: supraspinous ligament, interspinous ligament, ligamentum flavum
epidural space: epidural roots (lumbar, local anesthetic works here)
dura mater
subdural space
arachnoid membrane
subarachnoid space: CSF (spinal anesthetic, more potent, C-section)

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12
Q

rupture of middle meningeal artery (br. of maxillary a.) secondary to temporal bone fracture will cause

A

epidural hematoma

high pressure artery - rapid expansion

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13
Q

what causes this course:
head injury → LOC → LUCID interval →hrs later: uncal herniation → CN3 palsy (down + out, blown pupil), headache, vomit, seizure, death

A

epidural hematoma

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14
Q

epidural hematoma on CT

A

Epidural = Eye (lens, biconvex)

can’t go past suture lines

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15
Q

rupture of bridging veins seen in elderly fall (esp if on warfarin), alcoholic fall, whiplash, shaken baby syndrome causes

A

subdural hematoma

slow venous bleed

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16
Q

subdural hematoma on CT

A

Subdural = CreScent

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17
Q

causes of interparenchymal hemorrhage

A 
anything that can rupture cerebral blood vessels:
severe systemic hypertension (consider this when hypertensive emergency)
amyloid angiopathy
vascular malformations
vasculitis
neoplasm growing in vessel wall
anti-coagulant therapy
cocaine - ↑bp
18
Q

most susceptible vessels that will rupture and cause intraparenchymal hemorrhage

A

lenticulostriate vessels supplying basal ganglia + internal capsule
charcot-bouchard aneurysm of these vessels → rupture → hemorrhage

19
Q

newborns at risk for intraventricular hemorrhage in the newborn

A

premature

20
Q

cause of intraventricular hemorrhage in the newborn

A

germinal matrix in subependymal, subventricular zone that gives rise to neurons and glia in development

21
Q

if considering a stroke in a patient first step in management:

A

order CT scan w/o contrast
if acute bleed (white): consider hemorrhagic stroke
otherwise consider ischemic stroke

22
Q

causes of interparenchymal hemorrhage

A 
anything that can rupture cerebral blood vessels:
severe systemic hypertension (consider this when hypertensive emergency)
amyloid angiopathy
vascular malformations
vasculitis
neoplasm growing in vessel wall
anti-coagulant therapy
cocaine - ↑bp
23
Q

most susceptible vessels that will rupture and cause intraparenchymal hemorrhage

A

lenticulostriate vessels supplying BASAL GANGLIA + internal capsule
charcot-bouchard aneurysm of these vessels → rupture → hemorrhage

24
Q

irreversible damage to brain occurs after

A

5 minutes of hypoxia (vs 20 minutes after MI)

25
Q

most vulnerable locations for ischemic stroke

A

hippocampus
neocortex
cerebellum
watershed areas - with severe hypotension, first affected since most distal

26
Q

watershed areas in brain: receive dual blood supply

A

MCA/ACA

MCA/PCA

27
Q

causes of hemorrhagic stroke (ischemia)

A 
primary cause: rupture of vessels (esp BASAL GANGLIA - lenticulostriate a.)
amyloid angiopathy
vascular malformations
vasculitis
neoplasm growing in vessel wall
anti-coagulant therapy
cocaine - ↑bp
secondary cause: reperfusion of ischemic stroke (↑ vessel fragility)
28
Q

reversible episode of focal ischemia with no acute infarction is caused by

A

transient ischemic attack

negative MRI: but treat as ischemic stroke since can’t wait for MRI results

29
Q

ischemia → infarction of neural tissue → liquefactive necrosis is caused by

A

acute ischemic stroke

30
Q

causes of ischemic strokes

A

thrombotic:
thrombosis over atherosclerotic plaque in carotid → embolizes to brain (MCA most common)
embolic:
afib → thrombus in LA → brain
infective endocarditis → septic emboli
DVT with patent foramen ovale → RA to LA → brain
broken long bone, pelvis → fat emboli

31
Q

when can thrombolytic (t-PA, streptokinase, or urokinase) be given for ischemic stroke patient

A
32
Q

if wake up with stroke symptoms can you give thrombolytics?

A

no - assume stroke began 9 hrs ago - no longer a candidate

33
Q

imaging diagnosis of ischemic stroke

A

bright on diffuse-weighted MRI in 3-30 minutes (highest sensitivity for early ischemia)

34
Q

if considering a stroke in a patient first step in management:

A

order CT scan of head w/o contrast
if acute bleed (white): consider hemorrhagic stroke
otherwise consider ischemic stroke

35
Q

when can thrombolytic (t-PA, streptokinase, or urokinase) be given for ischemic stroke patient

A

less than 3-4 hrs

36
Q

artery damaged:

unilateral facial and arm sensory and/or motor loss

A

MCA

37
Q

artery damaged:

unilateral lower extremity sensory and/or motor loss

A

ACA

38
Q 
artery damaged:
broca or wernicke aphasia (if dominant - usually left lobe) OR
hemispatial neglect (if nondominant - usually right lobe)
A

MCA

39
Q

aneurysm of this artery may cause:

bilateral loss of lateral visual fields

A

anterior communicating aneurysm - compresses optic chiasm

40
Q

aneurysm of this artery may cause:

eye to look down + out

A

posterior communicating aneurysm - CN3 damage

DIT topics (115 decks)

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