Vascular Disorders Flashcards
Focal ischemic cerebral neurologic deficits that last <24 hours, usually <1-2 hours
or even minutes
Sudden onset, resolves completely
Transient Ischemic Attacks
Why are we concerned about TIAs?
Because TIA precede 30% of strokes
What age range is at the highest risk for TIAs?
those age 70-80 years
The most common cause of a TIA is what?
embolism
List some causes of TIAs
Most common cause – embolism
Vascular abnormality
Hematologic causes
Severe anemia
Subclavian Steal Syndrome
Spontaneous
Post-traumatic (ex- fat embolus from fracture)
What are some cardiac risk factors for a TIA?
HTN
NIDDM
HPL
Peripheral vascular disease
CAD
Name some reasons for hospitalizing a patient who had a TIA?
For patients seen within 72 hours of attack when they are at risk for early recurrence regardless of symptoms (48-72 hour window)
ABCD2 score >3
Crescendo attacks
Hypercoagulable state
High grade stenosis 70-99% of carotid artery
What is the main goal with TIA patients?
Prevention! Long term modification of risk factors
Sudden brain cell death in a localized area due to inadequate blood flow
Third leading cause of death
Symptoms depend on which vessel is affected
Stroke
What are the two types/categories of strokes?
Ischemic stroke
Hemorrhagic stroke
What is the more common type of stroke?
Ischemic stroke
What are the cardioembolic risk factors?
Afib
dilated cardiomyopathy
MI in previous 4-6 weeks
What type of stroke is described below?
Usually <5mm lesions, that occur in the distribution of short penetrating arterioles
Commonly seen with poorly controlled HTN and NIDDM
Tend to recover quickly, low morbidity, less rehab than other strokes which are more debilitating
Lacunar Stroke
What history questions are important in examining for a stroke?
Hand dominance
History of stroke
Baseline neurological examination
Time of onset
What is the gold standard imaging after you’ve ruled out hemorrhage in a stroke?
MRI
What is the initial imaging of choice in stroke?
CT without contrast
Describe why a CT over an MRI is the initial imaging?
CT used to rule out hemorrhage
Preferred over MRI to rule out hemorrhage since MRI is not sensitive in the first 48 hours
Acute bleed vs. ischemia
What is the window of time after a stroke that tPA can be used?
3 hours
What are the contraindications for tPA?
NO thrombolytics if symptoms >4.5 hours
BP >185/110
Recent surgery
Recent hemorrhage
Administration of anticoagulants
Arterial puncture at non-compressible site
Internal bleeding
Hx ICH or suspicion of SAH
Platelets <100,000
Head trauma, prior stroke, cranial surgery
What is the key risk factor in hemorrhagic strokes?
HTN
Which type of stroke has the highest mortality rate?
hemorrhagic strokes
What is the key risk factor for an aneurysm?
smoking
Tangled vascular mass with tortuous afferent and efferent vessels
Congenital vascular malformations of variable sizes
AVNs
Where are most of the AVNs found?
in the MCA region
