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Neurology > Vascular Disorders > Flashcards

Vascular Disorders Flashcards

1
Q

Focal ischemic cerebral neurologic deficits that last <24 hours, usually <1-2 hours
or even minutes

Sudden onset, resolves completely

A

Transient Ischemic Attacks

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2
Q

Why are we concerned about TIAs?

A

Because TIA precede 30% of strokes

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3
Q

What age range is at the highest risk for TIAs?

A

those age 70-80 years

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4
Q

The most common cause of a TIA is what?

A

embolism

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5
Q

List some causes of TIAs

A

Most common cause – embolism
Vascular abnormality
Hematologic causes
Severe anemia
Subclavian Steal Syndrome
Spontaneous
Post-traumatic (ex- fat embolus from fracture)

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6
Q

What are some cardiac risk factors for a TIA?

A

HTN
NIDDM
HPL
Peripheral vascular disease
CAD

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7
Q

Name some reasons for hospitalizing a patient who had a TIA?

A

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

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8
Q

What is the main goal with TIA patients?

A

Prevention! Long term modification of risk factors

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9
Q

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

A

Stroke

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10
Q

What are the two types/categories of strokes?

A

Ischemic stroke

Hemorrhagic stroke

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11
Q

What is the more common type of stroke?

A

Ischemic stroke

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12
Q

What are the cardioembolic risk factors?

A

Afib
dilated cardiomyopathy
MI in previous 4-6 weeks

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13
Q

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

A

Lacunar Stroke

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14
Q

What history questions are important in examining for a stroke?

A

Hand dominance

History of stroke

Baseline neurological examination

Time of onset

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15
Q

What is the gold standard imaging after you’ve ruled out hemorrhage in a stroke?

A

MRI

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16
Q

What is the initial imaging of choice in stroke?

A

CT without contrast

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17
Q

Describe why a CT over an MRI is the initial imaging?

A

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

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18
Q

What is the window of time after a stroke that tPA can be used?

A

3 hours

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19
Q

What are the contraindications for tPA?

A

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

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20
Q

What is the key risk factor in hemorrhagic strokes?

A

HTN

21
Q

Which type of stroke has the highest mortality rate?

A

hemorrhagic strokes

22
Q

What is the key risk factor for an aneurysm?

A

smoking

23
Q

Tangled vascular mass with tortuous afferent and efferent vessels
Congenital vascular malformations of variable sizes

A

AVNs

24
Q

Where are most of the AVNs found?

A

in the MCA region

25
Q

What are some risks of having an AVN?

A

hemorrhages
recurrent seizures
headaches

26
Q

What are some signs/symptoms of AVNs?

A

Headache
Abnormal mental status
Meningeal irritation

27
Q

Saccular “berry”

many people walk around with these unnoticed – asymptomatic until
something happens and it bleeds

A

Intracranial Aneurysm

28
Q

What does AVN stand for?

A

Arteriovenous malformation

29
Q

Intracranial aneurysms are associated with what?

A

Associated with polycystic kidney disease and coarctation of the aorta

30
Q

What are some risk factors for intracranial aneurysms?

A

TOB
HTN
hypercholesterolemia

31
Q

What imaging is diagnostic for intracranial aneurysms?

A

Angiogram

32
Q

What size of an intracranial aneurysm warrants surgical intervention?

A

If aneurysm is >10 mm

33
Q

List some risk factors for intracranial hemorrhages

A

HTN in 50-80%
Noncompliance with medications
Smoking
≤55 years of age
Excessive EtOH
Male gender

34
Q

What is the biggest risk factor for intracranial hemorrhages?

A

uncontrolled HTN

35
Q

Why is a lumbar puncture CONTRAINDICATED for intracranial hemorrhages?

A

It can precipitate a herniation syndrome in patients with a large hematoma

36
Q

What is the most common cause of subarachnoid hemorrhage?

A

Cerebral Aneurysm

37
Q

Blister of a blood vessel from a genetic malformation of arterial wall

A

Cerebral Aneurysm

38
Q

Where are the majority of cerebral aneurysms located?

A

Usually occur at the bifurcation of the vasculature

Most often are anterior portions of Circle of Willis

39
Q

Thunderclap headache

Sudden onset that reaches maximal and severe intensity within seconds or minutes

“worse headache of my life”

A

Subarachnoid Hemorrhage

40
Q

What is the most common cause of subarachnoid hemorrhages?

A

Trauma

41
Q

Bleeding between the dura and arachnoid membranes

Occurs when bridging vessels between these membranes tear during trauma

Associated with severe head injury

A

Subdural Hematoma

42
Q

What imaging is diagnostic in a subdural hematoma?

A

CT is diagnostic

43
Q

What is the finding on a CT in a subdural hematoma?

A

concave lesions toward the brain
Not limited by suture line

44
Q

Rare

Occurs when blood pools between the dura mater and the skull

Surgical emergency!

A

Epidural Hematoma

45
Q

Trauma to which artery is seen in epidural hematomas?

A

middle meningeal artery

46
Q

What imaging is diagnostic in a epidural hematoma?

A

CT is diagnostic

47
Q

What is the finding on a CT in a epidural hematoma?

A

Convex toward brain
Restricted by suture lines

48
Q

Intracranial venous thrombosis is associated with what state(s)?

A

hypercoagulable states

49
Q

Infarction of the spinal cord is a rare phenomenon that usually occurs where?

A

Usually occurs caudally/Anterior spinal artery territory (anterior/of the cord)

Neurology (15 decks)

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