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
What are some risks of having an AVN?
hemorrhages
recurrent seizures
headaches
What are some signs/symptoms of AVNs?
Headache
Abnormal mental status
Meningeal irritation
Saccular “berry”
many people walk around with these unnoticed – asymptomatic until
something happens and it bleeds
Intracranial Aneurysm
What does AVN stand for?
Arteriovenous malformation
Intracranial aneurysms are associated with what?
Associated with polycystic kidney disease and coarctation of the aorta
What are some risk factors for intracranial aneurysms?
TOB
HTN
hypercholesterolemia
What imaging is diagnostic for intracranial aneurysms?
Angiogram
What size of an intracranial aneurysm warrants surgical intervention?
If aneurysm is >10 mm
List some risk factors for intracranial hemorrhages
HTN in 50-80%
Noncompliance with medications
Smoking
≤55 years of age
Excessive EtOH
Male gender
What is the biggest risk factor for intracranial hemorrhages?
uncontrolled HTN
Why is a lumbar puncture CONTRAINDICATED for intracranial hemorrhages?
It can precipitate a herniation syndrome in patients with a large hematoma
What is the most common cause of subarachnoid hemorrhage?
Cerebral Aneurysm
Blister of a blood vessel from a genetic malformation of arterial wall
Cerebral Aneurysm
Where are the majority of cerebral aneurysms located?
Usually occur at the bifurcation of the vasculature
Most often are anterior portions of Circle of Willis
Thunderclap headache
Sudden onset that reaches maximal and severe intensity within seconds or minutes
“worse headache of my life”
Subarachnoid Hemorrhage
What is the most common cause of subarachnoid hemorrhages?
Trauma
Bleeding between the dura and arachnoid membranes
Occurs when bridging vessels between these membranes tear during trauma
Associated with severe head injury
Subdural Hematoma
What imaging is diagnostic in a subdural hematoma?
CT is diagnostic
What is the finding on a CT in a subdural hematoma?
concave lesions toward the brain
Not limited by suture line
Rare
Occurs when blood pools between the dura mater and the skull
Surgical emergency!
Epidural Hematoma
Trauma to which artery is seen in epidural hematomas?
middle meningeal artery
What imaging is diagnostic in a epidural hematoma?
CT is diagnostic
What is the finding on a CT in a epidural hematoma?
Convex toward brain
Restricted by suture lines
Intracranial venous thrombosis is associated with what state(s)?
hypercoagulable states
Infarction of the spinal cord is a rare phenomenon that usually occurs where?
Usually occurs caudally/Anterior spinal artery territory (anterior/of the cord)
