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Medical Sciences B > Vascular disturbances > Flashcards

Vascular disturbances Flashcards

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USMLE® Step 1 flashcards
1
Q

How much of the telencephalon and diencephalon are supplied by the a) internal carotids; b) vertebral arteries

A
  • 80% from internal carotids

* 20% from vertebral arteries

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2
Q

don’t forget to revise the blood supply to the brain images

A

don’t forget to revise the blood supply to the brain images

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3
Q

don’t forget to revise the venous drainage of the brain images

A

don’t forget to revise the venous drainage of the brain images

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4
Q

What is cerebrovascular disease?

A
  • pathology affecting blood vessels (mostly arteries)

* common cause of neurological disease in Western countries

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5
Q

What are the consequences of ophthalmic artery lesion?

A

ipsilateral mono-ocular vision loss

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6
Q

What are the consequences of anterior cerebral artery lesion?

A

producing contralateral weakness and sensory loss primarily in the leg

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7
Q

What are the consequences of middle cerebral artery lesion?

A
  • contralateral weakness and sensory loss most in face and arm and bit to leg
  • contralateral homonymous hemianopia
  • aphasia
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8
Q

What are the clinical features of lesions of the carotid arterial system?

A 
Combinations of:
• hemiparesis
• hemisensory deficit
• monocular visual loss
• homonymous hemianopia
• aphasia
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9
Q

What are the consequences of lesions of the branches to the brain stem?

A
  • loss of brain stem function
  • cranial nerve abnormalities
  • maybe hemiparesis and hemisensory deficits
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10
Q

What are the consequences of lesions of the branches to the cerebellum?

A

ataxia and disequilibrium

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11
Q

What are the consequences of lesions to the posterior cerebral artery?

A

unilateral or bilateral hemianopia

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12
Q

What are the clinical features of lesions of the vertebra-basilar arterial system?

A 
Combinations of:
• diplopia
• dysarthria
• dysphasia
• disequilibrium
• hemiparesis
• hemisensory deficit
• homonymous hemianopia
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13
Q

What is a cerebrovascular accident?

A
  • CVA
  • common
  • clinical manifestation of cerebrovascular disease
  • sudden, non-convulsive focal neurological deficit
  • minimal or severe symptoms
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14
Q

What is a stroke?

A
  • broad term for cerebrovascular accident

* refers to both ischemic and hemorrhagic lesions

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15
Q

What is a cerebral infarct?

A

area of necrosis within the brain due to vascular occlusion

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16
Q

What are transient ischaemic attacks?

A
  • TIA
  • sudden focal neurological dysfunction, followed by complete recovery (in 5-30min)
  • no infarction, no permanent

• emboli obstructs then breaks up prior to neural damage

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17
Q

What is global hypoxic ischaemic encephelopathy?

A
  • generalised reduction in blood flow to brain
  • gradual loss of cerebral activity
  • blunted intellectual function
  • motor deficits
  • increasing dementia
  • bilateral tract symptoms
  • especially bulbar palsy
  • dysarthria
  • dysphagia
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18
Q

List the causes of ischaemic cerebrovascular disease?

A
  • atherosclerosis
  • thrombosis
  • collagen diseases and vasculitis
  • embolism
  • systemic hypotension
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19
Q

What is the most important disease process responsible for thromboembolism?

A

atherosclerosis

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20
Q

What are causes of thrombosis?

A
  • vasculitis
  • meningitis
  • encephalitis
  • periarteritis nodosa
  • polycythemia
  • dehydration
  • mechanical obstruction by masses
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21
Q

What vessels are mostly affected by thrombosis?

A
  • cervical portion of carotid
  • cerebral
  • basilar
  • vertebral aa.
  • watershed area between anterior and middle cerebral artery
  • middle cerebral artery
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22
Q

Where are embolisms from? where do they mostly occlude?

A
  • heart (valvular lesion, arrhythmias, bacterial endocarditis)
  • aorta, carotid vessels

• occlude middle cerebral artery

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23
Q

What is systemic hypotension?

A
  • haemodynamic failure of circulatory system

* causes diffuse ischaemia and infarction (anoxic encephalopathy)

24
Q

What is the biggest risk factor for hemorrhagic cerebrovascular disease?

A

hypertension

25
Q

What are the predisposing factors of ischaemic cerebrovascular disease?

A
  • age > 40yrs
  • diabetes mellitus
  • hypertension
  • cigarette smoking
  • medication
  • obesity
  • oral contraceptives
  • chronic heart failure (by embolus and thrombus)
  • hyperhomocysteinaemia
  • atrial fibrilation
  • polycythaemia and thrombocythaemia
  • bleeding tendency
  • illicit drug use
26
Q

What is a lacunar infarct?

A
  • “micro-infarct”
  • < 1cm diameter
  • due to thickening of vessel wall (from smoking, diabetes mellitus, hypertension)
  • usually in pons, basal ganglia, internal capsule
27
Q

What mechanisms cause a thrombus?

A
  • changes to vessel wall
  • turbulent blood flow
  • change in blood constituents
28
Q

List the causes of ischaemic strokes?

A
  • thrombosis
  • embolism
  • vasculitis
  • occasionally trauma
29
Q

What are the stages of development of a cerebral infarct?

A

1) Acute
• architecture preserves, softening, discolouration

2) Organising
• day 3, parenchyma soft and friable, architecture lost

3) Remote
• cystic lesion, gliosis at periphery

30
Q

What artery is involved in a patient with hemiplegia of face, arm and leg on one side, dysphasia?

A

branch of the middle cerebral artery

31
Q

What artery is involved in a patient with hemiplegia (leg more than arm), apraxia, motor dysphasia, disturbance in micturition?

A

branch of the anterior cerebral artery

32
Q

What artery is involved in a patient with contralateral homonymous hemianopia and occasionally diffuse burning pain on one side of body?

A

branch of contralateral posterior cerebral artery

33
Q

What artery is involved in a patient with severe headaches, vertigo, ataxia, vomiting, diplopia, nystagmus?

A

vascular lesion in brain stem

34
Q

List the haemorrhage cerebrovascular diseases?

A
  • subarachnoid
  • intracerebral
  • epidural
  • subdural
35
Q

List the causes of hemorrhagic cerebrovascular diseases?

A
  • hypertension (#1)
  • intracranial arterial aneurysms
  • coagulation disorders
  • vascular malformations
  • anticoagulant meds
  • illicit substance abuse
36
Q

What are the effects of hypertension on the cerebral circulation?

A
  • acceleration of atherosclerosis
  • weakening of blood vessel walls
  • reductio of blood flow
  • formation of micro aneurysms
  • if malignant hypertension - dilated segments of intracranial blood vessels with loss of endothelial integrity -> leak of proteinaceous fluid +/- abc out of vessels -> oedema in brain
37
Q

Where are intracranial arterial aneurysms mostly located?

A
  • bifurcation of vessels
  • anterior half of Circle of Willis
  • internal carotid / post. communicating artery junction
  • anterior cerebral and ant. communicating artery junction
  • middle cerebral artery junction
38
Q

What is the aetiology of intracranial aneurysms?

A
  • congenital (berry)
  • mycotic (from bacterial)
  • atheroma
  • hypertension
  • associated with polycystic disease of kidneys
39
Q

What is the pathogenesis of intracranial arterial aneurysms?

A
  • ballooning of intima + defect in medial and internal elastic lamina
  • 1mm to 10mm
40
Q

What are the clinical features of intracranial arterial aneurysms?

A
  • asymptomatic prior to rupture
  • maybe headache on effort
  • may cause pressure on cranial nerves 3-6
  • if rupture -> subarachnoid haemorrhage
41
Q

List the vascular malformations that may cause intracranial arterial aneurysms?

A
  • arteriovenous malformations
  • cavernous haemangioma
  • capillary telangiectasia
  • venous angioma
42
Q

What is arteriovenous malformation?

A
  • developmental abnormality
  • often in young
  • defective communication btw arteries, capillaries and veins with dilation of one or more vascular elements
  • forms tortuous meshwork
  • produce chronic ischaemic state
43
Q

List the types of haemorrhagic stroke?

A
  • intracerebral
  • sub-arachnoid
  • sub-dural
  • epidural
44
Q

What is an intracerebal haemorrhage?

A
  • blood accumulation within substance of the brain
  • focal mass lesion
  • acts as space occupying lesion
  • if clots -> intracerebral hematoma
  • massive or small
  • if smaller: steady progression of symptoms
45
Q

Compare a massive hemorrhage to a smaller hemorrhage?

A

Massive:
• rupture into ventricles
• rapidly fatal

Smaller:
• causes headache of increasing intensity, vomiting, mental confusion, convulsion, impairment of consciousness, focal signs
• presents abruptly
• brought on by physical exertion

46
Q

What is a subarachnoid haemorrhage?

A
  • occurring in sub-arachnoid space
  • # 1 cause is rupture of cerebral artery aneurysm
  • sudden extreme headache, starting at back of skull
  • neck rigidity, fever
  • mostly in 20-40yr olds
47
Q

What are the causes of meningitis?

A
  • bacterial meningococcal meningitis
  • subarachnoid bleed
  • supratentorium tumour
48
Q

What is a sub-dural haemorrhage?

A
  • blood btw dura and arachnoid
  • acute or chronic
  • often from head injury
  • often extensive because of loose attachment to membranes
  • often with subarachnoid hemorrhage and contusions
  • blood clot increases in size by osmosis (because greater density than CSF)
  • raises ICP
49
Q

Why is atherosclerosis a risk factor for thrombotic stroke?

A
  • platelets can bind on atherosclerotic plaque and block flow
  • thromboembolic stroke: a piece of plaque can break free and travel until blocks smaller artery
  • VBI: narrowed vessels mean not enough flow
  • TIA: emboli breaks down in under 30min
50
Q

What is a lacunar infarct?

A
  • occlusion of a single small perforating artery
  • effects deep cerebral white mater, basal ganglia or pons
  • small area of necrosis
51
Q

What is the relationship between hypertension and haemorrhage stroke?

A
  • acceleration of atherosclerosis (hard risk factor)
  • weakening of blood vessel walls
  • formation of micro-aneurysms (may rupture)
  • reduction of blood flow
  • if malignant hypertension (dilated segments of intracranial blood vessels with loss of endothelial integrity -> leak of proteinaceous fluid +/- RBC out of vessels -> oedema in brain
52
Q

What is an example of vasogenic oedema?

A

when malignant hypertension causes dilated segments of intracranial blood vessels with loss of endothelial integrity -> leak of proteinaceous fluid +/- RBC out of vessels -> oedema in brain

53
Q

What is the relationship btw aneurysms and haemorrhage stroke?

A
  • aneurysms are at risk of rupturing
  • atherosclerosis weakens walls
  • wall weakening
  • aneurysm is weakest point that rupture if stressed
54
Q

What changes occurring in the blood vessel are associated with aneurysm formation?

A

wall weakness or destruction

55
Q

What are the risk factors for a stroke?

A

Uncontrollable:
• family Hx, od age, male

Atherosclerosis factors:
• hypertension (#1)
• smoking
• diabetes mellitus
• high blood cholesterol
• obesity
• increased age
56
Q

What is the pathophysiological basis for right sided weakness in a patient that had a stroke?

A

left cerebral hemisphere lost blood supply

57
Q

What is the pathophysiological basis for slurred speech in a patient that had a stroke?

A

middle cerebral artery occlusion -> brocas or wernickes areas

Medical Sciences B (23 decks)

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