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Neuro > Vascular Emergencies and Neoplasm > Flashcards

Vascular Emergencies and Neoplasm Flashcards

1
Q

What are arteriovenous malformations (AVM)?

A

Snarled tangles of blood vessels that can cause multiple irregular connections between the arteries and the veins

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2
Q

Where do AVMs occur?

A

Occur in the spinal cord and in any part of the brain or on the surface, and anywhere in the body

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3
Q

What are cavernous hemangiomas?

A
  • Type of vascular lesion
  • Groups of tightly packed abnormally thin walled, small blood vessels that displace normal neurological tissue in the brain or spinal cord.
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4
Q

Are cavernous hemangiomas filled with fast or slow moving blood?

A

These vessels are filled with slow-moving or stagnant blood that is usually clotted or in a state of decomposition.

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5
Q

Why do cavernous hemangiomas sometimes leak?

A

Sometimes they leak blood into surrounding tissues because the walls are extremely fragile

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6
Q

What can cavernous hemangiomas cause?

A

Seizures

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7
Q

What are capillary telangiectasis?

A
  • Group of abnormal swollen capillaries

- Usually benign

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8
Q

What can develop in a pt with an inherited disorder who also has capillary telangiectasis?

A

HA and seizures

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9
Q

What are Venous angiomas?

A
  • Radically arranged configuration of medullary veins (circular pattern) separated by normal brain parenchyma
  • Usually benign and an incidental finding
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10
Q

What effects does HTN have on the brain?

A

Weakening of the blood vessels wall

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11
Q

What can occur in HTN microaneurysms?

A

Perforating vessels called charcot-bouchard aneurysm can rupture and cause bleeding

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12
Q

What are the MC sites for a HTN bleed?

A

Thymus, basal ganglia, pons, and cerebellum

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13
Q

What causes a CVA?

A

Ischemia or hemorrhage

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14
Q

What is the cause of a ischemic stroke?

A

A vessel supplying blood to the brain is obstructed

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15
Q

What is the cause of a hemorrhagic stroke?

A

Blood vessel in the brain parenchyma ruptures and causes accumulation of blood in the brain tissue.

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16
Q

Which last longer than a few minutes and causes residual sxs a CVA or a TIA?

A

CVA

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17
Q

What is a TIA?

A

“mini” stoke, usually only last a few minutes

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18
Q

What causes a TIA?

A

Blood supply to part the brain that is briefly blocked

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19
Q

What are sxs of a TIA?

A

Numbness or weakness to one side of the body that occur suddenly

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20
Q

What causes a cerebral aneurysm?

A

Weakness in the blood vessel in the brain that fills with blood

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21
Q

What is the MC location for a cerebral aneurysm?

A

Circle of Willis

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22
Q

What occurs when a cerebral aneurysm ruptures?

A

Presence of cerebral edema (which may prevent brain retraction and relaxation) and clot around the aneurysm increases the technical difficulty

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23
Q

What is the tx for a ruptured cerebral aneurysm?

A

Craniotomy and clipping or Endovascular therapy: coil embolism

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24
Q

Does an un-ruptured cerebral aneurysm cause sxs?

A

Usually asymptomatic and an incidental finding

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25
Q

What warrants surgery for an un-ruptured cerebral aneurysm?

A

> 7 - 10 mm in diameter

- Age and existing medical and neuro conditions

26
Q

What is an intracerebral hemorrhage (ICH)?

A

Bleeding that is spontaneous, nontraumatic, and no evidence of aneurysm or angioma

27
Q

What are ICH usually due to?

A

HTN

- Presence of microaneurysms that develop on perforating vessels in HTN pts

28
Q

What are the MCC of ICH in younger pts?

A

AVMs

29
Q

What are s/sxs of an ICH?

A
  • Consciousness is initially lost or impaired in 50% of pts

- Vomiting occurs at onset of bleeding and HA is sometimes present.

30
Q

What diagnostics are done in a pt whos suspected to have ICH?

A

CT scan w/o contrast

- Confirms hemorrhage and determines size and site of the hematoma

31
Q

Why are LP contraindicated in a pt with a potential ICH?

A

It may precipitate a herniation syndrome in pts with a large hematoma

32
Q

What labs are done in a pt whos suspected to have ICH?

A

CBC, Platelet, Prothrombin, Liver, and kidney test

33
Q

What is the tx for ICH?

A
  • Lower systolic to 140 w/ IV labetalol or nicardipine.

- Platelet transfusion for thrombocytopenia

34
Q

What are s/sxs of a subarachnoid hemorrhage (SAH)?

A
  • Worst HA of life (thunderclap)
  • Sudden onset
  • N/V
  • LOC
  • Can be traumatic or caused by aneurysmal rupture
35
Q

What diagnostic test are performed for SAH?

A

CT head non-contrast
- Bleeding into subarachnoid space, disruption of small pia vessels

Lumbar puncture
- Xanthochromia

36
Q

What is 1st step in treating a SAH?

A

Stop the bleed

- Angiography w. stent or coil vs craniotomy and clip aneurysm

37
Q

What is the 2nd step in treating a SAH?

A

Prevent secondary brain injury:

  • Control B/P
  • If hydrocephalus: extraventricular drain then shunt placement
  • Prevent vasospasm: Nimodipine (CCB) for 21 days- improves outcome rather than prevention
  • Transcranial doppler to monitor
38
Q

What is the 3rd step in treating a SAH?

A

Rehab as appropriate: TBI Rehab

39
Q

What are space occupying lesions?

A

Tumors, abscesses, or cysts that can directly or indirectly impair circulation and cause progressive neurological deficits.

40
Q

What is an arachnoid cyst?

A

Filled sac that does not communicate with the ventricular system

41
Q

What is a colloid cyst?

A

Fluid filled sac usually in the 3rd ventricle

42
Q

Colloid cyst can lead to sudden death through the ball-valve mechanism, what sxs do you look for that indicate a colloid cyst?

A

Positional HA and syncope

43
Q

What is a dermoid cyst?

A
  • Congenital inclusion cyst

- Often in sella turcica, midline vermis, or 4th ventricle

44
Q

What can occur with a dermoid cyst?

A

It can rupture causes seizures and neuro decline

45
Q

What is an epidermoid cyst?

A

Fluid filled sac located CPA angle, 4th ventricle, or middle cranial fossa

46
Q

What cells do astrocytomas arise from?

A

Arise from astrocytes in the brain

47
Q

What is the MC cerebral brain tumor in children?

A

Astrocytomas

48
Q

Are astrocytomas fast or slow growing and where can they be found?

A

Slow growing

Can be anywhere in the brain

49
Q

What is the grade range for astrocytomas?

A

1-4

50
Q

What cells do oligodentrogliomas arise from?

A

Arise from glial cells (supportive cells)

51
Q

Where are oligodentrogliomas found in the body?

A

Tumor can occur in brain or spinal cord

52
Q

Oligodentrogliomas usually occur in who?

A

Can occur at any age but primarily seen in adults

53
Q

What is the grade range for oligodentrogliomas?

A

2-3

54
Q

What cells do ganglion cell tumors arise from?

A

Arise from mature neurons and glial cells

55
Q

Ganglion cell tumors usually occur in who?

A

Occurs in children and young adults

56
Q

What is the grade range for ganglion cell tumors?

A

1-3 (most are 1-2)

57
Q

Ganglion cell tumors can cause what?

A

Seizures

58
Q

What cells do medulloblastomas arise from?

A

Cerebral stem cells

59
Q

What is the 2nd MC brain tumor in children?

A

Medulloblastomas

60
Q

What is the grade for Medulloblastomas?

A

Grade 4

- but 80% survival rate if they don’t spread

Neuro (14 decks)

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