Vascular Emergencies and Neoplasm

Question 1

What are arteriovenous malformations (AVM)?

Answer 1

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

Question 2

Where do AVMs occur?

Answer 2

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

Question 3

What are cavernous hemangiomas?

Answer 3

• 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.

Question 4

Are cavernous hemangiomas filled with fast or slow moving blood?

Answer 4

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

Question 5

Why do cavernous hemangiomas sometimes leak?

Answer 5

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

Question 6

What can cavernous hemangiomas cause?

Answer 6

Seizures

Question 7

What are capillary telangiectasis?

Answer 7

• Group of abnormal swollen capillaries

- Usually benign

Question 8

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

Answer 8

HA and seizures

Question 9

What are Venous angiomas?

Answer 9

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

Question 10

What effects does HTN have on the brain?

Answer 10

Weakening of the blood vessels wall

Question 11

What can occur in HTN microaneurysms?

Answer 11

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

Question 12

What are the MC sites for a HTN bleed?

Answer 12

Thymus, basal ganglia, pons, and cerebellum

Question 13

What causes a CVA?

Answer 13

Ischemia or hemorrhage

Question 14

What is the cause of a ischemic stroke?

Answer 14

A vessel supplying blood to the brain is obstructed

Question 15

What is the cause of a hemorrhagic stroke?

Answer 15

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

Question 16

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

Answer 16

CVA

Question 17

What is a TIA?

Answer 17

“mini” stoke, usually only last a few minutes

Question 18

What causes a TIA?

Answer 18

Blood supply to part the brain that is briefly blocked

Question 19

What are sxs of a TIA?

Answer 19

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

Question 20

What causes a cerebral aneurysm?

Answer 20

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

Question 21

What is the MC location for a cerebral aneurysm?

Answer 21

Circle of Willis

Question 22

What occurs when a cerebral aneurysm ruptures?

Answer 22

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

Question 23

What is the tx for a ruptured cerebral aneurysm?

Answer 23

Craniotomy and clipping or Endovascular therapy: coil embolism

Question 24

Does an un-ruptured cerebral aneurysm cause sxs?

Answer 24

Usually asymptomatic and an incidental finding

Question 25

What warrants surgery for an un-ruptured cerebral aneurysm?

Answer 25

> 7 - 10 mm in diameter | - Age and existing medical and neuro conditions

Question 26

What is an intracerebral hemorrhage (ICH)?

Answer 26

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

Question 27

What are ICH usually due to?

Answer 27

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

Question 28

What are the MCC of ICH in younger pts?

Answer 28

AVMs

Question 29

What are s/sxs of an ICH?

Answer 29

- Consciousness is initially lost or impaired in 50% of pts | - Vomiting occurs at onset of bleeding and HA is sometimes present.

Question 30

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

Answer 30

CT scan w/o contrast | - Confirms hemorrhage and determines size and site of the hematoma

Question 31

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

Answer 31

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

Question 32

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

Answer 32

CBC, Platelet, Prothrombin, Liver, and kidney test

Question 33

What is the tx for ICH?

Answer 33

- Lower systolic to 140 w/ IV labetalol or nicardipine. | - Platelet transfusion for thrombocytopenia

Question 34

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

Answer 34

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

Question 35

What diagnostic test are performed for SAH?

Answer 35

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

Question 36

What is 1st step in treating a SAH?

Answer 36

Stop the bleed | - Angiography w. stent or coil vs craniotomy and clip aneurysm

Question 37

What is the 2nd step in treating a SAH?

Answer 37

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

Question 38

What is the 3rd step in treating a SAH?

Answer 38

Rehab as appropriate: TBI Rehab

Question 39

What are space occupying lesions?

Answer 39

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

Question 40

What is an arachnoid cyst?

Answer 40

Filled sac that does not communicate with the ventricular system

Question 41

What is a colloid cyst?

Answer 41

Fluid filled sac usually in the 3rd ventricle

Question 42

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

Answer 42

Positional HA and syncope

Question 43

What is a dermoid cyst?

Answer 43

- Congenital inclusion cyst | - Often in sella turcica, midline vermis, or 4th ventricle

Question 44

What can occur with a dermoid cyst?

Answer 44

It can rupture causes seizures and neuro decline

Question 45

What is an epidermoid cyst?

Answer 45

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

Question 46

What cells do astrocytomas arise from?

Answer 46

Arise from astrocytes in the brain

Question 47

What is the MC cerebral brain tumor in children?

Answer 47

Astrocytomas

Question 48

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

Answer 48

Slow growing | Can be anywhere in the brain

Question 49

What is the grade range for astrocytomas?

Answer 49

1-4

Question 50

What cells do oligodentrogliomas arise from?

Answer 50

Arise from glial cells (supportive cells)

Question 51

Where are oligodentrogliomas found in the body?

Answer 51

Tumor can occur in brain or spinal cord

Question 52

Oligodentrogliomas usually occur in who?

Answer 52

Can occur at any age but primarily seen in adults

Question 53

What is the grade range for oligodentrogliomas?

Answer 53

2-3

Question 54

What cells do ganglion cell tumors arise from?

Answer 54

Arise from mature neurons and glial cells

Question 55

Ganglion cell tumors usually occur in who?

Answer 55

Occurs in children and young adults

Question 56

What is the grade range for ganglion cell tumors?

Answer 56

1-3 (most are 1-2)

Question 57

Ganglion cell tumors can cause what?

Answer 57

Seizures

Question 58

What cells do medulloblastomas arise from?

Answer 58

Cerebral stem cells

Question 59

What is the 2nd MC brain tumor in children?

Answer 59

Medulloblastomas

Question 60

What is the grade for Medulloblastomas?

Answer 60

Grade 4 | - but 80% survival rate if they don't spread