Vascular Neurology Flashcards
transient ischemic attack (TIA)
defined as a transient episode (<24 hours) of neurologic dysfunction caused by focal ischemia, without acute infarction
ABCD2 score
used to predict 7 day risk for stroke after TIA
Age, Blood pressure, Clinical features, Duration of TIA, Diabetes
No points: Age <60, BP <140/90, Clinically no speech deficit or unilateral weakness, duration <10 mins, no diabetes
1 point: Age >/=60, BP >/= 140/90, speech deficit without unilateral weakness, duration 10-59 mins, + diabetes
2 points: unilateral weakness, >/= 60mins
7 day risk of stroke based on ABCD2 score`
0-3 points: 1.2%
4-5 points: 5.9%
6-7 points: 11.7%
what does ABCD2 score not include
does not take into account severe carotid or intracranial stenosis which is also a risk for ischemic stroke after TIA
ischemic stroke subtypes
large-artery atherosclerosis
cardioembolism
lipohyalinosis/small-vessel disease
stroke of other undetermined etiology
stroke of undetermined etiology
large-artery atherosclerosis
most common cause of ischemic stroke in the world
patients will either have significant stenosis or occlusion of a major brain artery or branch cortical artery
symptomatic carotid
stenosis of the common carotid ipsilateral to a TIA or infarct
treatment for symptomatic carotid
carotid endarterectomy (CEA) or carotid artery stent (CAS) is indicated if the stenosis is 50-99% in men or 70-99% in women
asymptomatic carotid stenosis should be treated surgically if the stenosis is 80-99%
CEA has a higher risk of periprocedural myocardial infarction
CAS has a higher risk of periprocedural stroke
treatment with CEA or CAS can lead to cerebral hyperfusion syndrome
cerebral hyperfusion syndrome
presents with headaches, visual disturbances, and seizures
occurs secondary to dysautoregulation of cerebral vessels in regions which have been in chronic low flow states
cardioembolism
most common cause of ischemic stroke in the US
patients can present similarly with comparable imaging to those with large artery atherosclerosis but will have a cardiac source for the embolic phenomenon
sources of cardioembolism
atrial fibrillation, mechanical heart prosthetic valve, left atrial or ventricular thrombus, recent myocardial infarction, dilated cardiomyopathy, valvular heart disease, structural heart defects, tumors
CHA2DS2-VASc score
helps to calculate risk of stroke in patients with untreated atrial fibrillation
CHF, Hypertension, Age (>/=75), Diabetes, Stroke or TIA history, Vascular disease, Age (65-74), Sex category
CHA2DS2-VASc scoring
0 points: no CHF, BP </= 140/90, no diabetes, no history of stroke or TIA, no vascular disease, age <65, male
1 point: yes CHF, BP >140/90, yes diabetes, yes vascular disease, age 65-74, female
2 points: age >/= 75, yes stroke or TIA history
lipohyalinosis/small-vessel disease
commonly occurs in the lenticulostriate vessels of deep cortical structure
also known as lacunar strokes that are felt to be related to chronic hypertension, diabetes, and smoking
hypercoagulable states and coagulopathy
examples: Factor V Leiden, antiphospholipid antibody syndrome, protein S/C deficiency, prothrombin gene mutation, antithrombin III syndrome, sickle cell disease, thrombotic thrombocytopenic purpura (TTP), polycythemia, hyperhomocysteinemia, MTHFR gene mutations, and malignancy
more likely to cause venous events than arterial
cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)
autosomal dominant disease due to a mutation of the NOTCH3 gene on chromosome 19 leading to a vasculopathy affecting the small to medium-sized arteries of white matter
cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) presentation
patient will present with recurrent stroke, headaches, seizures, and cognitive defects
cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) pathology
granular osmiophilic material (GOM) in the basal lamina of small cutaneous arterioles on electron microscopy or will be PAS-positive and congo-red negative on staining
cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) imaging
scattered bihemispheric T2 FLAIR hyperintense lesions
CNS Vasculitis
caused by a diverse spectrum of diseases that typically involves the gray/white matter junction
CNS Vasculitis DWI
multiple small focal areas of acute infarction in multiple vascular territories
CNS vasculitis vessel imaging
marked beading and segmentation alongside numerous arterial structures
primary angiitis of the CNS (PACNS)
vasculitis confined only to the small-medium sized blood vessels in the brain, spinal cord, and meninges
moyamoya disease
congenital moyamoya disease is seen most often in patients of Asian descent
Mysterin/RNF213 is a susceptibility gene for congenital moyamoya