Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CK_Neuro > Vascular Neurology > Flashcards

Vascular Neurology Flashcards

1
Q

4 classes of ischemic stroke

A

transient ischemic attack (TIA)
reversible ischemic neurologic deficit
evolving stroke
completed stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

TIA vs. stroke

A

main difference is in DURATION of symptoms
TIAs usually last a few minutes to less than 24 hours
blockage of blood flow does not last long enough to cause permanent infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why are TIA symptoms transient

A

reperfusion occurs (either due to collateral circulation or break up of embolus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Etiologies of TIA

A

embolic (most common)

but transient hypotension 2/2 carotid artery stenosis (>75% occlusion) can also cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TIA increases risk for…

A

STROKE in coming months

10% per year and 30% 5- year risk of stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

risk factors for ischemic stroke

A

2 MOST IMPORTANT = age and HTN

others - smoking, DM, hyperlipidemia, afib, CAD, fmaily hx of stroke, PREVIOUS STROKE/TIA, carotid bruits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

risk factors for stroke in younger patients

A 
OCP use
hypercoagulable states (protein C/S def, APA syndrome, cocaine/amphetamines, polycythema vera, sickle cell
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

transient, curtain like loss of sight in ipsilateral eye due to microemboli to the retina

A

amaurosis fugax (example of TIA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

common sources of emboli that cause stroke

A

heart (mural thrombus from afib)
internal carotid artery
aorta
paradoxical stroke (ASD, patent foramen ovael, pulmonary AV fistula)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

thrombotic strokes occur due to atherosclerotic plaques in which arteries typically

A

large arteries of neck (carotid artery usu. at bifurcation of common carotid)
medium sized arteries of brain; i.e. middle cerebral artery MCA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

where do you typically see lacunar strokes

A

in small vessels of brain

usually affects subcortical structures (basal ganglia, thalamus, itnernal capsule, brainstem)…NOT CORTEX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how to evaluate for source of embolic stroke

A

echocardiogram
carotid doppler
ECG, holter monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

predisposing factors for lacunar stroke

A

hx of HTN!

DM also important risk factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

symptoms of vertebrobasilar arterial insufficiency

A

dizziniess, double vision, vertigo, numbness of ipsilateral face and contralateral limbs, dysarthria, hoarsness, dysphagia
caused by decreased perfusion in posterior fossa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

subclavian steal syndrome

A

stenosis of subclavian artery proximal to origin of vertebral artery - exercise of left arm causes reversal of blood flow down the ipsilateral artery to fill the subclavian artery distal to stenosis because it cannot supply adequate blood to left arm; leads to decreased cerebral blood flow “stolen” from basilar system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

BP in left arm is less than right arm; decreased pulses in left arm

A

subclavian steal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

treatment for subclavian steal syndrome

A

surgical bypass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

stroke with contralateral lower extremity and face

A

ACA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

stroke with aphasia, contralateral hemiparesis

A

middle cerebral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

dizziness, double vision, numbness of ipsilateral phase, contralaterla limbs, dysarthria, hoarseness, dysphagia, projectile vomiting, headahces, drop attacks

A

vertebrobasilar system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

pure sensory deficit

A

thalamus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

pure motor hemiparesis

A

internal capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

alexia without agraphia

A

left PCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

patient presents to ED with stroke like symptoms…what to do and in what order

A

1) non contrast CT head
2) ECG, chest radiograph
3) CBC, plts
4) PT/INR
5) electrolytes
6) glucose
7) bilateral carotid ultra sound
8) echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how do ischemic strokes look on non contrast CT?

A

dark area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If you suspect stroke, but CT negative…what other test can you order?

A

MRI

more sensititive but no ideal in emergencies

27
Q

What labs to order in YOUNG patient with stroke

A

high suspicion for vasculitis, hypercoagulable, or thrombophilia
get: protein c, protein s, antiphospholipid antibodies, factor V leiden mutation, ANA/rheumatoid factor, ESR, VDRL/RPR, Lyme serology, TEE

DON’T FORGET COCAINE NIGGA

28
Q

definitive test for identifying stenosis of vessels of head and neck, and check for aneurysms

A

magnetic resonance angiogram (MRA)

evaluates carotids, vetebrobasilar circulation, circle of Willis, ACA, MCA, PCA

29
Q

complications of stroke (3)

A

cerebral edema within 1-2 days -> mass effect
seizure
hemorrhage into infarction

30
Q

When not to give TPA

A
  • more than 3 hours have passed
  • uncontrolled HTN
  • bleeding disorder
  • patient is taking anticoagulants
  • hx or recent trauma or surgery

these all increase risk for hemorrhagic transformation

31
Q

If patient presents after 3 hours of stroke, what to give?

if patient can’t take that, what else to give?

A

aspirin only!
if not, clopidogrel
if not, clopidogrel….ticlopidine

32
Q

if patient is given TPA, what else can be given to reduce bleeding risk?

A

antihypertensives!

do NOT give aspirin (this will make bleeding worse)

33
Q

When to give warfarin/heparin for stroke

A

these haven’t been proven effective in acute setting

34
Q

antihypertensives are typically not given in stroke unless….

A

1) super high BP (>220/120)
2) patient is receiving tPA
3) acute MI< aortic dissection, severe heart failure, hypertensive encephalopathy

35
Q

indications for carotid endarterectomy in preventing stroke in the setting of carotid artery atherosclerosis

A

1) symptomatic

2) >70% occlusion

36
Q

how to prevent carotid atherosclerotic strokes in NON-symptomatic patients

A

aspirin, BP control, control DM, smoking cessation, reduce obesity and hypercholesterolemia

37
Q

how to prevent embolic strokes

A

aspirin, warfarin/NOACs if afib, reduction of atherosclerotic risk factors

38
Q

how to prevent lacunar stroke

A

HTN control

39
Q

causes of hemorrhagic stroke

A

1) HTN, particularly sudden increase
2) ischemic stroke converting to hemorrhagic stroke
3) amyloid angiopathy, iatrogenic (anticoag/antithromb use), brain tumors, AVMs)

40
Q

locations of hemorrhagic stroke

A

basal ganglia (MOST COMMON)
pons
cerebellum

41
Q

how to hemorrhagic strokes present

A

sudden focal neurologic deficit
altered levels of consciousness, stupor/coma
headache/dizziness/vomiting from increased ICP

42
Q

in addition to noncon CT head, what panel to get in evaluating for hemorrhagic stroke

A

coag panel

43
Q

complications hemorrhagic stroke

A 
increased ICP
rebleeding
seizure
hydrocephalus
SIADH
vasospasm
44
Q

In ICH, what pupillary findings can be seen if pons, thalamus, and or putamen involved?

A

pons - pinpoint pupils
thalamus - poorly reactive pupils
putamen - dilated pupils

45
Q

how to acutely manage hemorrhagic strokes

A

ICU admission
ABCs NIGGA DAYUM
BP control
reduce ICP with mannitol/diuretics and hyperventilation

46
Q

Dangers with aggressive BP control in hemorrhagic stroke

A

correcting too quickly can reduce CPP which will worsen neurologic deficit

47
Q

Is surgery helpful for ICH?

A

not usually, treatment usually supportive for intraparenchymal bleeds

DO IT FOR CEREBELLAR BLEEDS THOUGH, they can be life saving

48
Q

subarachnoid hemorrhage (SAH) often occurs at junction of anterior communicating artery and…

A

ACA

49
Q

SAH often occurs at bifurcation of….

A

MCA

50
Q

SAH often occurs at junction of posterior communcating and….

A

internal carotid

SAH’s HAPPEN AT JUNCTIONS…see the pattern?

51
Q

Where can you typically find berry/saccular aneurysms?

A

bifurcations

52
Q

If you see a patient with polycystic kidney disease, you should check for…

A

BERRY ANEURYSMS

53
Q

MCC SAH

A

berry aneurysm rupture

can also be caused by trauma/AVMs

54
Q

besides “worst headache of my life” how can SAH present?

A 
sudden LOC
vomiting
meningismus (photophobia/nuchal rigidity/meningeal irritation)
retinal hemorrhage
death
55
Q

First test for SAH….and if this is unrevealing, what to get?

A

non con CT

LP to look for blood in CSF/xanthochromia

56
Q

once SAH is diagnosed, what test to get?

A

cerebral angiogram to detect bleeding source (and for surgical clipping)

57
Q

If suspect SAH, CT negative, and there is papilledema, what test to get?

A

NOT LP!!! YOU CAN CAUSE HERNIATION

repeat CT first

58
Q

contraindications for LP

A 
herniation
infection overlying puncture site
bleeding disorder/coagulopathy
brain abscess
increased ICP (do imaging first)
mass lesion (do imaging first)
59
Q

treatment SAH

A

CONSULT NEURO

60
Q

non surgical rx SAH

A

reduce rebleeding risk and cerebral vasospasm

  • bed rest
  • stool softeners to reduce straining
  • analgesia for headache
  • IV fliuds
  • gradual lowering of BP
61
Q

what pharmacotherapy to prevent cerebral vasospasm

A

nifedipine

62
Q

5 “deadly D’s” of posterior circulation strokes?

A 
Diplopia
dizziness
dysphagia
dysarthria
drop attacks + vertigo

can also cause homonymous hemianopsia

63
Q

MCA strokes can cause CHANGes.

What CHANGes?

A 
Contralateral paresis and sensory loss in face/arm
Hemiparesis
Aphasia (dominant)
Neglect (non dominant)
Gaze preference toward side of lesion

CK_Neuro (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions