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cd 3303 > Stroke, Aneyrysm > Flashcards

Stroke, Aneyrysm Flashcards

1
Q

R and L Vertebral arteries join together to form the [ ] artery

A

basilar

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2
Q

circle of willis

A

A structure at the base of the brain that is formed by the joining of the carotid and basilar arteries.

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3
Q

Anterior cerebral artery supplies what two cortexes?

A

Primary motor cortex

primary somatosensory cortexe (hips to head)

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4
Q

Middle cerebral artery supplies what three cortexes?

A

frontal primary motor cortex (hips to head)

primary somatosensory cortex (hips to head ) in parietal lobe

auditory cortex (temporal lobe)

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5
Q

Posterior cerebral artery supplies what four cortexe?

A

Visual cortex

hippocampus (long-term memory_

Thalamus

hypothalamus

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6
Q

Homunculus and stroke deficit distribution

A

motor and somatosensory allocations on cerebral cortex

based on vascular compromise in stroke, certain areas will be affected, leading to specific deficits in sensory, motor, or both

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7
Q

Which of the following happens to cerebral circulation and aging:

a. low energy metabolism
b. lower perfusion
c. build up of neurovascular coupling
d. diaschisis
e. breakdown of cerebrovascular reactivity
f. high perfusion due to arrhythmia, heart failure, cardiac arrest
g. build up of cerebrovascular autoregulation

A

A, b, d, e

c: breakdown of coupling
f: low perfusion
G: breakdown of autoregulation

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8
Q

Diaschisis

A

decreased activity of surviving neurons after damage to other neurons

seen in aging brain

could be a distant area of brain that is damaged, yet since it’s still connected, there are deficits in other distant connected areas

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9
Q

Which is the more common form of stroke: ischemic or hemorrhagic?

A

ischemia

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10
Q

Ischemic stroke

A

Blocked blood flow to the brain

diminished flow–> ischemia/anoxia to brain–> brain tissue death–> cerebral infarction

Can be due to:

  • atherosclerotic plaquing
  • blockages from thromboembolisms
  • arterieal structure changes (e.g. stripping of tunica media resulting in arterial dissection)
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11
Q

Large-vessel thrombosis occurs with the blockage of larger arteries like:

A

carotid or middle cerebral artery

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12
Q

Lacunar stroke

A

Small-vessel thrombosis occuring in small, deep penetrating arteries of the brain.

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13
Q

Arteriovenous malformations (AVM)

A

abnormal connections between arterial and venous systems

blood flows too quickly from arteries, pushing on walls of veins, and walls thus begin to weaken/narrow and bulge

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14
Q

AVMs are often precursors of what two phenomena?

A
  1. aneurysm

2. hemorrhagic stroke (intracranial bleeding)

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15
Q

AVM that hasn’t burst

A

usually no signs/symptoms

but may cause headaches

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16
Q

AVM that has burst

A

hemorrhagic stroke

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17
Q

Aneurysm: what is it and how it develops?

A

out-pocketing of the arterial wall (like a hernia)

normally develops in an area of an artery where there’s abnormal loss/absence of the muscular layer of the artery wall–>leading to 2 layers, rather than the normal 3 layers

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18
Q

Where are aneurysms most common in the brain?

A

most often occur in circle of willis–specifically related to middle cerebral artery

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19
Q

signs and symptoms of aneurysm

A

can be innocuous (no s/s) or can cause symptoms if close to a sensitive structure (e.g. a cranial nerve)

MC s/s

  • headaches
  • eye pain
  • vision deficits
  • oculomotor deficits
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20
Q

subarachnoid hemorrhage

A

Ruptured cerebral aneurysm

“worst headache of my life”

  • stiff neck (blood + meningeal irritation)
  • nausea, vomiting
  • changes in mental status (drowsiness)
  • eye pain, photophobia, dilated pupils
  • LOC
  • hypertension
  • motor deficits
  • back/leg pain
  • CN defcitis
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21
Q

Case: patient comes in complaining of “worst headache of their life”. Headache, nausea and vomiting. You take vitals and heart rate and respiratory rate are both decreased. What is the most likely dx? Management?

A

subarachnoid hemorrhage

a cerebral aneurysm has ruptured, get them to ER asap

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22
Q

Causes of ISCHEMIC stroke

A
  • atherosclerosis
  • carotid emobli (especially with history of drop attacks or TIAs)
  • inflammatory disease
  • lacunar infarct
  • migraine
  • cardiac disease
  • hemotologic disorders
23
Q

Causes of hemorrhagic stroke

A

brain aneurysm burst OR weakened blood vessel leakage

24
Q

Causes of intracranial masses

A

Mass effect, since the adult skull cannot expand like an infant’s

  • edema
  • infection (abscess)
  • hemorrhage
  • tumours
25
Q

14 physical exams for identifying vascular irregularities

A
  1. bilateral and orthostatic BP
  2. listen for bruits with stethoscope
  3. atrial fibrillation
  4. visual acuity
  5. horner’s
  6. check fundus of eye for emboli
  7. ocular alignment: H pattern
  8. central/peripheral nystagmus
  9. cranial nerves 1-12
  10. Gait and balance: steppage gait, foot drop, rhomberg, berg balance scale
  11. long tract signs: motor, DTR, sensory
  12. UMN lesion: babinski, hoffman, pronator drift
  13. Cushing’s triad
  14. mini mental status exam: time/date/place, memory
26
Q

Intracranial lessions can cause what three phenomena?

A
  1. compression
  2. increased intracranial pressure
  3. Displacement/brain herniations
    - subfalcine
    - central
    - uncal
    - upward transtentorial
    - tonsilar
27
Q

Subclavian steal syndrome

A

Stenosis of the subclavian artery proximal to the veretbral artery

rare congenital blockage of left subclavian artery

blood from right subclavian artery travels through right vertebral artery and down left vertebral artery into proximal part of left subclavian artery to supply the arm

Left subclavian artery would have LESS pressure than right

28
Q

orthostatic hypotension

A

Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions

29
Q

important sites to listen for bruits (with stethescope)

A
  • carotid bifurcation
  • angle of jaw
  • suocciputal
  • eye
  • temporal eye
30
Q

Implication of bruits at Carotid bifurcation:

A

excessive pressure, seen in hardening of arteries in elderly, gives a false perception that BP is high. The carotid body in the CNS reacts to this by lowering HR (to lower BP); this can lead to a stroke :(

31
Q

Optic nerve compression: findings

A

complete unilateral field loss

32
Q

Optic chiasmal lesion: findings

A

bitemporal hemianopia

33
Q

Optic tract lesion: findings

A

homonymous hemianopia (say this 3 times)

34
Q

horner’s syndrome

A

Sympathetic trunk/cervical ganglion damage, resulting in:

  • ptosis (drooping eyelid)
  • pupil constriction (miosis)
  • vasodilation
  • absence of sweating
35
Q

H pattern tests which cranial nerves

A

CN 3, 4, 6 (infratentorial zone)

36
Q

central nystagmus

A

can be vertical or horizontal

37
Q

peripheral nystagmus

A

only horizontal (due to labyrinth); assess using Dix-Hallpike, weber and rinne test

38
Q

Cushing’s triad

A

three clinical signs often indicating an increased in intracranial pressurre

  1. increase in systolic blood pressure
  2. decrease in respiratory rate
  3. decrease in heart rate
39
Q

Oxfordshire community stroke classification

A

Used to categorize strokes into four simple categories based on clinical presentation

40
Q

Total anterior circulation stroke (TACS)

A

large cortical stroke in middle/anterior CA
-usually due to embolic lesion (70-80%) or hematoma (25%)

most severe type of stroke–> only ~5% of patients are alive and independent at 1-year post-stroke

41
Q

What three phenomena need to be present for a diagnosis of TACS

A
  1. UL weakness +/- sensory deficit of face, arm and leg
    - contralateral to side of stroke
    - this includes incontinence
  2. Homonymous hemianopia contralaterally
    - e.g. the right field of vision is absent in both eyes
  3. Higher cerebral dysfunction
    - drowsiness, unconscious
    - dysphagia or limb neglect (failure to use one or both limbs on one side)
42
Q

Partial anterior circulation syndrome (PACS)

A

only part of the anterior circulation is affected; a smaller area of ischemia (wedge shaped area)
-usually due to embolic lesion

less severe than TACS; prognosis is better (55% alive and independent 1 year post stroke)

43
Q

What are the phenomena required for a diagnosis of PACS

A

You need two phenomena present for a diagnosis

  1. UL weakness +/- sensory deficit of face, arm and leg
    - contralateral to side of stroke
    - this includes incontinence
  2. Homonymous hemianopia contralaterally
    - e.g. the right field of vision is absent in both eyes
  3. Higher cerebral dysfunction
    - drowsiness, unconscious
    - dysphagia or limb neglect (failure to use one or both limbs on one side)
44
Q

T or F: PACS differs from TACS by severity; PACS requires all three phenomena for diagnoses whereas TACS only needs to

A

false: PACS is two (Pair), TACS is three (trio)

45
Q

false: PACS is two (Pair), TACS is three (trio)

A

Stroke involving damage to the area of the brain supplied by posterior circulation (e.g., cerebellum and brainstem)

clinical features: 5 D and 3 N’s

46
Q

Diagnostic phenomena for POCS

A

only one of the following needs to be present for a diagnosis:

  1. cerebellar or brainstem syndromes
    - CN palsies
    - CL motor/sensory deficits
    - cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
  2. LOC
  3. Isolated homonymous hemianopia
47
Q

“5 D’s And 3 N’s” of stroke

A
  1. Dizziness
  2. Drop Attack
  3. Diplopia
  4. Dysarthria
  5. Dysphagia

Ataxia

  1. Nausea
  2. Numbness
  3. Nystagmus
48
Q

Lacunar syndrome (LACS)

A

Involves subcortical stroke that occurs secondary to small vessel disease

NO loss of higher cerebral functions and it has the best prognosis

60% of patients are alive and independent 1-year post-stroke

49
Q

4 diagnostic phenomena for LACS

A

only one of the following needs to be present for a diagnosis

  1. pure motor hemiparesis (MC)
  2. ataxic hemiparesis (2nd MC)
  3. pure sensory stroke
  4. sensorimotor stroke
50
Q

Transient ischemic attacks (TIA) and reversible ischemic neurological deficit (RIND): what and symptoms

A

“mini strokes”

result of temporary altered blood supply to an area of the brain

symptoms:

  • temporary loss of vision in one eye (“amaurosis fugax”)
  • dysphagia/aphagia weakness
  • weakness on one side of body
  • numbness or tingling (paresthesia) on one side of body
  • impairment of consciousness
  • dizziness, lack of coordination, poor balance
51
Q

Difference between TIA and RIND

A

TIA: brief neurological dysfunction for less than 24 hours

RIND: neurological dysfunction for more than 24 hours but less than 72 hours (aka 1-4 days)

52
Q

Anterior circulation: opthalamic artery ischemia

A

ischemia may cause UL blindness, loss of visual field

transient visual loss–> amaurosis fugax (sign in MS)

53
Q

Anterior circulation: middle cerebral artery supply and ischemiac

A

supplies: tempora, anterolateral and parietal lobes

ischemic stroke: may cause true hemiplegic pattern (CL hemiplagia, hemianesthesia, hemianopia)

54
Q

anterior cerebral artery: unilateral vs bilateral lesions

A

UL: causes contralateral anesthesia of leg, expansive aphagia

BL: causes BL lower limb paresis, akinetic mutism

cd 3303 (24 decks)

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