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Neurology > 7 (CVA) > Flashcards

7 (CVA) Flashcards

(60 cards)

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1
Q

CVA management steps? (6)

A

1-ABC, Blood Glucose, NIHSS,
2-CT (within 20mins) ,
3-Decision Reperfusion therapy (Thrombolysis (yes=Withhold Aspirin for 24h, no=give aspirin immediately), Mechanical Thrombectomy, ),
4-Supportive: BP Fluids Glucose DVT (compression socks, Intermittent Pneumatic Compression devices, LMWH after 1-2days),
5-Secondary Prevention ( anti Platets) ,
6-Rehabilitation and Carotid doppler

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2
Q

Thrombolysis Indication?

A

4.5h time for thrombolysis, BP must be under 185/110 (otherwise 220/120)
between 4.5-9h: consider, first CT Perfusion, MRI DWI-Flair mismatch, also woken with symptoms within 9 hours of midpoint sleep
If giving thrombolysis, Withhold Aspirin for 24h!

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3
Q

Thrombolysis absolute Contraindication?

A

Prior ICH, intracranial mass neoplasm, seizure at onset,INR above 1.7, PLT below 100,00k, active bleeding, varices, HTN 185/110 despite treatment, hypoglycemia, 3 month CVA brain trauma

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4
Q

Thrombolysis Relative contraindication?

A

3 weeks GIB, 2 week major surgery, 1 week LP, elevated PTT on heparin, DOACs

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5
Q

How to give Aspirin in CVA?

A

immidiately if NO thrombolysis
or
post 24h if thrombolysis

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6
Q

How to give Clopidogrel in CVA?

A

mild/TIA: within 24h Moderate/severe: After 1-2days,

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7
Q

Duration of Dual anti platet therapy and what happens after that?

A

Continue anti platet dual therapy for 3 weeks, then clopidogrel indefinitely

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8
Q

What if patient has AF in CVA?

A

AF: Mild 3 days, Mod 6 days, Severe 2 weeks

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9
Q

CVA sevirity based on NIHSS?

A

Mild Up to 3, Mod up to 15, Severe above 15

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10
Q

Explain NIHSS score and what higher score mean?

A

Severity, Treatment, Prognosis, 0-42 ( worst )
the higher means the more likely hemorrhagic transformation may happen.

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11
Q

Thrombectomy indication?

A

within 6 hours, together with 4.5hour, evidence of proximal anterior circulation, pre functional score less than 3, more than 6 NIHSS, up to 24 h if salvageable tissue ( like limited infarct core volume) Large vessel occlusion (like Proximal MCA),

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12
Q

Post stroke Complication?

A

within 24h: Acute hemorrhagic transformation
Within 48h: Malignant MCA syndrome, young patient, extensive MCA infarct, causes rise of ICP, decompressive craniotomy

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13
Q

Post Stroke DLVA?

A

1 month car, 1 year bus

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14
Q

TACS stands for?

A

total anterior circulation stroke

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15
Q

TACS can be due to obstruction of?

A

MCA>ACA>Internal carotid

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16
Q

TACS triad?

A

must have all 3:
motor or sensory/homonymous hemianopia/higher cortical function (aphasia dominant, Neglect non dominant)

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17
Q

Common Carotid Stroke affects?

A

MCA+ACA+sometimes Ophthalmic ( ocular )

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18
Q

Internal carotid Affects?

A

Both MCA+ACA symptoms, TACS, amaurosis fugax

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19
Q

Internal carotid affects? (more details)

A

Contralateral sensory/motor hemiplegia, homonymous hemianopia, Aphasia (dominant) Neglect (non dominant), amaurosis fugax

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20
Q

External carotid affects?

A

Horner with anhidrosis

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21
Q

Investigation for suspected dissection?

A

MRI and MR angiography

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22
Q

Most common stroke site?

A

MCA

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23
Q

ACA features?

A

Contralateral Weakness leg,
Contralateral sense (leg), perineum,
gait apraxia, anosmia, urinary incontinence,
apathetic, non communicative: Distal ACA

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24
Q

MCA symptoms is based on?

A

Superior/Inferior division

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25
MCA inferior division?
contralateral sensory homonymous hemianopia, contralateral loss vision, gaze/looks at the lesion Dominant:Wernicke’s Aphasia Agraphesthesia Astereognosis Non dominant: anosognosia (awareness of deficit), neglect contralateral body/space, dressing/constructional apraxia ) acute confusion
26
MCA superior division:
Contralateral face hand more severe than legs, Broca Aphasia ( dominant side ) contralateral Hemi neglect (non dominant)
27
Distal ACA features?
apathetic, non communicative: Distal ACA
28
AICA features?
Vertigo, vomiting, Horizontal+vertical nystagmus, 7 ipsilateral facial weakness, 8 hearing loss tinnitus, conjugate lateral gaze paralysis, cerebellar ataxia, pain and temperature face, contralateral pain and temperature
29
What artery causes Lateral medullary syndrome?
Vertebral (most common)/PICA
30
Which artery aneurysm causes bitemporal heminopia?
anterior communicating artery aneurysm
31
Parietal Blood supply?
ACA=MCA
32
How to differentiate lateral medullary syndrome from AICA?
AICA has 7+8 involvement
33
What is another name for lateral medullary syndrome?
Wallenberg syndrome
34
Describe Lateral medullary syndrome?
ipsilateral horner, pain temperature face, pharyngeal paralysis, corneal reflex, falls ipsilateral Contralateral pain temperature body, uvula deviates contralateral, tongue sticking out dragged to contralateral, palatal myoclonus nystagmus, ataxia, diplopia, Vertigo, N/V, Dysphagia
35
How to diagnose Lateral medullary syndrome?
MRI ( posterior fossa lesion)
36
How to approach Vertebral dissection caused by hyperextension neck?
CT angio
37
Vertebral artery dissection without hemorrhagic transformation management?
heparin
38
What causes locked in syndrome?
Basilar artery, correcting hyponatremia too fast
39
Medial medullary syndrome which block causes this?
Vertebral -> anterior spinal artery
40
Medial medullary syndrome features
ipsilateral tongue deviation (12/hypoglossal paralysis) Contralateral paralysis, loss of proprioceptive and vibration
41
Vertebral dissection how it happens and what to do
caused by hyperextension neck: CT angio
42
how to treat Vertebral artery dissection without hemorrhagic transformation
IV heparin
43
What causes Locked in syndrome?
(also treating hyponatremia too fast)
44
What is Perinaud Syndrome?
Dorsal midbrain/Parinaud syndrome: upgaze palsy , pupil no react to light, young patient who keeps head down, MRI to rule out pineal tumor
45
Which artery is compressed in uncal herniation?
Posterior cerebral artery
46
Where does Posterior cerebral artery blood supply?
temporal/occipital midbrain
47
What causes Weber syndrome and what are the signs?
Posterior cerebral artery, ipsilateral 3rd nerve palsy + Contralateral palsy
48
What causes Benedikt syndrome and what are the features?
Posterior cerebral artery, Ipsilateral 3rd nerve palsy + contralateral ataxia and tremor
49
what happens in Occipital infarct?
contra lateral homonymous hemianopia with central sparing )
50
Name 3rd nerve palsy causes based on pupil effect
Pupil controll fibers outside: Posterior communicating artery aneurysm Muscle control fibers inside: Ischemic like Diabetes/ temporal arthritis
51
what can have 3rd nerve palsy with just mydriasis? and also paralyze 4th nerve?
posterior communicating artery aneurysm
52
what 3rd palsy has no pupil effect?
ischemic 3rd nerve palsy (like in diabetes), temporal arthritis
53
What arteries get Lacunar stroke
maximum 1.5cm, lenticulostriate arteries ( LCA )
54
Explain 5 parts of Lacunar Stroke
pure motor: Contralateral, Posterior internal capsule, Ventral/basis Pontis (corticospinal) sensory: Contralateral, Thalamus sensorimotor: Internal capsule Thalamus ataxia Hemiparesis: Internal capsule Basis pontis clumsy hand dysarthria: Basis pontis Same density CSF, DWI (best) Hypointense T1, Hyperintense T2,, around it hypointense
55
Explain Motor path
Frontal Precentral Gyros -> Internal capsule -> Basis pontis -> Medulla (cross) -> Lateral cord -> LMN -> Peripheral nerve -> muscle
56
What is nternal capsule
White matter, containing Sensory+motor
57
How to differentiate brain infarct from brain stem
*if it is in the brain itself (cerebral hemisphere), both paralysis will be on the same side.
58
What is Medial Pontine syndrome?
6 Ipsilateral horizontal gaze INO Contralateral paralysis, Vibration proprioception,
59
What happens in pons Infarct
Pons infarct: Locked in syndrome ->Basilar artery, treating hyponatremia too fast)
60
What happens in Pons Hemorrhage ?
sudden Reduced GCS, pinpoint pupils bilateral, paralysis

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