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Vascular Neurology Masterclass > CAPLAN CH10: Brain Embolism > Flashcards

CAPLAN CH10: Brain Embolism Flashcards

1
Q

The most important risk factor for stroke after cardiopulmonary bypass surgery is ___.

A

aortic atheromatosis

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2
Q

What is the triad of fat embolism syndrome?

A

Respiratory distress
Decreased alertness
Petechial rash eveloping 24-49 hours after an injury

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3
Q

These strands probably form because of a degenerative process that causes fibrinous deposits on valve surfaces.

A

Lambl excrescences

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4
Q

Name diseases with similar lesions of the cardiac valves and endocardium.

A

SLE
APLA
NBTE

all likely have a similar pathogenesis

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5
Q

TRUE OR FALSE. Bioprosthetic valves have low thrombogenic tendencies, so long-term anticoagulation is ordinarily not prescribed?

A

TRUE

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6
Q

Six groups of cardiac disorders leading to stroke:

A
  1. Arrhythmias
  2. Valvular heart diseases
  3. Ventricular myocardial abnormalities
  4. Lesions in the cavity of the ventricles (tumors)
  5. Shunts
  6. Atrial lesion
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7
Q

What is the most common cause of brain ischemia?

A

Brain embolus

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8
Q

T/F. Brain emboli only loosely adhere to blood vessel walls.

A

TRUE

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9
Q

When does hemorrhagic transformation often occurs?

A

Day 2-7 after stroke

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10
Q

What do you call this description of a clinical pattern of embolic strokes: sudden, complete, or nearly complete clearing of sudden-onset severe neurological signs.

A

Spectacular shrinking deficits

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11
Q

Our of five emboli, how many goes to anterior circulation? posterior circulation?

A

4/5 anterior (equally on L and R)
1/5 posterior

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12
Q

Most frequent posterior circulation brain areas infarcted:

A
  1. PICA branch of ICVA- posterior inferior portion of the cerebellum
  2. SCA territory- superior surface of the cerebellum
  3. PCA- thalamic and hemispherical territories of the PCA
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13
Q

What is the essential cause of hemorrhagic infarction?

A
  1. Reperfusion of previously ischemic tissue
  2. Another cause is systemic hypoperfusion
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14
Q

Virchow’s Triad

A
  1. Circulatory stasis
  2. Endothelial injury
  3. Incrased blood coagulability
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15
Q

What is the ejection velocity of the left atrial appendage in patients with atrial fibrillation?

A

< 20 cm/s

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16
Q

Accordingf to the Framingham study:

What is the risk of stroke in:
a. AFIB + RHD?
b. AFIB alone?

A

A. 17.6x
B. 5.6x

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17
Q

Threshold of thrombi that cannot easily be detected?

A

< 2mm

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18
Q

Refers to the swirling hazes of echogenicity within the cardiac chambers.

A

Spontaneous echo contrast

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19
Q

Spontaneous echo contrast may be seen in _ % of patients with AFIB, and _% of patients with afib _ left atrial thrombi?

A

60%
85%

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20
Q

Two studies checking the utility of various durations of rhythm monitoring in detecting reater than 30-second instances of atrial fibrillation?

A
  1. EMBRACE
  2. CRYSTAL AF
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21
Q

Parameters that are studied to be related with increased chances of having atrial fibrillation:

A
  1. QT interval
  2. BNP
  3. NT-proBNP
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22
Q

ARISTOTLE drug?

A

Apixaban

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23
Q

Chaotic atrial activity, changing p-wave contour, and bradycardia, admixed with multiple and recurrent ectopic beats and runs of atrial and nodal tachycardia.

A

Sick sinus syndrome

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24
Q

Which arrhythmias are more likely to embolize in the brain? tacchyarrythmias or bradyarrythmias?

A

tachyarrhythmias

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25
Why do we not like a valvular outlet obstruction?
Valcular outlet obstruction --> Increased turbulence of blood flow --> platelets are activated (hence, amount of thrombus formed is directly related to valve orifice turbulence)
26
Affected valves in RHD?
Top 1: Mitral valve Top 2: Mitral + Aortic valves isolated aortic valves is unusual
27
Most common causes of AORTIC LEAFLET DISEASE causing aortic insufficiency.
1. Rheumatic valvulitis 2. Infective endocarditis
28
Usual cases of AORTIC ROOT DISEASE.
Marfan's syndrome Aortic dissection Annulo-aortic ectasia
29
Most frequently diagnosed cardiac valvular abnormality
Mitral Valve Prolapse
30
The most common TTE finding among elderly patients referred for a cardiac source of embolism?
Mitral annular calcification
31
Frequency of major embolism in patients with mechanical valves: _ if no antithromboci therapy is used _ if with medication that decrease platelet aggregation _ if with warfarin anticoagulation?
4% 2% 1%
32
TRUE OR FALSE. Anticoagulation is recommended for all aptients with prosthetic heart valves.
TRUE.
33
What is the most common life-threatening complication in patients with infective endocarditis?
1st: congestive heart failure 2nd: arterial embolism
34
Features of TEE of IE patients with high risk for clinical thromboembolism?
1. >10mm size 2. high mobility of the lesions
35
TRUE or FALSE. Patients with S. aureaus acute endocarditis are more often encephalopathic than in endocarditis caused by other ogranisms.
TRUE
36
Valve most commonly affected in SLE?
Mitral valve
37
Characteristics of APLA:
fetal loss myocardial infarcts phlebothrombosis pulmonary emboli thrombocytopenia
38
Serological testing for patients with APLA
lupus anticoagulant anticardiolipin antibodies
39
Non-infective valvle lesions are found in patients with carcinoid tumors or after use of some drugs like?
Ergotamine Methysergide Dexfenfluramine Fenfluramine Phentermine Cabergoline Pergolide
40
Finding of the GISSI-3 trial (location of carduac infarct location and infarct size)
The incidence of left ventricule thrombus among those with an anterior infarction increased to 18% for pt with <40% EF compared to 10% with higher EF.
41
Systemic embolization happens at what day after a myocardial infarction?
14 days after a myocardial infarction and is unusual after 4-6 weeks.
42
Limitation of TEE in searching for thrombi in left ventricles post-MI?
Inability of TEEto visualize the true left ventricle apex makes TEEa less appropriate imaging test for suspected left ventricle apical thrombi.
43
Three most important factors that determine thrombus formations.
1. involvement of the endocardial surface 2. ventricular contractility and blood flow and ejection patterns 3. activation of platelets and coagulation system
44
Characteristic apical ballooning of the heart recognizable on echcardiography that resembles the Japanese octobus trap.
Takotsubo
45
In patients with cardiomyopathies, mural thrombi form mostly within ___.
trabeculae carnae near the cardiac apex
46
TRUE or FALSE. Embolism iis usual in patients with hypertrophic cardiomyopathies.
FALSE. It is unusual unless they develop atrial fibrillation.
47
Most common area of cardiac myxoma?
Left atrium
48
Aside from emboli, give another mechanism of stroke in patients with cardiac myxoma?
Embolism from myxoma tissue to the wall of brain arteries causes ANEURYSYMS that are identical to mycotic aneurysms found in patient with bacterial endocarditis.
49
Tumors consisting of multiple papillary fronds that radiate from an avascular fibrocollagenous core attached by a short pedicle to the endothelium.
Papillary fibroelastomas (cardiac tumor that can give rise to embolism)
50
The most common potential intracardiac shunt
Residual PFO
51
Number of bubbles and TTE/TEE.
<10 trivial 10-30 small shunt >30 large shunt
52
These are usually defined by echocardiography as bulging/ spetal mobility in the region of the fossa ovalis due to redundant atrial septal tissue
ASA- Atrial septal aneurysms
53
Electrocardiographic finding in patients with PFO
M-shaped notch on the ascending branch or on the peak of the R-wave in II, III aVF.
54
Why was the ARCH trial stopped prematurely? (Aortic Arch Related Cerebral Hazard Trial)
Hemorrhages were common in both groups and there was no clear superiority of either antiplatelets or anticoagulant therapy,
55
Most common neurologic complication of CABG surgery?
Cognitive dysfunction without accompanying focal motor, sensory, or visual dysfunction
56
What is the most important cause of cognitive deficits after cardiac surgery using cardiopulmonary bypass?
Microembolism
57
What is the triad of fat embolism syndrome?
1. respiratory distress 2. decreased alertness 3. petechial rash developing 24-48 hours after an injury
58
Where can one find the petechiae in a patient with fat embolism syndrome?
lower palpebral conjunctivae skin of the neck, shoulder and axillary folds
59
One of the most effective and specific tests for fat embolism
bronchopulmonary lavage
60
The most common tumors to embolize to the brain?
Primary pulmonary neoplasms or tumors that have metastasized to the lungs

Vascular Neurology Masterclass (6 decks)

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