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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
Q

Why do we not like a valvular outlet obstruction?

A

Valcular outlet obstruction –> Increased turbulence of blood flow –> platelets are activated (hence, amount of thrombus formed is directly related to valve orifice turbulence)

26
Q

Affected valves in RHD?

A

Top 1: Mitral valve
Top 2: Mitral + Aortic valves

isolated aortic valves is unusual

27
Q

Most common causes of AORTIC LEAFLET DISEASE causing aortic insufficiency.

A
  1. Rheumatic valvulitis
  2. Infective endocarditis
28
Q

Usual cases of AORTIC ROOT DISEASE.

A

Marfan’s syndrome
Aortic dissection
Annulo-aortic ectasia

29
Q

Most frequently diagnosed cardiac valvular abnormality

A

Mitral Valve Prolapse

30
Q

The most common TTE finding among elderly patients referred for a cardiac source of embolism?

A

Mitral annular calcification

31
Q

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?

A

4%
2%
1%

32
Q

TRUE OR FALSE. Anticoagulation is recommended for all aptients with prosthetic heart valves.

A

TRUE.

33
Q

What is the most common life-threatening complication in patients with infective endocarditis?

A

1st: congestive heart failure
2nd: arterial embolism

34
Q

Features of TEE of IE patients with high risk for clinical thromboembolism?

A
  1. > 10mm size
  2. high mobility of the lesions
35
Q

TRUE or FALSE. Patients with S. aureaus acute endocarditis are more often encephalopathic than in endocarditis caused by other ogranisms.

A

TRUE

36
Q

Valve most commonly affected in SLE?

A

Mitral valve

37
Q

Characteristics of APLA:

A

fetal loss
myocardial infarcts
phlebothrombosis
pulmonary emboli
thrombocytopenia

38
Q

Serological testing for patients with APLA

A

lupus anticoagulant
anticardiolipin antibodies

39
Q

Non-infective valvle lesions are found in patients with carcinoid tumors or after use of some drugs like?

A

Ergotamine
Methysergide
Dexfenfluramine
Fenfluramine
Phentermine
Cabergoline
Pergolide

40
Q

Finding of the GISSI-3 trial (location of carduac infarct location and infarct size)

A

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
Q

Systemic embolization happens at what day after a myocardial infarction?

A

14 days after a myocardial infarction and is unusual after 4-6 weeks.

42
Q

Limitation of TEE in searching for thrombi in left ventricles post-MI?

A

Inability of TEEto visualize the true left ventricle apex makes TEEa less appropriate imaging test for suspected left ventricle apical thrombi.

43
Q

Three most important factors that determine thrombus formations.

A
  1. involvement of the endocardial surface
  2. ventricular contractility and blood flow and ejection patterns
  3. activation of platelets and coagulation system
44
Q

Characteristic apical ballooning of the heart recognizable on echcardiography that resembles the Japanese octobus trap.

A

Takotsubo

45
Q

In patients with cardiomyopathies, mural thrombi form mostly within ___.

A

trabeculae carnae near the cardiac apex

46
Q

TRUE or FALSE. Embolism iis usual in patients with hypertrophic cardiomyopathies.

A

FALSE. It is unusual unless they develop atrial fibrillation.

47
Q

Most common area of cardiac myxoma?

A

Left atrium

48
Q

Aside from emboli, give another mechanism of stroke in patients with cardiac myxoma?

A

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
Q

Tumors consisting of multiple papillary fronds that radiate from an avascular fibrocollagenous core attached by a short pedicle to the endothelium.

A

Papillary fibroelastomas (cardiac tumor that can give rise to embolism)

50
Q

The most common potential intracardiac shunt

A

Residual PFO

51
Q

Number of bubbles and TTE/TEE.

A

<10 trivial
10-30 small shunt
>30 large shunt

52
Q

These are usually defined by echocardiography as bulging/ spetal mobility in the region of the fossa ovalis due to redundant atrial septal tissue

A

ASA- Atrial septal aneurysms

53
Q

Electrocardiographic finding in patients with PFO

A

M-shaped notch on the ascending branch or on the peak of the R-wave in II, III aVF.

54
Q

Why was the ARCH trial stopped prematurely? (Aortic Arch Related Cerebral Hazard Trial)

A

Hemorrhages were common in both groups and there was no clear superiority of either antiplatelets or anticoagulant therapy,

55
Q

Most common neurologic complication of CABG surgery?

A

Cognitive dysfunction without accompanying focal motor, sensory, or visual dysfunction

56
Q

What is the most important cause of cognitive deficits after cardiac surgery using cardiopulmonary bypass?

A

Microembolism

57
Q

What is the triad of fat embolism syndrome?

A
  1. respiratory distress
  2. decreased alertness
  3. petechial rash developing 24-48 hours after an injury
58
Q

Where can one find the petechiae in a patient with fat embolism syndrome?

A

lower palpebral conjunctivae
skin of the neck, shoulder and axillary folds

59
Q

One of the most effective and specific tests for fat embolism

A

bronchopulmonary lavage

60
Q

The most common tumors to embolize to the brain?

A

Primary pulmonary neoplasms or tumors that have metastasized to the lungs

Vascular Neurology Masterclass (6 decks)

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