Cerebrovascular Disease

Question 1

Which Cerebral artery is most commonly affected?

Answer 1

Middle Cerebral Artery

Question 2

What gaze symptom will be present with Middle Cerebral A. issues?

Answer 2

Gaze TOWARD the side of the lesion

Question 3

What symptoms will be present with Middle Cerebral A. issues?

Answer 3

• Gaze toward lesion
• Aphasia (issues with language comprehension)
• Hemineglect (lack of awareness of 1/2body)
• Hemianopia (loss of 1/2 visual field)
• Face-arm sensorimotor loss

Question 4

What symptoms (2) will be present with Anterior Cerebral A. issues?

Answer 4

• Contralateral leg hemiplegia

- Alien hand syndrome (contralateral arm NOT under voluntary control)

Question 5

What symptom will be present with Posterior Cerebral A. issues?

Answer 5

Contralateral Homonymous Hemianopia

Question 6

Region between 2 vessels that is the most susceptible to ischemia and infarction?

Answer 6

Watershed infarcts

Question 7

What shape are watershed infarcts?

Answer 7

Sickle shaped band of necrosis

Question 8

What are the symptoms of a watershed infarct between ACA-MCA?

Answer 8

Proximal arm and leg weakness with aphasia

Question 9

When may ACA-MCA watershed infarcts occur?

Answer 9

Internal Carotid A. stenosis

Question 10

What is the symptom of a watershed infarct between the MCA-PCA?

Answer 10

Issues with higher order visual processing

Question 11

Injury to the brain as a consequence of altered blood flow

Answer 11

Cerebrovascular disease

Question 12

What are the 3 categories of Cerebrovascular Disease and what is all of their clinical designation?

Answer 12

• Thrombosis
• Embolism
• Hemorrhage
  ==> Stroke

Question 13

A stroke involves neurologic symptoms that persist for more than 24 hours. If the symptoms resolve in less than 24 hours, what occurred?

Answer 13

Transient Ischemic Attack (TIA)

Question 14

Carotid Stenosis

Answer 14

Atherosclerosis of internal carotid A. just beyond the bifurcation point

Question 15

If Carotid Stenosis is present, thrombi are likely to form. What will the symptoms be if it embolizes to the CNS?

Answer 15

Contralateral face-arm weakness, sensory changes, visual field defects and aphasia

Question 16

Thrombosis usually causes occlusions due to _____. How?

Answer 16

Atherosclerosis

– Rupture/ulceration/erosion of the plaque exposes blood to thrombogenic substances ==> clot!

Question 17

What are 3 common sites in the brain for Thrombosis? What shape will the infarct be?

Answer 17

1. Carotid bifurcation
2. MCA origin
3. Basilar ends
   == Wedge shaped infarct

Question 18

There are many sources of Emboli. Which vessel is most often affected by them?

Answer 18

MCA

Question 19

What is the typical duration of a TIA?

Answer 19

10 minutes

Question 20

Why are TIA’s neurologic emergencies?

Answer 20

Warning sign for potentially larger ischemic event

– Full stroke likely within 48 hours to 3 months

Question 21

What can cause TIA’s?

Answer 21

Temporary emboli, thrombi, vasospasm

Question 22

What are 3 common risk factors for a stroke?

Answer 22

HTN
DM
Hypercholesterolemia

Question 23

What are the 2 types of strokes?

Answer 23

1. Hemorrhagic

2. Ischemic Infarction

Question 24

Hemorrhagic stroke

Answer 24

Intracerebral or subarachnoid hemorrhage

- emboli associated

Question 25

Ischemic (pale) stroke

Answer 25

Bloodless infarction | - Thrombi associated

Question 26

Deep brain hemorrhages are often associated with?

Answer 26

HTN

Question 27

With Hypertensive Cerebrovascular Disease, what infarcts involve the lenticulostriate arteries?

Answer 27

``` Lacunar infarcts (lake-like) -- deep penetrating lenticulostriate arteries ```

Question 28

With Hypertensive Cerebrovascular Disease, slit hemorrhages may occur. What vessels are affected and what results?

Answer 28

Small penetrating vessels | => slit like cavities surrounded by macrophages

Question 29

What are 5 syndromes that are associated with Hypertensive Cerebrovascular Disease?

Answer 29

1. Vascular multi-infarct Dementia 2. Binswanger Disease 3. Charcot-Bouchard Microaneurysms 4. Cerebral Amyloid Angiopathy 5. Cadasil

Question 30

Vascular Multi-infarct Dementia

Answer 30

Dementia and gait issues

Question 31

Binswanger Disease

Answer 31

Area of subcortical white matter with myelin and axon loss

Question 32

Charcot-Bouchard Microaneurysms and what they are associated with

Answer 32

Minute aneurysms in the Basal Ganglia | -- associated with CHRONIC HTN

Question 33

Cerebral Amyloid Angiopathy

Answer 33

Lobar hemorrhage with amyloid deposited in vessels

Question 34

Cadasil

Answer 34

Recurrent strokes and dementia with an onset around 35

Question 35

How is Cadasil inherited and what gene is overexpressed?

Answer 35

Autosomal Dominant | - Notch 3 gene

Question 36

With Cadasil, what are the manifestations and changes?

Answer 36

``` Manifestations = recurrent strokes and dementia at 35 Changes = thickened media/adventitia, loss of smooth m. and PAS deposits ```

Question 37

Localized dilation of blood vessel

Answer 37

Aneurysm

Question 38

What is the most common cause of a subarachnoid hemorrhage?

Answer 38

Saccular (berry) Aneurysm in the anterior circulation of the circle of willis

Question 39

Where are saccular (berry) aneurysms most often found?

Answer 39

Anterior circulation of the circle of willis

Question 40

How do Aneurysms develop?

Answer 40

Over time due to defect in media of a vessel

Question 41

When and in who do aneurysms usually rupture?

Answer 41

Females in their 5th decade | - ruptures associated with stool straining and sexual orgasm

Question 42

What do Arteriovenous Malformations (AVMs) look like and what type of flow do they have?

Answer 42

Worm-like tangles with pulsatile shunting from A. to V. | = High flow

Question 43

Where are AVMs most common?

Answer 43

MCA and posterior branches

Question 44

Males are more likely to have AVMs, what mutations may be present?

Answer 44

(+) KRAS mutations

Question 45

What are Cavernous Malformations/Hemangiomas?

Answer 45

Loosely organized vascular channels arranged back to back with NO intervening brain parenchyma

Question 46

With Cavernous Malformations/Hemangiomas, what is the flow rate and is there shunting?

Answer 46

Low flow | -- NO shunting

Question 47

Loosely organized vascular channels arranged back to back with NO intervening brain parenchyma at the cerebellum and pons

Answer 47

Cavernous Malformations/Hemangiomas

Question 48

What are the symptoms of AVMs and Cavernous Malformations?

Answer 48

Hemorrhage and neuro symptoms