Cerebrovascular Disease Flashcards Preview

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Flashcards in Cerebrovascular Disease Deck (29):
1

What do Ischemia or hemorrhage manifest as?

FOCAL neurological deficits related to specific vascular territories (some migraines may mimic cerebrovascular disease)

2

TIAs

sudden, focal neurological deficits which completely resolve within 24 hrs

3

Stroke

sudden, focal neurological deficit which does not completely resolve within 24 hours but may variably improve over several weeks to months

4

Where do atherosclerotic changes predominate?
What are the two main mechanisms of ischemic infarction?

bifurcation points of major cervical and intracranial arteries

1. arterial thrombosis of an atheroma (pale)
2. embolic arterial occlusion from proximal sources (hemorrhagic)

5

What do the perforator or lenticulostriate arteries supply

deeper structures with significant functions, such as the basal ganglia, internal capsule, thalamus and corona radiata

6

Amaurosis fugax
(monocular blindness)

carotid territory TIA
involving the ophthalmic artery or its retinal branches
-patient describes lowered dark shade in one eye

7

Other carotid TIAs may cause what?

Hemiparesis or aphasia

8

Vertebrobasilar territory TIAS cuase

ischemia of the brainstem, cerebellum, visual cortex producing symptoms of ataxia, homonymous hemianopsia, or hemiparesis associated with crossed brainstem syndromes

9

lacunar infarcts in the in the thalamus may cause?

pure sensory stroke

10

lacunar Infarcts in the internal capsule, corona radiata, or basilar pons cause?

pure motor hemiplegia, ataxic-hemiparesis, and clumsy hand dysarthria

11

what can hypercoagulable states cause occlusions of?

1. large and small arteries
2. cortical veins

12

what can hypercoaguable states cuase occlusions of?

1. large and small arteries
2. cortical veins

13

What do symptomatic atheromatous lesions of 70-99% stenosis at the origin of the internal artery benefit from?

carotid endarterectomy
-surgically removal of this lesion

(complete 100% stenotic lesion precludes any surgery since its thrombotic occlusion extends from the neck to the base of the skull)

14

What drugs help reduce the risk of stroke?

1. warfarin-large artery occlusion (carotid endarterectomy or interventional procedures)
2. antiplatelet-small artery occlusion
3. statin drugs

15

What drugs help reduce the risk of stroke?

1. warfarin
2. antiplatelet
3. statin drugs

16

If a patient with a recent cerebral infarction develops impaired consciousness in absence of hypoglycemia, what must be considered?

increased intracranial pressure
-edema (within 3-5 days) or hemorrhagic transformation of an initially ischemic infarct

-->hyperventilate to reduce intracranial pressure (vasoconstriction)
-->intravenous mannitol-osmotic diuretic

17

How does a hemorrhagic stroke present?

1. severe headache
2. impairment or LOC
3. focal neurological deficit

18

How does a hemorrhagic stroke present?

1. severe headache
2. impairment or LOC
3. focal neurological deficit

19

What does a deeply located hemorrhage suggest was the cuase

hypertension

20

WHat does a superficial hemorrhages at the poles of the frontal, temporal , or occipital lobe often occur from

head trauma

21

What is the most common cause of cerebral hemorrhage?

hypertension
-weakened walls of lenticulostriate arteries rupture bleeding into the striatum and thalamus

also caused by:
1. trauma
2. warfarin
3. bleeding disorder
4. cocaine
5. cerebral amyloid angiopathy
6. AVM -arteriovenous malformations
7. within brain tumors or ischemic infarcts

22

What is the most common cause of cerebral hemorrhage?

hypertension
-weakend walls of lenticulostriate arteries rupture bleeding into the striatum and thalamus

23

What is the common cause of subarachnoid hemorrhage? What about in the absence of that?

trauma #1

in absence of trauma-ruptured congenital berry aneurysm

24

What is a sentinel headache?

warning leaks from mild to moderate bleeding

25

What does xanthochromia of the CSF indicate?

breakdown of blood within the CSF prior to lumbar puncture-from subarachnoid blood

26

What does xanthochromia of the CSF indicate?

breakdown of blood within the CSF prior to lumbar puncture-from SAH?

27

What are some ways to visualize the aneurysm?

1. non contrast CT brain scan
2. Emergent angiography-optimal imaging to locate

28

What happens to the berry aneurysm one it is located?

clipped

29

What is postoperative cerebral spasm minimized by?

the triple H therapy
1. hypertension
2. hypervolemia
3. hemodilution