Cerebrovascular disorders

Question 1

Stroke/ TIA- Sx

Answer 1

• Sudden onset of weakness in face, arm, leg
• Unilateral
• Numbness
• loss of vision, double vision
• Trouble talking (language problem), slurred speech
• True vertigo
• Incoordination on one side

Question 2

Cardioembolic stroke- Eti

Answer 2

• 25-30% ischemic stroke
• Afib and post MI- begins in heart
• Can go to any vessel
• Anterior and middle cerebral most common

Question 3

Lacunar stroke- Eti

Answer 3

• 25% ischemic stroke
• Small arteries, small stroke
• DM and HTN
• Better prognosis

Question 4

Transient ischemic attack- Eti

Answer 4

• Highest risk of progression to stroke in 1 month
• Embolization commonly
• Afib, heart dz, MI
• Hx of vascular disease

Question 5

Transient ischemic attack- Sx

Answer 5

• Acute, focal neurologic deficit
• Resolves within 24 hours
• Weakness on contralateral arm
• Numbness and paresthesia
• Transient monocular blindness (Amaurosis fugax)

Question 6

Transient ischemic attack- Dx

Answer 6

• CT or MRI scan within 24 hrs

- Asses for underlying cause

Question 7

Transient ischemic attack- Tx

Answer 7

• Anticoagulants
• Aspirin
• Angioplasty or stenting

Question 8

Lacunar infarct- Tx

Answer 8

Aspirin

- Tx chronic dz

Question 9

Lacunar infarct- Dx

Answer 9

-MRI

Question 10

Carotid artery obstruction- Anterior- Sx

Answer 10

• Anterior: Sensory loss in contralateral leg
• Arm weakness
• Contralateral grasp reflex
• Paratonic rigidity
• Confusion
• Behavioral and memory disturbance
• Incontinence

Question 11

Carotid artery obstruction- Middle- Sx

Answer 11

• Contralateral hemiplegia
• Hemisensory memory loss
• Homoymous hemianopia
• Eyes deviated to side of lesion
• Drowsiness, stupor and coma

Question 12

Vertebrobasilar obstruction- Posterior- Sx

Answer 12

• Spontaneous pain
• Macular sparing hemionymous hemiopia
• Mild hemiparesis

Question 13

Vertebrobasilar obstruction- Vertebral- Sx

Answer 13

• Clinically silent

Question 14

Vertebrobasilar obstruction- Basilar- Sx

Answer 14

Coma with pinpoint pupils

• Flaccid quadriplegia
• Sensory loss
• Cranial nerve abn
• Diplopia,

Question 15

Ischemic stroke- Dx

Answer 15

• CT or MRI

- Determine cause

Question 16

Ischemic stroke- Tx

Answer 16

• IV throbolytics before 4.5 hrs
• Aspirin if tPA contraindicated
• Manage systemic sx

Question 17

Intracerebral hemorrhage- Eti

Answer 17

• Spontaneous, non truamatic
• No vascular anomolies
• HTN- microaneuryisms
• Advanced age, male

Question 18

Intracerebral hemorrhage- Sx

Answer 18

• LOC
• Vomiting, HA
• Rapidly evolving neuro deficit- hemiplegia

Question 19

Intracerebral hemorrhage- Dx

Answer 19

CT scan

Question 20

Intracerebral hemorrhage- Tx

Answer 20

• Supportive tx

- Ventricular drainage, hemostasis

Question 21

Spontaneous subarachnoid hemorrhage- Eti

Answer 21

• 5-10% strokes
• Trauma
• Old, female, ethnic, smoker with high alcohol consumption

Question 22

Spontaneous subarachnoid hemorrhage- Sx

Answer 22

• Sudden, severe HA
• N/V
• Signs of meningeal irritation, nuchal rigidity
• Transient LOC to coma to death

Question 23

Spontaneous subarachnoid hemorrhage- Dx

Answer 23

• CT
• CSF exam
• Cerebral arteriography

Question 24

Spontaneous subarachnoid hemorrhage- Tx

Answer 24

• Prevent further hemorrhage

- Greatest within first days

Question 25

Intracranial aneurysm- Eti

Answer 25

- Polycystic disease, coarctation of aorta - Smoking, HTN, hypercholesterol - Circle of willis - Old, female, ethnic, smoker with high alcohol consumption

Question 26

Intracranial aneurysm- Sx

Answer 26

- Asymptomatic, nonspecific until rupture - Same sx as subarachnoid: - Sudden, severe HA - N/V - Signs of meningeal irritation, nuchal rigidity - Transient LOC to coma to death

Question 27

Intracranial aneurysm- Dx

Answer 27

- Angiography

Question 28

Intracranial aneurysm-Tx

Answer 28

Prevent hemorrhage- surgically or endovascularaly

Question 29

Arteriovenous malformations- Eti

Answer 29

- Congenital vascular malformation - Assoc with arterial aneurysm - Supratentoral most common - Sx manifest before age 40

Question 30

Arteriovenous malformations- Sx

Answer 30

- Hemorrhage - Recurrent seizure - HA - Focal neuro deficiencies depending on brain region affected Cranial bruit- over ipsilateral eye

Question 31

Arteriovenous malformations- Dx

Answer 31

- CT | - Arteriography

Question 32

Arteriovenous malformations- Tx

Answer 32

- Surgery to prevent further hemorrhage

Question 33

Subclavian steal syndrome- Eti

Answer 33

- Subclavian artery stenosis

Question 34

Subclavian steal syndrome- Sx

Answer 34

- Unequal upper extremity BP - Vertigo and syncope - Ulcerated or gangrenous fingers

Question 35

Subclavian steal syndrome- Tx

Answer 35

Revascularization

Question 36

Amaurosis fugax- Eti

Answer 36

- TIA of retina - Emboli stuck in retinal vessel - HTN, hypercholesterol

Question 37

Amaurosis fugax- Sx

Answer 37

- Curtain of blindness, monocular - Whitened, edematous retina - Cherry red fovea

Question 38

Pseudotumor cerebri- Eti

Answer 38

- Lots of causes: thrombosis, otitis media, mastoiditis, pulm dz, lupus... - Benign intracranial htn - Overweight women 20-44

Question 39

Pseudotumor cerebri- Sx

Answer 39

- HA, diplopia - Enlargement of blind spots - Papilledema - Abducens nerve dysfunction

Question 40

Pseudotumor cerebri- Dx

Answer 40

- Lumbar puncture - CT- RO lesion - MR venography

Question 41

Pseudotumor cerebri- Tx

Answer 41

- Acetaxolamide- reduction of CSF | - Tx underlying cause