Chapter 86 - Cerebrovascular disease introduction

Question 1

first clinical anatomic correlation of carotid occlusion

Answer 1

Fisher 1951

Question 2

First surgical treatment for carotid plaque with resection of disease

Answer 2

Eastcott, Pickering, Rob 1954

Question 3

First CEA

Answer 3

Debakey 1953

Question 4

% of stroke that are ischemic

Answer 4

87%

Question 5

Risk factors for stroke

Answer 5

1) age (q10yr after 55 doubles risk) 2) male (age matched) 3) black 4) HTN (120/80 reduced risk by 50%) 5) DM 6) CAD 7) current smk: 3-4x increased risk than those that quit 10 yr 8) Family history: 1.4-3.3x (cva + cad) 9) Afib: 3-5x 10) hypercholesterol: 25% increase per 38.7 increase total cholesterol 11) physical activity: < 4/wk causes 20% risk 12) obesity especially abdominal obesity in men 13) CKD statin is protective Mediterranean diet is protective

Question 6

Relative risk reduction of stroke with statin use

Answer 6

21%

Question 7

INTERSTROKE study 5 most important factors for stroke

Answer 7

accounted for 80% of strokes 1) HTN 2) current smk 3) abdominal obesity 4) poor diet 5) physical inactivity

Question 8

Risk of recurrent stroke and death after initial stroke

Answer 8

RECURRENT STROKE 7 days - 2% 30 days - 4% 1 year - 12% 5 years - 29% DEATH 7 days - 7% 30 days - 14% 1 year - 27% 5 years - 53%

Question 9

NASCET 2 year risk of ipsilateral stroke with high grade carotid stenosis

Answer 9

26%

Question 10

TIA definition

Answer 10

ministroke symptoms last < 24 hr clinical diagnosis

Question 11

Risk of stroke in 5 year after TIA

Answer 11

30%

Question 12

TIA’s that have infarction on imaging

Answer 12

24%

Question 13

Percentage of strokes that have a herald TIA

Answer 13

15%

Question 14

Rate of stroke after TIA in 90 days and 2 days

Answer 14

2 days - 3-10% 90 days - 9-17%

Question 15

Asymptomatic carotid stenosis and risk of stroke

Answer 15

ACSRS - determine CVA risk on 1) degree of stenosis 2) clinical feature 3) US plaque characteristic 1) 1121 patients 2) 50-99% asymptomatic ICA stenosis 3) f/u 6-96 months

Question 16

ASCAR factors that increase risk of ipsilateral stroke

Answer 16

1) stenosis 2) age 3) SBP 4) creatinine 5) smk x 10 years 6) contralateral CVA history 7) low gray-scale median 8) increased plaque area 9) absence of discrete white areas without acoustic shadowing 10) juxtaluminal black hypoechoic area

Question 17

ASCAR prediction chart

Answer 17

TABLE 86.1

Question 18

High intensity transient signals (HITS)

Answer 18

in transcranial doppler represent microemboli to brain

Question 19

Asymptomatic carotid emboli study (ACES) key points

Answer 19

Use TCD to predict stroke risk 1) 70% + stenosis 2) 2 year follow up prospective 3) 267 patients (77 had HITS) stroke risk in those without signal 1-3.62% vs with signal 7.13-15.6% problem costly cumbersome 10% do not have acoustic window

Question 20

TOAST 5 categories of ischemic stroke

Answer 20

1) cardioembolic 2) large vessel disease 3) small vessel disease 4) unusual causes 5) undertermined etiology

Question 21

Percentage of ischemic strokes likely related to extracranial carotid artery atherosclerosis

Answer 21

20%

Question 22

Medical therapy of ICA stenosis

Answer 22

1) HTN BP < 140/90 2) LDL < 100 3) TG < 150 4) HDL > 40 5) statins use 6) antiplatelet use

Question 23

Rate of ICA stenosis

Answer 23

3.8-10.5% in men 2.7-5.5% in women higher in older age groups

Question 24

Rate of stroke annually in asymptomatic high grade stenosis ACA, NASCET, ACST

Answer 24

2%

Question 25

Progression of carotid stenosis natural course

Answer 25

19.8% will progress in 4 years

Question 26

Multivariate predictor of outcome in asymptomatic carotid stenosis

Answer 26

TABLE 86.2

Question 27

Vertebrobasilar territories

Answer 27

1) brain stem 2) cerebellum 3) thalamus 4) occipital cortex

Question 28

Percentage of CVA from posterior circulation

Answer 28

20%

Question 29

Sensorimotor deficits in subclavian steal indicates

Answer 29

Concomitant carotid occlusive disease usually symptoms should be cerebellar

Question 30

Cerebellar infarction symptoms

Answer 30

1) vertigo 2) vomiting 3) blurred vision 4) difficult walking

Question 31

Global cerebral ischemia cause

Answer 31

1) prolonged cardiogenic shock 2) dysrhythmias 3) cardiac arrest correct cardiac failure and return perfusion

Question 32

Lacunar infarct definition

Answer 32

1) small cubcortical infarct (1-2 cm) 2) occlusion of single penetrating artery of brain 3) often in internal capsule, basal ganglia 4) areas supplied by lenticulostriate vessels

Question 33

Percentage of CVA that are lacunar

Answer 33

20%

Question 34

Symptoms of lacunar infarct

Answer 34

1) pure motor hemiparesis 2) pure sensory syndrome 3) sensorimotor syndrome 4) ataxic hemiparesis 5) dysarthria-clumsy hand syndrome