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Joeli lectures > CVA, ICH, Cerebral Flow > Flashcards

CVA, ICH, Cerebral Flow Flashcards

1
Q

Vertebral artery

A

posterior circulation
joins basilar artery
supplies brainstem, cerebellum, posterior cerebrum

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2
Q

Internal carotid artery

A

supplies middle cerebral artery, anterior cerebral artery, ophthalmic artery
supplies cortex

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3
Q

Communicating vessels

A

anterior communicating
posterior communicating

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4
Q

Anterior cerebral artery

A

mostly leg
cognitive/personality changes (frontal lobe supply)

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5
Q

Middle cerebral artery

A

mostly arm and face
homonymous hemianopsia
left MCA –> aphasia

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6
Q

Posterior cerebral artery

A

vision and hearing

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7
Q

posterior inferior cerebral artery (PICA)

A

cerebellar signs

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8
Q

Basilar artery

A

goes to brain stem and cerebellum – depending on the location can be catastrophic

large artery - permanent disability, coma, death
small artery - dizziness, ataxia, cerebellar signs, vertigo, etc

can also cause bulbar symptoms - facial weakness, dysphonia, dysarthria, dysphagia, limited jaw movement, oculomotor symptoms

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9
Q

Extracranial vertebral artery (ECVA)

A

most common symptom dizziness
bilateral leg weakness, hemiparesis, numbness can lead to ataxia
atherosclerosis or compression near upper cervical vertebra in elderly

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10
Q

Epidural space

A

contains meningeal arteries (middle meningeal artery)
sight of epidural hematoma –> arterial bleed, skull fractures or skull trauma usually at pterion

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11
Q

Subdural space

A

cerebral veins penetrate subdural space to enter dural sinus (also called bridging veins)

sight of subdural hematoma –> caused by shearing force; consider atrophy of brain in elderly/AD or shaken baby

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12
Q

Subarachnoid space

A

cerebral vessels (aneurysm)
CSF (blood within CSF on lumbar puncture should have same amount with each)

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13
Q

Ischemic stroke

A

sudden decrease in cerebral blood flow
most common type of stroke (80-85%)

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14
Q

Ischemic stroke caused by thrombosis

A

local obstruction of artery caused by arteriosclerosis

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15
Q

Ischemic stroke caused by embolism

A

debris originating elsewhere and moving to cerebral vasculature

EX: clot caused by a-fib

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16
Q

Ischemic stroke caused by systemic hypoperfusion

A

general circulatory problem which can be due to cardiac failure leading to widespread hypoperfusion

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17
Q

Hemorrhagic stroke

A

ruptured vessel causes blood to seep into surrounding tissue and causes compression of surrounding brain tissue
less common (15-20%)

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18
Q

Hemorrhagic stroke - intracerebral

A

bleed within the brain
HTN, trauma, drug use (cocaine, meth)
gradually worsens over time!!!

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19
Q

Hemorrhagic stroke - subarachnoid

A

bleeding surrounding the brain to CSF
vascular malformations near pial surface, ruptured arterial aneurysm at base of brain
sudden onset of symptoms

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20
Q

Where does lacunar infra most commonly occur

A

in basal ganglia, subcortical white matter, and pons

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21
Q

What is lacunar infarct primarily caused by

A

lipohyalinosis – degeneration of small vessels caused by lipid accumulation in vessel wall

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22
Q

Biggest risk factor of lacunar infarct

A

HTN

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23
Q

People with lacunar infarct lack –

A

aphasia
agnosia
apraxia
hemianopsia

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24
Q

TIA

A

transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction

indicates high risk of recurrent and more severe CVA

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25
Ischemic core
area directly affected by ischemia --> cell death within minutes ischemic core cannot be saved
26
Ischemic penumbra
area surrounding ischemic core --> receiving some collateral circulation --> ischemic but viable tissue --> cell death within hours goal of repercussion is to save the penumbra
27
Treatment for ischemic stroke
alteplase within 4.5 hours ideally within 3
28
door to needle time
less than or equal to 60 min
29
first imaging performed for ischemic stroke
non contrast CT helps distinguish ischemic stroke mimics like tumor, infection, hemorrhage
30
CT should be performed and interpreted within
< 45 min
31
CTA/CTP for ischemic stroke
may be used to determine collateral flow, size of penumbra studies are determining if this could help guide treatment selection bigger penumbra = better candidate for therapy
32
Contraindications for tPA
-current intracranial hemorrhage -signs or symptoms of subarachnoid hemorrhage (sudden -severe headache, stiff neck, nausea, light sensitivity, decreased vision, altered LOC) -active internal bleed -recent (w/in 3 mos) intracranial or intraspinal surgery, stroke, or serious head trauma -CT confirmation of multi lobar infarction -intracranial neoplasm, aneurysm, or arteriovenous malformation -bleeding disorders -current anticoagulant therapy -elevated BP (systolic > 185 or diastolic > 110)
33
Praxis
the performance of movement neurology: the performance of learned, skilled movement or planned movement
34
Apraxia
the loss of the skilled movements inability to correctly perform learned, skilled movements not due to weakness
35
Disorder of voluntary movement
a cognitive disorder - not a primary motor disorder the proper use of an object cannot be carried out
36
Apraxia and neuroanatomy ---
disconnect between thinking and carrying out the movement not a problem in the primary motor cortex - strength is fine, coordination is fine; usually involves injury to the PARIETAL LOBE
37
ideomotor apraxia
knows what a comb is but cannot use it
38
ideational apraxia
unable to carry out a sequence of action (fold paper in half, put in envelope, set on floor)
39
Aphasia
the loss of the ability to produce or understand language most often occurs due to the LEFT HEMISPHERE damage 00 language centers of the brain
40
Broca's aphasia
affecting frontal lobe comprehension spared, writing and speech impaired may have right hemiparesis bc close to motor area
41
Wernicke's aphasia
affecting posterior superior temporal gyrus comprehension defect, fluent with words but they are nonsensical - "word salad" may have right superior visual field defect bc close to optic radiations motor function is spared
42
Blood brain barrier formed by
tight junctions between endothelial cells (filter) pericytes (cerebral blood flow regulation) astrocytes
43
diffusion of BBB according to concentration gradient
lipophilic molecules H20
44
Efflux channels BBB
ATP dependent keep toxins, medications, etc out of brain
45
Transported via proteins (BBB)
glucose amino acids and nucleosides
46
where does communicating hydrocephalus occur
occurs at arachnoid space
47
non-communicating hydrocephalus is due to
tumor mass stenosis *fluid is unable to pass around
48
over-production hydrocephalus
tumor papilloma
49
Decreased absorption - hydrocephalus
arachnoid space
50
Hydrocephalus in infant
sutures are not closed --> enlarged head sunsetting eye sign
51
Causes of hydrocephalus in infant
congenital stenosis of cerebral aqueduct infection tumor etc ---
52
other symptoms of hydrocephalus in patient
decreased LOC irritability poor feeding bulging fontanelle enlarged scalp veins
53
Normal pressure ICP
5-15 mmHg
54
Elevated ICP
> 15 mmHg caused by inflammation, edema, hydrocephalus, mass lesions
55
Early response for ICP
CSF displaced into lumbar cistern and decreased cerebral blood flow
56
Later response of ICP
reduced production of CSF, increased CSF absorption
57
When body is unable to compensate for ICP
brain herniation focal mass effect (tumor, bleed, abscess) diffuse mass effect (generalized cerebral edema --> CVA, meningitis)
58
Uncal herniation
temporal lobe herniates downward toward brainstem (herniates under tentorium) Pressure on CN3 --> ipsilateral dilation compression of PCA --> occipital CVA --> homonymous hemianopia compression of basilar artery or break branches --> decreased supply to brainstem compression of brain stem --> indirect pressure to opposite side of brainstem --> ipsilateral weakness
59
Transcalvarial herniation
external herniation brain through skull generally due to fracture or surgery
60
cingulate herniation
cingulate gyrus herniates under faux cerebri common type of herniation compresses ACA leading to CVA often precedes other supratentorial herniations
61
Central herniation
diencephalon slipped under tentorium responsible for processing sensory info and emotions regulates hormone production CN6 palsy
62
Infratentorial herniation
upward herniation tonsillar herniation -- part of cerebellum pushed into foramen magnum compression of brainstem alterations in breathing and cardiac function decreases LOC may present with headache and neck stiffness
63
Physical findings of herniation
decreased LOC focal neurological signs papilledema Cushing's triad AVOID LUMBAR PUNCTURE
64
Cushing's triad
increased blood pressure - cerebral auto regulation attempt to maintain cerebral perfusion pressure in presence of increased ICP irregular breathing - compression of brainstem/respiratory centers bradycardia - activation of PNS due to baroreceptors signaling elevated systemic BP
65
Subclavian steal
subclavian artery supplies axillary and brachial arteries blockage = decreased supply to arm = decreased blood pressure in arm if there is increased arm usage --> more blood supply needed --> subclavian steals blood supply from vertebral artery vertebral artery supplies posterior brain causes retrograde flow in vertebral artery back to subclavian
66
Why do lacunar infarcts occur there...
Basal ganglia, subcortical white matter, and pons are supplied by small branches from the anterior, middle and posterior cerebral artery as well as basilar artery -- very few areas of anastomosis --> decreased collateral circulation --> predisposition to infarction
67
What can communicating hydrocephalus lead to
Normal pressure hydrocephalus
68
What can cause normal pressure hydrocephalus/communicating
subarachnoid hemorrhage infection meningitis
69
On PE, what might a patient with over-production hydrocephalus have
Papilledema

Joeli lectures (18 decks)

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