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CVA/TIA Flashcards

1
Q

Anterior Circulation

A
  • Internal Carotid
  • anterior cerebral
  • middle cerebral
  • anterior choroidal
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2
Q

Posterior circulation

A
  • Vertebrals
  • Basilar artery
  • posterior cerebral
  • cerebellar arteries
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3
Q

What are the risk factors for a stroke? (6)

A
  • HTN
  • Obesity
  • Smoking
  • Hyperlipidemia
  • Diabetes
  • Diet
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4
Q

What are 3 ways a stroke can happen?

A
  • Ischemic (thromboembolic)
  • Hemorrhage
  • Systemic hypotension (very rare)
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5
Q

What does a stroke result from?

A

Occlusion of a vessel, hemorrhage, or systemic hypotension causes ischemia from hypoperfusion

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6
Q

What are the 3 types of ischemic stroke?

A
  • Carotid circulation obstruction
  • Vertebrobasilar obstruction
  • Lacunar infarction
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7
Q

Carotid Artery Occlusion Obstruction

A
  • occlusion of a major vessel, cerebral infarction
  • Higher risk of early mortality and reinfarction than lacunar infarcts
  • Not much progression of symptoms besides brain swelling
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8
Q

What are the cardiac causes of carotid artery circulation obstruction? (7)

A
  • afib
  • rheumatic heart dz
  • mitral valve dz
  • infective endocarditis
  • atrial myxoma
  • mural thrombi
  • ASD/patent foramen
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9
Q

What are vascular causes of carotid artery circulation obstruction? (9)

A
  • Carotid arter plaque/dissection
  • AIDS
  • fibromuscular dysplasia
  • atherosclerosis of aortic arch
  • giant cell arteritis
  • polyarteritis
  • granulomatous angitis
  • meningovascular syphilis
  • SLE
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10
Q

S/S of CACO (2)

A
  • onset usually sudden

- symptoms depend on the vessel blocked and where it is blocked

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11
Q

What are the S/S of CACO of the anterior cerebral artery distal to the communicating artery? (7)

A
  • contralateral weakness (leg>arm)
  • contralateral grasp reflex
  • Paratonic rigidity
  • Abulia (lack of initiative)
  • Confusion
  • Urinary incontinence
  • Behavioral disturbances/memory
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12
Q

What are S/S of CACO of the middle cerebral artery? (5)

A
  • contralateral hemiplegia
  • contralateral hemisensory loss
  • contralateral homonomous hemianopia
  • drowsiness, stupor, coma
  • blockage of one carotid artery looks similar
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13
Q

S/S of CACO of anterior main division of the middle cerebral artery (2)

A
  • expressive aphasia

- weakness and sensory loss in the contralateral arm/face>leg

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14
Q

S/S of CACO of posterior main division of the middle cerebral artery (2)

A
  • Sensory aphasia (wernicke’s)

- contralateral homonomous visual field defect

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15
Q

CACO on the non-dominant side of the brain (4)

A
  • speech and comprehension may be preserved
  • confusional state
  • dressing apraxia
  • constructional and spatial defects
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16
Q

Vertebrobasilar Obstruction in the Post. Cerebral Artery (8)

A
  • contralateral hemisensory disturbance +/- paresis
  • Pain in the effected area of the body
  • syncope
  • involuntary movements
  • alexia
  • tinnitus
  • mild, transient hemiparesis
  • macular sparing contralateral homonomous hemianopia
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17
Q

Vertebrobasilar Obstruction in the vertebral artery (3)

A
  • inferior convergence, may not manifest
  • bilateral vertebral artery occlusion acts like a basilar artery occlusion
  • vertebrobasilar insufficiency (pass out from looking up)
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18
Q

Vertebrobasilar obstruction in the basilar artery (5)

A
  • coma
  • pinpoint pupils
  • flaccid quadriplegia
  • sensory loss
  • variable cranial nerve abnormalities
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19
Q

Vertebrobasilar Occlusion- partial basilar obstruction (7)

A
  • diplopia
  • visual loss
  • vertigo
  • dysarthria
  • ataxia
  • weakness or sensory disturbances in limbs
  • discrete cranial nerve palsies
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20
Q

Vertebrobasilar Occlusion in the superior cerebellar artery (6)

A
  • contralateral spinothalmic sensory loss
  • contralateral facial sensory loss
  • vertigo
  • N/V
  • nystagmus
  • ipsilateral limb ataxia
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21
Q

Vertebrobasilar occlusion in the posterior inferios cerebellar artery (5)

A
  • ipsilateral sensory loss in the face
  • CN IX &X
  • ipsilateral limb ataxia
  • Horner’s syndrome
  • contralateral spinothalamic sensory loss
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22
Q

Vertebrobasilar occlusion in the anterior inferior cerebellar artery (6)

A
  • ipsilateral facial sensory loss
  • ipsilateral facial weakness
  • vertigo
  • N/V
  • nystagmus
  • ipsilateral limb ataxia
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23
Q

Vertebrobasilar obstruction in the cerebellar arteries

A
  • massive infarction leads to coma, tonsillar herniation, and death
24
Q

Lacunar Infract (7)

A
  • SMall lesions in the distribution of the short penetrating arterioles in the:
  • basal ganglia
  • pons
  • cerebellum
  • anterior limb of the internal capsule
  • deep cerebral white matter
  • a/w HTN and diabetes
25
S/S of Lacunar Infarct (6)
- contralateral pure motor or sensory loss - ipsilateral ataxia with crural paresis - dysarthria with clumsiness of the hand * *deficit may progress over 24-36 hrs - good prognosis - CT may see it, may not
26
What are the 3 main risk factors for hemorrhagic stroke?
- HTN- intraparenchymal - AV malformation- subarachnoid - Aneurysm- subarachnoid
27
Other risk factors for hemorrhagic stroke (5)
- bleeding disorders - anticoagulant therapy - liver dz - high alcohol intake - cerebral amyloid angiopathy
28
Common S/S of Hemorrhagic Stroke (4)
- initial decrease in LOC - Vomiting - headache if the meninges are involved - focal signs according to location
29
Intraparenchymal Hemorrhage (5)
- HTN - May extend into the ventricular system or subarachnoid space - meningeal irritation - basal ganglia (common for micro aneurysm) - pons, thalamus, cerebellum, cerebral white matter can all of micro aneurysms as well
30
Subarachnoid Hemorrhage (3)
- AVMs and aneurysms - very painful - "worst headache of my life"
31
AVM
- congenital abnormality | - tortuous vessels connect the arterioles and veins in a delicate network that is prone to hemorrhage
32
What are the 4 types of aneurysms?
- saccular (berry) - fusiform - charcot bouchard aneurysm - mycotic
33
What is the definition of a saccular aneurysm?
Failure of circular smooth muscle to interdigitate leading to weakening of the muscle
34
What is used to classify saccular aneurysms?
Hunt and Hess scale, manifestations of rupture
35
Saccular aneurysm Diagnosis (2)
- CT no contrast | - appears as a subarachnoid hemorrhage
36
Tx of Saccular Aneurysms (3)
- coiling - clipping - medication to prevent vasospasms
37
CVA Diagnosis Overview (3)
- Hard to tell the different btw hemorrhagic/ischemic based on presentation * * CT without contrast - CBC, bleed time/coags, LFT
38
What should you do if CT shows a hemorrhage?
Conservative management and supportive care
39
What should you do if CT does not show hemorrhage?
Proceed with thrombolytics, assume ischemic stroke, start tap if you are within the time range
40
Hemorrhagic Stroke Tx Overview (3)
- Generally supportive - angiography used to check for aneurysm - blood in the ventricles with increased ICP, is indicative of ventriculostomy
41
Hemorrhagic Stroke Sx Indications
- Decompression - superficial hemorrhage in the cerebral white matter (decreases likelihood of herniation and damage from mass effect) - cerebellar hemorrhage (pt deteriorates and dies w/out it, deficits are generally minimal afterwards)
42
Ischemic Stroke Tx Overview
- Does not appear right away on CT - TPA, windo 3-4.5 hrs - MRI picks up ischemic stroke but it takes a long time
43
CVA Supportive Care
Increased ICP - elevate head - mannitol
44
CVA CPP TX (6)
- maintain CPP - prevents further ischemia - Do not lower BP to normal within the first two wks of stroke - loss of auto regulation - Systolic BP>220 brought down with IV labetolol or nicardipine - the bigger the MAP the easier it is to maintain cerebral pressure
45
When should ICP be treated?
When it is over 20-25mmHg
46
CVA Anticoagulation (2)
- used for most ischemic strokes | - Warfarin, INR should be 2-3
47
Other CVA Tx (2)
- PT/OT | - Speech therapy
48
CVA prognosis (4)
- ischemic infarct is better for survival than hemorrhagic - TPA improves chance for recovery - LOC poor prognostic indicator - Increased risk for stroke and MI
49
TIA (3)
- Focal neurological deficit of acute onset which resolves in 24 hours - Some patients with stroke have a TIA hx - Risk of stroke is highest in 48 hrs after TIA
50
TIA Causes (2)
- Emboli (cardiac or vascular) | - Multiple TIAs can manifest differently in some patients but it is usually not the case
51
TIA S/S in the Carotid Distribution (4)
- weakness/heaviness in contralateral arm, leg, face - sensory deficits on the contralateral side - Amaruosis fugax (shade pulled over eye) if opthalmic artery involved - Dysphasia
52
TIA S/S in the Vertibrobasilar distribution (6)
- vertigo - ataxia - diplopia - visual disturbances - perioral numbness - weakness or numbness on one, both or alternating sides
53
TIA Diagnostic Work up (6)
- CT/MRI to r/o stroke and tumor - Carotid ultrasound - Standard arteriography is gold standard - CBC, glucose, cholesterol, sed rate, syphilis serology - EKG/CXR - Echo
54
Hospitalize TIA if? (6)
- W/in 48 hrs of first attack - If attacks crescendo - Symptoms last more than an hr - Symptomatic Carotid stenosis - known cardiac source - hypercoagulable state
55
What is the single most helpful lifestyle modification a patient can make for TIA?
STOP SMOKING
56
TIA Surgery
- Surgery or stent for high grade stenosis
57
TIA Tx
- If surgery cannot be done, then medical tx - for a cardiac source, warfarin (or aspirin) - non- cardiac event, aspirin

Neurology (12 decks)

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