Flashcards in CVD Deck (94):
What is cerebral ischemia?
Inadequate blood flow/O2 to the brain
If cerebral ischemia is short lived?
What is syncope?
no air for temp time --> faint --> come back to life
If cerebral ischemia is long?
What is cerebral vascular accident?
FOCAL vascular (blood) cause affecting PORTION OF THE BRAIN
What is the main difference between cerebral ISCHEMIA and cerebral VASCULAR ACCIDENT?
ischemia: NO BLOOD/O2 TO THE BRAIN
vascular accident: BLEEDING TO ONE POINT IN THE BRAIN
What is intraparenchymal damage?
damage w/in the brain
What is the most important thing to distinguish when patient comes in with a "stroke"?
is it: 1) ischemic or 2) hemorrhagic
Which stroke is more common?
Cx of ischemic stroke?
What is thrombosis?
clotting of bv d/t a large amount of platelets
What is embolic?
can be from a thromobus but also includes air bubbles, FB
occurs in a fib pts, patent foramen, R->L shunt
What is TIA?
transient ischemic attack
-short time when brain does not receive O2/blood but quickly resolves --> usually when pt is brought into ER they are asymptomatic
-MUST COMPLETELY RESOLVE IN 24 HRS OR ELSE CONSIDERED STROKE
What links ischemic and hemorrhagic strokes?
ischemic can turn into hemorrhagic stroke
Cx for TIA?
What is a hallmark of TIA?
resolves in 24 hours
-usually short (<1hr)
What can happen in the next 48 hrs of a TIA?
What are some sx of TIA?
-suddenly not able to talk: ischemia to broca's
-transient blindness: AMAUROSIS FUGAX
What is the diff between aspirin and heparin?
Aspirin prevents platelet aggregation
heparin is a coag that helps blood keep moving (pts who are stasis/bedridden
TIA - imaging?
What is small vessel stroke-lacunar stroke?
occlusion of the small vessel (pons)
Cx of small vessel stroke?
thrombosis 3mm to 2cm
Small vessel stroke - sx?
pure motor hemiparesis (internal capsule)
pure sensory stroke (ventral thalamus)
ataxic hemiparesis (ventral pons)
dysarthria and clumsy hand
Small vessel stroke - prognosis?
fast and complete
Small vessel stroke - hallmark?
Pt cannot talk suddenly?
Pt suddenly has blindness?
Pt has clumsy hand?
small vessel stroke
Middle cerebral artery - sx?
contralateral hemianesthesia (paralysis)
ipsilateral gaze preference (looks to the side of the stroke)
What is PCA? What arteries are included?
Posterior Cerebral Arteries
PCA - what parts of the brain is affected?
PCA - PE?
third nerve palsy
What is third nerve palsy?
eye is closed
cannot move eyeball up
eyeball does not react to light
Distal PCA affect which part of the brain?
Distal PCA - sx?
cortical blindness (blind but has reactive pupils to light)
hemianopia (vertical blindness)
acute memory disturbances
Ischemic stroke RF?
ASCVD - thrombosis (w/in the CNS), embolism (rusty pipes from thrombosis)
older age, fam hx, DM, HTN, smoking, lipids
A fib (emoblic form clot in atria)
valvula dz (emoblic vegetation)
patent foramen ovale
vascular dz (gient cell arteritis, lupus, sarcoidosis, syphilis)
cancer, thrombocytosis, factor V leiden, oral contraceptives
Acute Ischemic stroke -tx?
2) tPA w/in 4.5 hrs of sx - usual contradictions still stand (MI, surgery, pregnancy, trauma)
3) antithrombotic (ASA) - clopidogrel if allergic to ASA
* anticoagulation (heparin) is USELESS (b/c there is a prob w/ the platelets, NOT blood)
Cerebral hemorrhage - cx?
cerebral amyloid angiopathy (age related arteriolar degeneration)
Hemorrhagic stroke - RF?
What are types of hemorrhagic stroke?
1) basal ganglia hemorrhage
2) thalamic hemorrhage
3) cerbellar hemorrhage
4) lobar hemorrhage
What are the types of ischemic strokes?
2) small vessel
3) middle artery
4) posterior artery
Which ischemic stroke goes away quickly - self resolves?
TIA and small vessel artery
If pt has high HTN comes in w/ "stroke" - what are you suspecting?
1) CT - differeniate between ischemic and hemorragic
2) look for sx of: face sag, slurred speech, arm/leg weakness
* if severe: flaccid paralysis, coma, deep irregular breathing, dilated fixed ipsilateral pupil
Thalamic hemorrhage - sx?
Why is there dilated fixed ipsilateral pupil in hemorrhagic strokes?
increased ICP: parasympathetic is not working --> sympathetic overrides cxing the widening of the pupil and "stuck"
Pontine hemorrhage - sx?
coma w/ quadriplegia over minutes
pinpoint pupils w/ reactive to light
dolls eye phenomena
hyperapnea, severe HTN, hyperhidrosis
Cerebellar hemorrhage - sx?
HOURS (can intervene)
Lobar hemorrhage - sx?
depends on which part of the lobe is hemorrhaging
Lobar hemorrhage - occipital?
hemianopia (vertical visual loss)
Lobar hemorrhage - left temporal?
Lobar hemorrhage - parietal?
Lobar hemorrhage - frontal?
How long does pontine, cerebellar, lobar hemorrhage take?
pontine - min
cerebellar - hours
lobar - min
Headaches of cerebellar vs lobar hemorrhage?
lobar - focal
Sx of intraranial hemorrhage?
increased ICP sx?
cushings triad (increasing BP, dec pulse, widening pulse pressure)
how is intracranial hemorrhage named?
depending on the location of the hemorrhage
ie) subdural hemorrhage
ie) subarachnoid hemorrhage
What is cushing triad?
widening pulse pressure
Subarachnoid hemorrhage occurs where most commonly?
between arachnoid and pia mater
Subarachnoid hemorrhage found...?
circle of willis
Subarachnoid hemorrhage - RF
Subarachnoid hemorrhage prognosis?
not very good - mortality 50-70%; morbidly 70%
Subarachnoid hemorrhage - hallmark
WORSE HEADACHE OF MY LIFE
Subarachnoid hemorrhage - what happens in the head?
ICP suddenly rises --> passes out (headache, vomitting, seizures, papilledema, cushings triad)
Subarachnoid hemorrhage - sx?
headache, vomitting, BP increases (trying to perfuse brain)
Subarachnoid hemorrhage - little bleeding - sx?
focal neurological deficit (loss of vision)
Subarachnoid hemorrhage - cx?
trauma - check w/ manometer and give mannitol until surgery
Subarachnoid hemorrhage - gold standard?
Subarachnoid hemorrhage - labs?
1) CT FIRST!!!!!! to r/o "mass lesion" (if there is a mass lesion and you LP --> brainstem herniation occurs!!)
2) LP - SF has blood (HALLMARK)
Subarachnoid hemorrhage - tx?
BP should be ~150 (keep brain perfused)
2) elevate head
4) cerebral vasospasm (4-14 days after) - cx "delayed" death
5) surgical clipping/endovascular coil placement
Subdural hemorrhage - acute vs. chronic?
acute: sloshing the brain around (no trauma needs to happen - accelerating/deceleration) ie) shaken baby syndrome
chronic: common in elderly ie) overtime the briding veins are stretched as brain shrinks
*BOTH: BRIDGING VEINS (venous bleed) is torn
Subdural hemorrhage - acute RF?
elderly that bump their head
Subdural hemorrhage acute - sx?
unilateral headahce w/ slightly enlarged pupil
-stupor, coma, blow pupil
acute subdural hemotoma - acute - dx?
CT scan - CRESCENT SHAPE
Subdural hemorrhage acute - tx?
burr hole drainage
until surgery: mannitol, hyperventilation
Subdurl hemorrhage chronic subdural hemotoma - sx?
personality changes, depression
Subdural hemorrhage chronic - RF?
chronic alcoholics: they have smaller brains so the venous bridging stretches!
Subdural hemorrhage chronic -tx?
Subdural hemorrhage chronic - imaging?
arterial bleed between skull and dura
Epidural hemorrhage - cx?
trauma that tears the middle meingeal artery w/ skull fx (pt is in coma)
Epidural hematoma - sx? Hallmark
1) hit and unconscious
2) comes to life - "LUCID INTERVAL"
3) deteriorates over min to hrs --> fall into coma
CN 3 is altered --> fixed, dilated pupil
CN III injured?
subdural and epidural hemorrhage
fixed, dialted pupil - if traumatic
Epidural hemorrhage - imaging?
CT - NOT crescent (unlike subdural hemorrhage) --> rounded b/c the bleeding can't expand out of the sutures in the skull
Epidural hemorrhage - tx?
rapid surgery and control bleeding
Pt comes in after a fight, was hit in the head w/ a baseball bat. He was knocked unconscious and now he is awake. What to expect?
fixed dilated pupil - CN III damaged
lucid interval (patient is normal but will deteriorate overtime)
Pt comes in w/ a headache, pulsating noise in the head. Pt is 10-30yo. What to expect?
What is arterial-venous malformation?
congenital or developmental abnormality
can be surface or deep in the brain
asymptomatic until bleeding occur
can calcify overtime
Who is most likely to get aterial - venous malformation?
younger patients w/ intercranial bleeding (10-30yo)
Arterial-venous malformation - imaging
MRI >>> CT
angiogram is gold standard
Arterial venous malformation - tx?
surgery if accessable
"puff of smoke" when the collateral vasculature is weak and prone to bleeding and thrombosis - stenosis of the cerebral vessel develops (so the other collateral vasculature is useless as well!)