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Flashcards in CVD Deck (94):
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What is cerebral ischemia?

Inadequate blood flow/O2 to the brain

1

If cerebral ischemia is short lived?

Syncope

2

What is syncope?

no air for temp time --> faint --> come back to life

3

If cerebral ischemia is long?

hypoxic-ischemia encephalopathy

4

What is cerebral vascular accident?

FOCAL vascular (blood) cause affecting PORTION OF THE BRAIN

5

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

6

What is intraparenchymal damage?

damage w/in the brain

7

What is the most important thing to distinguish when patient comes in with a "stroke"?

is it: 1) ischemic or 2) hemorrhagic

8

Which stroke is more common?

ischemic (85%)
hemorrhagic (15%)

9

Cx of ischemic stroke?

1) thrombosis
2) embolic

10

What is thrombosis?

clotting of bv d/t a large amount of platelets

11

What is embolic?

can be from a thromobus but also includes air bubbles, FB
occurs in a fib pts, patent foramen, R->L shunt

12

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

13

What links ischemic and hemorrhagic strokes?

ischemic can turn into hemorrhagic stroke

14

Cx for TIA?

many cxs!
-a fib
-carotid artery
-foreman ovale
-carotid stenosis

15

What is a hallmark of TIA?

resolves in 24 hours
-usually short (<1hr)

16

What can happen in the next 48 hrs of a TIA?

STROKE (15%)

17

What are some sx of TIA?

-suddenly not able to talk: ischemia to broca's
-transient blindness: AMAUROSIS FUGAX

18

Tx TIA?

ASPIRIN

19

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

20

TIA - imaging?

CT

21

What is small vessel stroke-lacunar stroke?

occlusion of the small vessel (pons)

22

Cx of small vessel stroke?

thrombosis 3mm to 2cm

23

Small vessel stroke - sx?

pure motor hemiparesis (internal capsule)
pure sensory stroke (ventral thalamus)
ataxic hemiparesis (ventral pons)
dysarthria and clumsy hand

24

Small vessel stroke - prognosis?

fast and complete

25

Small vessel stroke - hallmark?

clumsy hand

26

Pt cannot talk suddenly?

TIA

27

Pt suddenly has blindness?

TIA

28

Pt has clumsy hand?

small vessel stroke

29

Middle cerebral artery - sx?

contralateral hemianesthesia (paralysis)
ipsilateral gaze preference (looks to the side of the stroke)

30

What is PCA? What arteries are included?

Posterior Cerebral Arteries
-vertebral
-basilar
-posterior

31

PCA - what parts of the brain is affected?

mid brain
subthalamic
thalamic
cerebellum

32

PCA - PE?

third nerve palsy
ataxia
coma

33

What is third nerve palsy?

eye is closed
cannot move eyeball up
eyeball does not react to light

34

Distal PCA affect which part of the brain?

occipital
temporal lobes

35

Distal PCA - sx?

cortical blindness (blind but has reactive pupils to light)
hemianopia (vertical blindness)
acute memory disturbances

36

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)
MI
valvula dz (emoblic vegetation)
patent foramen ovale
vascular dz (gient cell arteritis, lupus, sarcoidosis, syphilis)
cancer, thrombocytosis, factor V leiden, oral contraceptives
HIV/AIDs

37

Acute Ischemic stroke -tx?

1) ABC
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)

38

Cerebral hemorrhage - cx?

HTN (preventable)
trauma
cerebral amyloid angiopathy (age related arteriolar degeneration)

39

Hemorrhagic stroke - RF?

age
drinking
anticoagulation
cocaine (young)

40

What are types of hemorrhagic stroke?

1) basal ganglia hemorrhage
2) thalamic hemorrhage
3) cerbellar hemorrhage
4) lobar hemorrhage

41

What are the types of ischemic strokes?

1) TIA
2) small vessel
3) middle artery
4) posterior artery

42

Which ischemic stroke goes away quickly - self resolves?

TIA and small vessel artery

43

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

44

Thalamic hemorrhage - sx?

sensory defect
contralateral hemiplegia/hemiparesis

45

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"

46

Pontine hemorrhage - sx?

coma w/ quadriplegia over minutes
decerebrate rigidity
pinpoint pupils w/ reactive to light
dolls eye phenomena
hyperapnea, severe HTN, hyperhidrosis

47

Cerebellar hemorrhage - sx?

occipital headache
N&V
ataxia gait
dizziness/vertigo
HOURS (can intervene)

48

Lobar hemorrhage - sx?

depends on which part of the lobe is hemorrhaging
focal headache
VOMITTING

49

Lobar hemorrhage - occipital?

hemianopia (vertical visual loss)

50

Lobar hemorrhage - left temporal?

aphasia

51

Lobar hemorrhage - parietal?

sensory loss

52

Lobar hemorrhage - frontal?

arm weakness

53

How long does pontine, cerebellar, lobar hemorrhage take?

pontine - min
cerebellar - hours
lobar - min

54

Headaches of cerebellar vs lobar hemorrhage?

cerebellar- occipital
lobar - focal

55

Sx of intraranial hemorrhage?

increased ICP

56

increased ICP sx?

headahce
pailledema
cushings triad (increasing BP, dec pulse, widening pulse pressure)

57

how is intracranial hemorrhage named?

depending on the location of the hemorrhage
ie) subdural hemorrhage
ie) subarachnoid hemorrhage

58

What is cushing triad?

incr BP
dec pulse
widening pulse pressure

59

Subarachnoid hemorrhage occurs where most commonly?

between arachnoid and pia mater

60

Subarachnoid hemorrhage found...?

circle of willis

61

Subarachnoid hemorrhage - RF

polycystic kidney

62

Subarachnoid hemorrhage prognosis?

not very good - mortality 50-70%; morbidly 70%

63

Subarachnoid hemorrhage - hallmark

WORSE HEADACHE OF MY LIFE
THUNDERCLAP HEADACHE

64

Subarachnoid hemorrhage - what happens in the head?

ICP suddenly rises --> passes out (headache, vomitting, seizures, papilledema, cushings triad)

65

Subarachnoid hemorrhage - sx?

headache, vomitting, BP increases (trying to perfuse brain)

66

Subarachnoid hemorrhage - little bleeding - sx?

headache
stiff neck
focal neurological deficit (loss of vision)

67

Subarachnoid hemorrhage - cx?

trauma - check w/ manometer and give mannitol until surgery

68

Subarachnoid hemorrhage - gold standard?

angiogram

69

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)

70

Subarachnoid hemorrhage - tx?

1) ABC
BP should be ~150 (keep brain perfused)
2) elevate head
3) sedation
4) cerebral vasospasm (4-14 days after) - cx "delayed" death
5) surgical clipping/endovascular coil placement

71

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

72

Subdural hemorrhage - acute RF?

a fib
anticoagulation
elderly that bump their head

73

Subdural hemorrhage acute - sx?

unilateral headahce w/ slightly enlarged pupil
-stupor, coma, blow pupil

74

acute subdural hemotoma - acute - dx?

CT scan - CRESCENT SHAPE

75

Subdural hemorrhage acute - tx?

burr hole drainage
craniotomy
until surgery: mannitol, hyperventilation

76

Subdurl hemorrhage chronic subdural hemotoma - sx?

dementia
slow thinking
headache
seizure
personality changes, depression

77

Subdural hemorrhage chronic - RF?

elderly
chronic alcoholics: they have smaller brains so the venous bridging stretches!
anticoagulation

78

Subdural hemorrhage chronic -tx?

surgical
watchful waiting

79

Subdural hemorrhage chronic - imaging?

CT

80

Epidural hemorrhage?

arterial bleed between skull and dura

81

Epidural hemorrhage - cx?

trauma that tears the middle meingeal artery w/ skull fx (pt is in coma)

82

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

83

CN III injured?

subdural and epidural hemorrhage
fixed, dialted pupil - if traumatic

84

Epidural hemorrhage - imaging?

CT - NOT crescent (unlike subdural hemorrhage) --> rounded b/c the bleeding can't expand out of the sutures in the skull

85

Epidural hemorrhage - tx?

rapid surgery and control bleeding

86

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)

87

Pt comes in w/ a headache, pulsating noise in the head. Pt is 10-30yo. What to expect?

arterial-venous malformation

88

What is arterial-venous malformation?

congenital or developmental abnormality
can be surface or deep in the brain
asymptomatic until bleeding occur
can calcify overtime

89

Who is most likely to get aterial - venous malformation?

younger patients w/ intercranial bleeding (10-30yo)

90

Arterial-venous malformation - imaging

MRI >>> CT
angiogram is gold standard

91

Arterial venous malformation - tx?

surgery if accessable
stereotactic radiation

92

Moyamoya dz?

"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!)

93

Who can help pts w/ stroke?

PT
OT
SLP (esp those who are prone to getting pneumonia - if they can't aspirate - pneumonia!)
RT
case manager (esp if pt is not going back home after discharge)
psychologist - watch out for depression (b/c pt feels useless after stroke)