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For orals By Princess > Introduction to cerebrovascular disease > Flashcards

Introduction to cerebrovascular disease Flashcards

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1
Q

Abrupt onset of a neurologic deficit that is attributable to a vascular cause

A

Stroke or cerebrovascular accident

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2
Q

Reduction in blood flow that lasts longer than several seconds

A

Cerebral ischemia

**Neurologic symptoms are manifest within seconds becauses neurons lack glycogen so energy failure is rapid

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3
Q

All neurologic signs and symptoms resolve within 24 H WITHOUT evidence of brain infarction on brain imaging

A

Transient ischemic attack

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4
Q

Neurologic signs and symptoms last for >24H or brain infarction is demonstrated

A

Stroke

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5
Q

A generalized reduction in cerebral blood flow due to systemic hypotension (cardiac arrhthmia, myocardial infarction or hemorrhagic shock)

A

Produces syncope

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6
Q

What is the contellation of cognitive sequelae caused by global hypozia=ischemia

A

Hypoxic-ischemic encephalopathy

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7
Q
A
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8
Q

Neurologic symptoms of intracranial hemorrhage is due to

A

Producing mass effects on neural structures
From the toxic effects of blood itself
Increasing intracranial presure

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9
Q

Loss of appreciation that something is wrong

A

Anosognosia

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10
Q

85% of ischemic stroke patiients have hemiparesis

A

True

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11
Q

FAST

A

Facial weakness
Arm weakness
Speech abnormality
Time

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12
Q

Other causes of sudden onset neurologic symptoms that mimic stroke

A

Seizure (ongoing complex partial seizures without tonic-clonic activity)
Intracranial tumor
Migraine (acephalic migraine)
Metabolic encephalopathy

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13
Q

Stoke vs migrane

A

Stroke: sensory disturbance is prominent and sensory deficit and motor deficit tends to migrate slowly accross a limb over minutes

Migraine: cortical disturbances begin to cross vascular boundaries or if classic visual symptom (Scintillating scotoma is present)

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14
Q

Classic visual symptom in migrane

A

Scintillating scotoma

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15
Q

Standard imaging modality to detect the presence or absence of intracranial hemorrhage

A

CT imaging of the brain

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16
Q

Language loss and right homonymous hemianopia

A

Left middle cerebral emboli

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17
Q

Most common cause of occlusion of the proximal middle cerebral artery (MCA)

A

Embolus (artery-to-artery, cardiac, or of unknown source)

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18
Q

What prevents MCA stenosis from becoming symptomatic

A

Collateral formation via the leptomeningeal vessels

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19
Q

Cortical branches of the MCA supply that lateral surface of the hemisphere EXCEPT

A
  1. Frontal pole and strip along the superomedial border of the frontal and parietal lobes (S: anterior cerebral A)
  2. Lower temporal and occipital pole convolutions (S: posterior cerebral A)
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20
Q

Branches of the Proximal MCA (middle cerebral A)

A

M1 segment gives rise to
lenticulotriate A (s: putamen, outer globus pallidus, posterior limb of the internal capsule)

In sylvian fissure, the MCA divides into superior and inferior division (M2) branches
Superior division: S frontal and superior parietal cortex
Inferior division: S inferior parietal and temporal cortex

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21
Q

Symptoms if the entire MCA is occluded at the origin (block penetrating and cortical branches)

A
  1. Contralateral hemiplegia
  2. Hemianesthesia
  3. Homonymous hemoanopia
  4. A day or two of gaze preference to the ipsilateral side

*Dysarthria due to facial weakness
dominant hemisphere is affectd: global aphasia
Nondominant hemishphere: anosognosia, constructional apraxia, neglect

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22
Q

Partial syndromes due to embolic occlusion of a singl branch

A

Hand weakness
Hand and arm weakness alone (Brachial syndrome)
Facial weakness with nonfluent (Broca) aphasia
With or without arm weakness (frontal opercular syndrome)

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23
Q

Occlusion of the proximal superior division MCA

A

Supplies: Large portions of the frontal and parietal cortices

symptoms : combination of sensory disturbances, motor weakness and nonfluent aphasia

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24
Q

Occlusion of the inferior division of the MCA

A

Supply: Posterior part (temporal cortext) of the dominant hemisphere

Symptoms:
1.Fluent (Wenicke’s) aphasia without weakness: jargon speech and inability to comprehend written and spken language— **PROMINENT feature
2. Contralateral homonymous superior quandrantanopia
3. Hemineglect or spatial agnosia without weakness (non dominant hemisphere)

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25
Occulusion of a lenticulostriate vessel Prodcues small-vessel (lacunar) stroke within the internal capsule
Symptoms: Pure motor stroke or sensory-motor stroke contralateral to the lesion
26
Ischemia within the genu of the internal capsule
Primarily facial weakness followed by arm and then leg weakness contralateral hand: ataxic and dysarthria (clumsy hand, dysarthria lacunar syndrome )
27
Ischemia within the globus pallidus and putamen
Parkinsonism and hemiballisimus
28
Anterior cerebral artery (ACA) 2 Segments A1 (precommunal circle of Willis): connects the internal carotid artery to the anterior communicating artery 2 (postcommunal sement): distal to the anterior communicating artery
A1 supplies Anterior limb of the internal capsule, the anterior perforate substance, amygdala, anterior hypothalamus, inferior part of the head of the caudate nucleus Collaterals of proximal ACA: anterior communicating artery and collaterals through MCA and PCA
29
Occlusion of a single A2 segment: contralateral symptoms
Occlusion of both A2 segments from a signle anterior cerebral stem: affects both hemisphere Symptoms: profound abulia (delay in verbal and motor response) and bilateral pyramidal signs with paresis or quadriparesis and urinary incontinence
30
Anterior choroidal artery **Vulnerable to iatrogenic occlusion during surgical clipping of aneurysms arising from the internal carotid artery
Arises from: internal carotid artery Supples: posterior limb of the internal capsue and the posterolateral white mater Collaterals: proximal MCA, posterior communicating and posterior choroidal arteries
31
Complete syndrome of anterior choroidal artery occlusion / anterior choroidal stroke
symptoms Contralateral hemiplagia Hemianesthesia (hypesthesia) Homonymous hemianopia Cause: in situ thrombosis
32
Internal carotid artery
Most affected: the cortex supplied by the MCA territory supplies the ipsilateral brain origin of ACA, MCA, MCA, opthalmic artery
33
Occlusion of both ACA and MCA at the top of the internal carotid artery
Abulia or stupor Hemiplegia Hemianesthesia Aphasia Anosognosia
34
When posterior cerebral artery arises from the internal carotic artery
called fetal PCA
35
Internal carotid supplying the opthalmic artery
Perfuses the optic nerve and retina symptoms of occlusion of opthalic artery (***25% of symptomatic internal carotid disease) RECURRENT TRANSIENT MONOCULAR BLINDNESS (Amaurosis fugax) -horizontal shade that sweeps down or up accross the fielf of vision (only few minutes)
36
PE findings of stenotic internal carotid artery
High pitched prolonged carotid bruit fading into diastole *bruit becomes fainter and may disapper when occlusion is imminent
37
Common carotid artery occlusion
Symptoms 1. Jaw claudication: low flow in the external carotid branches
38
Vertebral arteries join to form the basilar artery at the
Pontomedullary junction
39
Basilar artery divides into two posterior cerebral Artery (PCA) in the
Interpeduncular fossa
40
Origins of the posterior cerebral artery
Bifurcation of the basilar artery (75%) posterior communicating artery (20%) Ipsilateral internal carotid artery (5%)
41
Main cause of posterior cerebral artery syndromes
Atheroma formation or emboli lodge at the top of the basilar artery (MC) Other causes: Dissection of vertebral A Fibromuscular dysplasia
42
2 Clinical syndromes with occlusion of PCA 1.P1 syndrome Supplies: midbrain, sub thalamic, thalamic Artery involved: Penetrating branches (thalamogeniculate, Percheron and posterior choroidal arteries)
2. P2 syndrome Supplies: Cortical temporal and occipital lobe Artery involved: P2 segment distal to the junction of the PCA with the posterior communicating artery
43
P1 syndrome Affects: Ipsilateral subthalamus and medial thalamus, ipsilateral cerebral peduncle and midbrain
Includes 1.Claude's syndrome 2.Webe's syndrome 3.Thalamic Dejerine-Roussy syndrome
44
P1 syndromes Claude's syndrome Third nerve palsy with contralateral ATAXIA Involvement of the red nucleus or dentatorubrothalamic tract
Weber's syndrome Third nerve palsy with contralateral HEMIPLEGIA Hemiplegia is localized to the cerbral peduncle
45
P1 syndromes Occlusion of artery with associated deficits
Atery of Percheron: paresis of upward daze, drowsiness and abulia Bilateral proximal PCA (affect midbrain and sub thalamus): Coma, unreactive pupils, bilateral pyramidal signs, decerebrate rigidity
46
P1 syndromes Dejerine-Roussy syndrome
Contralateral hemisensory loss FOLLOWED BY agonizing, searing or burning pain in the affected areas *respond poorly to analgesic -responsive to anticonvulsants (carbamazepine or gabapentin) or tricyclic antidepressant
47
P2 Syndromes Artery: occlusion of the distal PCA Affects: medial temporal and occipital lobes
Symptoms: contralateral homonymous hemianopia WITHOUT macula sparing Incontrast to MCA strokes that is perfused by P2 segment Produce contralateral homonymous hemianopia SPARES macula and calcarine cortex
48
Infarcted areas and deficits
Calcarine cortex: aware of visual defects Medical temporal lobe and hippocampal involvement (dominant): memory
49
Occlusion of artery and its deficits
Occlusion of PCA: peduncular hallucinosis (visual hallucinations of brightly colored scenes and objects) Bilateral infarction in the distal PCA: cortical blindness (blindness with preserved pupillary light reaction)
50
Anton's syndrome
Patient is UNAWARE of blindess with preserved papillary light reaction Due to Bilateral infarction in the distal PCAs
51
Balint's Syndrome
Disorder of the orderly visual scanning of the environment such as Palinopsia: persistence of a visual image for several minutes despite gazing at another seen Asimultanagnosia: inability to synthesize the whole of an image Due to infarction secondary to low flow in the "watershed" between the distal PCA and MCA territories Occurs after cardiac arrest
52
Hallmark of embolic occlusion of the top of the bailar artery
Sudden onset of bilateral signs including: ptosis, pupillary asymmetry or lack of reaction to light and somnolence non contrast CT scan finding: hyperdense basilar artery sign (indicating thrombus in the basilar artery)
53
Vertebral and posterior inferior cerebellar arteries Arises from a. Innominate artery on the right b. Subclavian artery on the left
Segments a. V1 b. V2 c. V3 d. V4: joins the other vertebral artery to form the basilar artery
54
ateries and the areas they supply
V4: brainstem and cerebellum Posterior inferior cerebellar artery (PICA): lateral medula and inferior surface of the cerebellum
55
Atherothrombotic lesions in the V1and subclavian artery may produce POSTERIOR circulation emboli
Collaterals of V1 that prevent low flow TIA/ stroke 1. contralateral vertebral artery 2. Ascending cervical, thyrocervical or occipital arteries
56
symptoms of low flow TIA
1. syncope 2. Vertigo 3. alternating hemiplegia
57
Atherothrombotic lesions in the distal V4 may produce Basilar artery thrombosis Causes ischemia of the lateral medulla
Subclavian artery occlusion produces POSTERIOR circulation TIA or subclavian steal
58
Lateral Medullary (Wallenberg's syndrome)
Due to tombosis of V4 segment Symtoms: vertigo, numbness of the ipsilateral face and contralateral limbs, diplopia, hoarseness, dysarthria, ipsilateral Horner's syndrome
59
Hemiparesis is not a typical feature of vertebral artery occlusion
Quadriparesis result from occulsion of the ANTERIOR spinal artery
60
Medial Medullary Syndrome
Due to infarction of the pyramid Symptoms: Contralateral hemiparesis of the arm and lef sparing the face *If medial lemniscus and hypoglossal nerve fibers is involved: contralateral loss of joint position sense and ipsilateral tongue weakness
61
Cerebellar infarction
Lead to: 1.respiratory arrest due to brainstem herniation from cerebellar swelling, closure of the aqueduct of Silvius or 4th ventricle--> hydrocephalus and central herniation Symptoms: drowsiness, Babinski signs, dysarthria, bifacial weakness
62
Basilar artery Supplies 1. Base of the pons 2. Superior cerebellum
3 Groups of Basilar artery 1. Paramedian 2. Short circumferential 3. Bilateral long circumferential
63
Atheromatous lesion most frequently occur in what area of the basilar trunk
Proximal basilar and distal vertebral segments
64
Occlusion of what arteries is more commonly responsible for top of the basilar syndromes
Emboli from the heart Emboli of proximal or basilar segments
65
Complete basilar occlusion
Bilateral long tract signs (sensory and motor) with signs of cranial nerve and cerebellar dysfunction Spontaneous posturing movement CT or MRA: detect basilar thrombosis Treatment: thrombectomy
66
Complete Pontine and lower midbrain infarction
"Locked in" state of preserved consciousness with quadripledia and cranial nerve signs Therapeutic goal: identify impending basilar oclusion before devastating infarction
67
What often herald an atherothrombotic occlusions of the distal vertebral or proximal basilar artery
Series of TIAs and slowly progressive fluctuating stroke
68
TIAs in the proximal basilar distribution TIA (5 to 30 minutes)- affect ONE side of the brainstem Hemiparesis: initial symptom of BILATERAL basilar TIA
Produce vertigo Diplopia Dysarthria Facial or circumoral numbness Hemisensory symptoms
69
Atherothrombotic occlusion of basilar artery with infarction
Bilateral brainstem signs: gaze paresis or internuclear ophthalmoplegia with ipsilateral hemiparesis
70
Occlusion of the superior cerebellar artery
Severe ipsilateral cerebellar ataxia Nausa and vomiting Dysarthria Contralateral loss of pain and temperature sensation over the extremities, body and face (spino and trigeminothalamic tract)
71
Occlusion of the anterior inferior cerebllar artery
1.Ipsilateral deafness Facial weakness Vertigo, nausea and vomiting Nystagmus Tinnitus Cerebellar ataxia Horner's syndrome Paresis of conjugate lateral gaze 2. Contralateral loss of pain and temperature sensation Cause corticospinal tract signs
72
Brain Ct scan Infarct may not be seen reliably for 24 to 48 h
May fail to show: 1 small ischemic strokes in the posterior fossa because of bone artifact 2. small infarcts in the cortical surfaces
73
Diffision-weighted imaging MRI
Brain regions showing poor perfusion but no abdnormality on diffusion: equivalent measure of the ischemic penumbra
74
Gold standard for identifying and quantifying atherosclerotic stenosis of the cerebral arteries
Conventional xray cerebral angiography Identifies aneurysms, vasospasm, intraluminal thrombi, fibromuscular dysplasia, arteriovenous fistulae, vasculitis, collateral channels of blood flow
75
Acute stroke treatment with endovascular thrombectomy effective in ischemic strokes caused by
1. Internal carotid terminus 2. MCA occlusions

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