Lect 7 & 8

Question 1

where do saccular aneurysms generally form?
___________ is a major risk factor.
These are rare in __________.

Answer 1

form where an artery bifurcates
cocaine/amphetamine use
rare in children

Question 2

saccular aneurysms are most frequently found where in the body? What do you do if you find one?

Answer 2

circle of willis

find one, look for more! 25% have more than one

Question 3

what are the 3 sx of a saccular aneurysm “warning leak”

Answer 3

HA
dizzy
eye pain with visual defects

Question 4

Rupture of a saccular aneurysm is called a ____________.

Answer 4

subarachnoid hemorrhage

Question 5

6 sx associated with subarachnoid hemorrhage?

Answer 5

thunderclap ha (worst ha of life)
mental status change
visual changes
n/v
stiff neck
photophobia

Question 6

2 emergency txs for intracranial hemorrhage rupture

Answer 6

breathing support

dec intracranial pressure

Question 7

________ and ________ both mean stroke

Answer 7

subarachnoid hemorrhage

intrcerebral hemorrhage

Question 8

with a ______ hemorrhage the dura is peeled from the skull

with a ________hemorrhage the dura is still attached

Answer 8

epidural - peel

subdural - still attached

Question 9

an ipsilateral fixed and dilated pupil following trauma should make you think….

Answer 9

epidural hemorrhage

often with collateral weakness

Question 10

epidural hemorrhages are _______ shaped on CT/MRI

Answer 10

lens

Question 11

subdural hemorrhages are ______ shaped on CT/MRI

Answer 11

crescent

Question 12

subarachnoid hemorrhages can be caused by….

Answer 12

rupture of a saccular aneurysm or trauma

Question 13

what should you do with pts who you suspect may be having an acute stroke

Answer 13

pts should be triaged as if they are having an MI regardless of metal status

Question 14

most important info from HPI of a stroke pt?

Answer 14

LKW - Last Known Well (must be <4.5 hrs since to admin tissue plasminogen factor)

Question 15

stroke pt should get what imaging?

Answer 15

stat head CT without contrast

Question 16

what is the penumbra?

Answer 16

surrounds the dead tissue of a stroke, this is “at risk” tissue that can be saved

Question 17

A TIA is

Answer 17

ministroke, all penumbra, very little necrosis

Question 18

what is pathognomic for meningeal irritation

Answer 18

nuchal rigidity

Question 19

2 tests for nuchal rigidity?

Answer 19

kernigs - “knee” ext while hip at 90 deg

brudinskis - “brain” flex head up

Question 20

viral meningitis is typically seen in those _____yo

bacterial meningitis is typically seen in those ______yo

Answer 20

viral: <5
bact: <20

Question 21

what is cerebral palsy?

Answer 21

NON-PROGRESSIVE, do of movement, muscle tone, or posture

Question 22

what causes cerebral palsy?

Answer 22

damage to the immature, developing brain - usually before, during or shortly after birth (every case is unique)

Question 23

paresis/paretic means

Answer 23

weakened

Question 24

plegia/plegic means

Answer 24

paralyzed

Question 25

diplegic means

Answer 25

lower limbs are affected

Question 26

spastic cerebral palsy means

Answer 26

increased REACTIVE muscle tone

Question 27

how do you test for spasticity?

Answer 27

do a fast PROM with the limb, it may tense up

Question 28

what are the 3 types of cerebral palsy

Answer 28

ataxia (no coordination, balance, posture)
athetoid
dystonic (abnormal sustained postures)

Question 29

AGAIN CT is goood for showing ______ and ______

Answer 29

blood and bone

Question 30

most important question with acute stroke is _______

what’s the second most important question?

Answer 30

LKW

Is there blood? (can be answered with MRI or CT)

Question 31

CT typically takes ____mins compared to 20mins for MRI

Answer 31

10mins

Question 32

benefits for CT with stroke

Answer 32

faster, cheaper, more widely available, dec risk of claustrophobia

Question 33

MRI is more informative in “acute stroke” caused by…. (4)

Answer 33

tumors, szs, migraine variant, MS etc

Question 34

______ shows area of ischemic stroke immediately… with _____ it may not be seen until the next day

Answer 34

MRI (immeadiate)

CT

Question 35

what is conventional angiography? why is it good?

Answer 35

catheter fed thru femoral artery to inject dye in brain

this has unsurpassed spatial and temporal resolution (one dimensional)

Question 36

CT angiography is similar to _______. what does the image look like?

Answer 36

similar to CT with contrast but shorter delay between dye and image
image looks like a 3D computer rendering

Question 37

why is MR angiography used?

Answer 37

similar to MRI, with better tolerated contrast or can be done NON-INVASIVELY with NO CONTRAST. Pt is not exposed to radiation either.

Question 38

MR angiography pitfalls

Answer 38

lowest imagining resolution, clausterphobia, can miss things in smaller vessles

Question 39

_________ can be used at bedside to see a live feed of structure and flow through a vessel

Answer 39

carotid duplex ultrasonography