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Flashcards in Neu 10 - Vascular Events Deck (69):
1

Where is the most common site of the aneurysm in the brain?

Anterior communicating artery. Visual field defects.

2

Which is the Saccular (berry) aneurysm ?

Occurs at bifurcations in the circle of Willis. Most comon site is junction of anterior communicating artery and anterior cerebral artery.

3

Which are the complications of the aneurysms?

1)Compression. 2)Stasis of blood results in embolize. 3)Spontaneous rupture (most common complication).

4

Which is the most common complication of the aneurysms?

Rupture resulting in subarachnoid hemorrhage, patients refer as the "worst headache of my life" or Hemorrhagic stroke.

5

Worst headache of my life...

Subarachnoid hemorrhage

6

How can the aneurysm cause bitemporal hemianopia?

Via compression of optic chiasm.

7

Which are the risk of factors for aneurysms?

1)ADPKD (Automosomal dominant polycystic Kidney Disease). 2)Ehlers-Danlos syndrome.
3)Hypertension. 4)Smoking. 5)advanced age. 6)Race (more common in black patients).

8

What is the Charcot-Bouchard microaneurysm?

Affects small vessels so there is small vessel aneurysm, and affect the lenticulostriate arteries that supply basal ganglia and thalamus, also associated with chronic hypertension.

9

Which is the most common cause of a non-traumatic Subarachnoid hemorrhage?

Ruptured aneurysm.

10

Which is the most common cause (overall) of a subarachnoid hemorrhage?

Trauma.

11

Which is the second most common cause of a non-traumatic subarachnoid hemorrhage?

Rupture ArterioVenous Malformation (AVM).

12

Patient refer his headache as the "worst headache of my life", which is the next step in this case?

CT scan of brain.

13

Patient that your suspect sufferer subarachnoid hemorrhage, but his CT scan do not show any signal of blood, which is the next step?

Lumbar puncture to examine the CSF for blood.

14

During a lumbar puncture, How many tubes you have to collect and send to laboratory ?

3 or 4 tubes, in the first one tube is where the blood is, and second one sure it have less blood, and the third tube, it should not have blood at all. If you see blood in the last tube of CSF you gonna think about Subarachnoid hemorrhage.

15

What is the name when the CSF is yellow?

Xanthochromic, 2-3 days afterwards. Bilirubin in the CSF.

16

Which are the treatments for a Subarachnoid aneurysm?

1)Surgical clip. 2)Nimodipine (Dihydropyridine CCB).

17

What type of drug is the Nimodipine?

It is a calcium channel blocker, prevent cerebral vasospasm. Used in subarachnoid hemorrhage.

18

which is the part of the spine is performed the lumbar puncture ?

Adults: L3-L4 or L4-L5.
Kids: L4-L5 or L5-S1.

19

Which are the structures that are crossed by the needle in the lumbar puncture?

1)Skin. 2)Superficial fascia. 3)3 ligaments (Supraspinous ligament, interspinous ligament & ligamentum flavum). 4)Epidural space. 5)Dura mater. 6)Subdural space. 7)Arachnoid membrane. 8)Subarachnoid space.

20

What is the definition of Epidural Hematoma?

Bleeding between the dura and skull, most common cause is the rupture of Middle Meningeal Artery (branch of maxillary artery).

21

What is the definition of aneurysm?

It is an abnormal dilation of artery due to weakening of vessel wall.

22

Which kind of herniation do you expect to find in epidural hematoma?

There is a rapid expansion under the systemic arterial pressure resulting in transtentorial herniation.

23

In which of the intracranial hemorrhages we can find CN III palsy?

Epidural hematoma.

24

In which of the intracranial hemorrhages we can find Lucid interval?

Epidural hematoma.

25

What is the name of the hematoma that is trapped b/w skull and dura matter?

Epidural hemorrhage

26

What is the name of the hematoma that is trapped b/w dura matter and arachnoid?

Subdural hemorrhage.

27

What is the definition of Subdural hematoma?

Rupture of bridging veins, slow bleeding (less pressure = hematoma develops over time).

28

In which patients can we see Subdural hematoma?

1)Elderly individuals. 2)Alcoholics. 3)Blunt trauma. 4)Shaken baby.

29

Patient with epidural hematoma, What can I see in his CT?

CT shows biconvex (lentiform), hyperdense blood collection not crossing suture lines. Can cross falx, tentorium.

30

Patient with subdural hematoma, What can I see in his CT?

Crescent-shaped hemorrhage that crosses suture lines. Midline shift. Cannot cross falx, tentorium.

31

What is intraparenchymal hemorrhage?

Bleeding whitin the brain parenchyma.

32

What is the most common cause of intraparenchymal hemorrhage?

Most commonly caused by systemic hypertension.

33

In which patients can we see the intraparenchymal hemorrhage?

Patients with amyloid angiopathy, vasculitis, neoplasm, vascular malformations, and anticoagulant therapy.

34

Which intracranial hemorrhage is characterized by typically occurs in basal ganglia and internal capsule (Charcot-Bouchard aneurysm of lenticulostriate vessels), but can be lobar?

Intraparenchymal (hypertensive) hemorrhage.

35

In which patients is most common find intraventricular hemorrhage in the newborn?

Most common in premature.

36

Where is originated the intraventricular hemorrhage in the new born?

Originates from the germinal matrix in the subependymal, su ventricular zone that gives rise to neurons and glia during development.

37

At what time the damage is irreversible in the hypoxia?

Irreversible damage begins after 5 minutes of hypoxia.

38

What is the uses of the Noncontrast CT on a stroke?

To exclude hemorrhage.

39

At what time the CT detects the ischemic damage?

CT detects ischemic changes in 6-24 hr.

40

It can detect ischemia within 3-30 min.?

Diffusion-weighted MRI

41

On a ischemic hypoxia which is the most vulnerable area in the brain?

Ischemia HYPOxia -> HYPOcampus is most vulnerable.

42

What histological feature can we see at 12-48 hours since the ischemic event begun?

Red neurons.

43

What histological feature can we see at 24-72 hours since the ischemic event begun?

Necrosis plus Neutrophils.

44

What histological feature can we see at 3-5 days since the ischemic event begun?

Macrophages (microglia).

45

What histological feature can we see at 1-2 weeks since the ischemic event begun?

Reactive gliosis plus vascular proliferation.

46

What histological feature can we see at 2 weeks or more since the ischemic event begun?

Glial scar.

47

Intra cerebral bleeding, due to hypertension, anticoagulation, cancer. May be second to ischemic stroke followed by reperfusion (increased vessel fragility).

Hemorrhagic stroke.

48

What area of the brain is the most common site of intracerebral hemorrhage in hemorrhagic strokes?

Basal ganglia are most common site of intracerebral hemorrhage.

49

What kind of necrosis can we see in ischemic stroke?

Liquefactive necrosis.

50

What happens in ischemic stroke?

Acute blockage of vessels resulting in disruption of blood flow and subsequent ischemia resulting in Liquefactive necrosis.

51

Which are the 3 types of ischemic strokes?

1)Thrombotic. 2)Embolic. 3)Hypoxic.

52

Which kind of ischemic stroke due to a clot forming directly at site of infarction (commonly the MCA)?

Thrombotic, usually over and atherosclerotic plaque.

53

What is Embolic?

It is a type of ischemic stroke where the embolus from another part of the body obstructs vessels, can affect multiple vascular territories.

54

Atrial fribrillation, DVT with patent foramen ovale, septic emboli and fat emboli are examples of ?

Ischemic stroke of Embolic type.

55

Which kind of ischemic strokes is most common during cardiovascular surgeries?

Hypoxic due to hypoperfusion or hypoxemia, tends to affect watershed areas.

56

Which are the thrombolytic contraindications?

Patients with 1)Active bleeding.2)History of intracranial bleeding. 3)Recent surgery. 4)Bleeding diathesis. 5)Severe hypertension.

57

Which therapy can we use if within 3-4.5 hr of onset and no hemorrhage/risk of hemorrhage?

tPA (Tissue Plasminogen Activator).

58

What parts of the brain are the most vulnerable to the ischemic damage?

Cerebellum, neocortex, hippocampus and the Watershed areas.

59

Which are the watershed areas in the brain?

1)Between Aneterior Cerebral Artery (ACA) and Meddle Cerebral Artery (MCA).
2)Between MCA and Posterior Cerebral Artery (PCA).

60

What is the most common site of a berry aneurysm?

Anterior communicating artery.

61

associated with berry aneurysms?

ADPKD (Automosal Dominant Polycystic Kidney Disease).
Ehlers-Danlos syndrome.

62

An 85-years old man with Alzheimer disease falls at home and presents 3days later with severe headache and vomiting. What is the most likely diagnosis and which structures were damaged?

Subdural hematoma (rupture of the bridging veins).

63

A healthy 52-year-old man presents to the ER with stroke symptoms that began 2 hours ago. What treatment should be considered immediately? What study must be ordered immediately?

Thrombolytic therapy (e.g. tPA) and CT of the head (without contrast).

64

RFF: "Worst headache of my life"

Subarachnoid hemorrhage.

65

RFF: Lucid interval following head trauma

Epidural hematoma .

66

RFF: Bloody CSF on LP.

Subarachnoid hemorrhage.

67

RFF: Most common cause of Subdural hematoma

Rupture of the bridging veins.

68

RFF: Most common cause of epidural hematoma

Rupture of the MMA (Middle Meningeal Artery).

69

RFF: On the CT, how can you tell if this patient has a Subdural hematoma or an epidural hematoma?

An epidural hematoma is lens-shaped or football shaped, like a biconvex disc, and a Subdural hematoma is crescent shaped.