- Hemorragic (subarachnoid hemorrhage, intracerebral hemorrage) - Ischaemic (atherosclerosis, small vessel disease, cardioembolism, rare causes, criptogenic)

Stroke, hemorrhage, cerebrovascular diseases Flashcards by María Ponce

Types of strokes

Hemorragic (subarachnoid hemorrhage, intracerebral hemorrage)
Ischaemic (atherosclerosis, small vessel disease, cardioembolism, rare causes, criptogenic)

How well did you know this?

Not at all

Perfectly

Consecuentes of parenchymal hemorrage

Increases in IP: secondary brainstem hemorrhage of Duret, pathomorphological confirmation of brain death
HErniations: subfalcine, transtentorial, tonsilar

How well did you know this?

Not at all

Perfectly

Subarachoid hemorrage clinical feature

Sudden severe headache
Vomiting
Neck stiffness (rigidez en el cuello)
Consciousness disturbances
Xantochromatic CSF

How well did you know this?

Not at all

Perfectly

Increased intracranial pressure causes

Bleeding
Impaired circulation
Brain edema

How well did you know this?

Not at all

Perfectly

Increased intracranial pressure consequences

Decresed cerebral perfusion pressure
Preretinal bleeding
Brain herniation
Hydrocephalus

How well did you know this?

Not at all

Perfectly

Clinical presentation of subarachnoid hemorrage

Sudden, worst headache which doesn’t go away
Vomiting
Disturbance of consciousness
Meningeal signs
Rarely focal neurological dysfunction

How well did you know this?

Not at all

Perfectly

Recognizing acute ischemic stroke

Sudden onset of symptoms and signs
Typical clinical signs: MCA, ACA, PCA, POCA, AICA syndromes
Improvement of clinical symptoms and sigs in less than a day
Patients can have:
-homonymous visual defect in field opposite involved artery
- Language defect when dominant hemisphere involved
- hemiparesis or the side opposite involved artery
- patient may awaken from sleep unable to move affected side

How well did you know this?

Not at all

Perfectly

Endovascular treatment for AIS

Blood vessel
Blood clot
Stent

How well did you know this?

Not at all

Perfectly

Patients with stroke and AF are prescribed

New coagulant drugs
Varfarine treatment

How well did you know this?

Not at all

Perfectly

Intracerebral haemorrhage

Sudden devastating presentation
Rupture of a vessel: development of hematoma–> focal clinical deficit, deterioration of conscious level secondary of mass effect.

How well did you know this?

Not at all

Perfectly

Patient in coma with vomiting and/or neck stiffness are more likely to have

Intracerebral hemorrhage than ischemic stroke

How well did you know this?

Not at all

Perfectly

Causes of intracerebral hemorrhage

Hypertensive small vessel disease
Anticoagulants
Amyloid angiopathy
Arteriovenous malformation
Aneurysm

How well did you know this?

Not at all

Perfectly

Thalamic haemorrage produces

sensory change in the contralateral limbs

How well did you know this?

Not at all

Perfectly

Putaminal haemorrage produces

contralateral hemiparesis and conjugate deviation of the eye towards the side of the hematoma

How well did you know this?

Not at all

Perfectly

Lobar haemorrage produces in frontal lobe

eye deviation
Contralateral hemiparesis

How well did you know this?

Not at all

Perfectly

Lobar haemorrage produces in the central region

hemisensory loss
dysphasia in the dominant hemisphere

How well did you know this?

Not at all

Perfectly

Lobar haemorrage produces in the parietal ole

Hemisensory loss
neglect or innatention

How well did you know this?

Not at all

Perfectly

Lobar haemorrage produces in temporal lobe

Fluent dysphasia with poor comprehension, secondary ro damage of Wernicke

How well did you know this?

Not at all

Perfectly

Pontine haemorrage produces

Coma with pinpoint pupils
Loss of horizontal eye movement
Quadriparesis

How well did you know this?

Not at all

Perfectly

Intraventricular haemorrhage produces

Headache
Vomiting
Neck stiffness
Depression of consciousness

How well did you know this?

Not at all

Perfectly

Treatment of intracranial aneurism

Embolisations with coils
Flow diverter stents

How well did you know this?

Not at all

Perfectly

Arteriovenous malformations and fistulas treatment

Embolisation with liquid agent (Onyx)

How well did you know this?

Not at all

Perfectly

Drug used for prevention of stroke

Arterial thrombosis: antiplatelet drugs (aspirin)
Venous thrombosis: anticoagulant drugs (warfarin)

How well did you know this?

Not at all

Perfectly

Drugs that affect coagulation cascade

Heparin (binds to antithrombin III and accelerates its binding to thrombin and factor Xa and prevent fibrin formation)
Warfarin (Antagonizes cofactor function of fit K and so affect factors II, VII, IX, X)

How well did you know this?

Not at all

Perfectly

Causes of TIA (transient ischemic attack)

Trombotic or embolic Small vessel disease Cardioembolism arterial disección or hypercoagulability Cryptpgenic TIA/stroke

TIA

Transient neurological condition due to focal cerebral, spinal cord or retinal ischemia without acute infarction. Lasting up to 24h

Symptoms of TIA

Focal neurological deficit or monocular visual disturbance Sudden onset. Maximal at onset Focal insufficiency of cerebral blood flow Lasting up to 24h

Patient with sudden pain on the left side of the neck, miosis of left pupil and ptosis of the left eyelid and hemiplegia on the right side. Cause

Dissection of the internal carotid artery

Most common location of hypertensive brain haemorrhage

Basal ganglia and thalamus

Test to confirm temporal arteritis

temporal arteritis biopsy

Temporal arteritis can be accompined by

rheumatic polymyalgia

Therapy for temporal arteritis

corticoesteroids

Right occipital headache after exercise. Her sister had breast carcinoma. Dysarthria, nystagmus, ataxia

Atherosclerotic cerebellar stroke

Antihypertensives succesful in secondary stroke prevention

ACE inhibitors

Patient with paraplegia, treated for hypertension and lipids, no sensory loss around her belly button

Spinal cord infarction

treatment in a patient with deep vein thrombosis with motor paresis after stroke

Low molecular weight heparin

The day after thrombolysis for stroke the patient is given

Aspirin, dipyridamole, statins, hypertensives

26 years old sudden headache, vomiting, slowly losing consciousness type of hemorrhage

Subarachnoid hemorrhage

Sudden hard headache, neck stiffness, vomiting without fever

subarachnoid hemorrhage

How long does a TIA usually last

20 min

temporal arteritis treatment

Methylprednisolone

Dull pain on the left side of head, radiating a little to the right. No nausea or vomiting, anemia

Temporal arteritis

Common location of lacunar ischaemic stroke

Internal capsule

Most common mechanism of cerebellar damage in penumbra

Excitotoxity

Gigantocellular temporal arteritis

Increased SR

Wallenberg syndrome which artery is affected

Vertebral artery o posterior inferior cerebellar artery (PICA)

Wallenberg syndrome damage in

Medulla oblongata

Wallenberg syndrome. CLinical

Contralateral body hyposthesia Ipsilateral facial hyposthesia Nauseas, vomiting Disartria, disfagia Horner's syndrome Ipsilateral ataxia No pyramidal or XII afectation

Speech disorder if ACM stroke

Aphasia

67 years old, dizziness, vomiting, nystagmus of grade 3 with rapid phase to the left, does not change direction when moving, little rotatory movement

Cerebellar infarction

22 years old fallen, unresponsive, looking to the right, waving her right arm, where is the damage

Right frontal lobe

Systemic vasculitis treatment

corticosteroids

CHA2 DS2-VASc is a scale for

risk of ischaemic stroke in patients with atrial fibrillation

Intracerebral hemorrhage

Abrupt onset, usually after exercise, headache, vomiting, progressive and fast loss of conscious

Cardiac patient after catheterisation with loss of sensation on the left side of the body and face damage in

Thalamus

Ischaemia critical for neurons occurs when cerebral blood flow is reduced to

10ml/100g/min

Cerebellar damage in ischaemic stroke has a pith where

cells are more severely affected

Cerebellar damage in ischaemic stroke has penembra where

cells are less severely affected

Most common location of intracerebral haemorrhage

thalamus and striatum

most important risk factor for stroke

arterial hypertension

treatment on the day after TIA in a patient with symptomatic carotid disease

high-dose statin, clopidogrel, antithypertensive until blood pressure is reduced to 139/85 mmHg

Sudden onset motor aphasia and right limb hemiparesis

Cardioembolic ischaemic stroke

Noise above the carotid artey will be

TIA

Sudden right limb hemiparesis, arms more affected than legs, unable to speak. Where is the lesion

left cerebral media artery

Consequence of a patient that felt and tore his meningea media artery

epidural haematom a

Right patient with infarction in the area of cerebral media artery on the right, desviation of the view to the

right

Right patient with infarction in the area of cerebral media artery on the right, hemiparesis on the

left

In neglet syndrome in which hemisphere are lesion and what happen

non-dominant hemisphere, deficit in the contralateral side of the lesion stimulus

how to remove large thrombus in cerebral veins

intra-arterial with mciro-tools

Long-term consequence of lacunar strokes

Dementia

Is bleeding common in the mesencephalon?

Lacunar stroke symptoms

right hemiparesis and dysarthria

Test for intracranial aneurysm

CT angiography

most sensitive test for intracranial aneurysm

digital substraction angiography

Cerebral artery is most commonly involved in aneurysms

cerebral artery

Treatment for obstructive hydrocephalus after SAC

external ventricular drainage

Sudden severe headache in the occipital area, spreading to the whole head

subarachnoid

Parient with SAH, aneurysm most common at

a. communicans anterior

bilateral aneurysm of a. carotis interna can cause

binasal haemianopsia

likely site of intracerebral haemorrhage due to hyalinosis

Thalamus

Stroke, hemorrhage, cerebrovascular diseases Flashcards

(81 cards)