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Cns > Vascular > Flashcards

Vascular Flashcards

1
Q

What is the most common cause of intracerebral hemmorage in the elderly?

A

Amyloid angiopathy

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2
Q

What amount of TIAs result in stroke?

A

1/3, 11% in the next week

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3
Q

Define TIA

A

transient ischemic attack
lasts average 12 min -rule: less than 24 hours
due to partial occlusion or blockage temporary
-not acute tissue infarct

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4
Q

What are causes of TIA’s?

A
  1. Atherosclerosis
  2. arterial disection
  3. embolic sources: valve, ventral throm, Afib, aortic arch disease
  4. arteritis (noninfectious necrotizing vasculitis), local trauma or drugs
  5. sympathomimetric drugs
  6. hyper coag state due to infection, cancer, genetic
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5
Q

Sympathometric durgs, arteritis, atherosclerosis, embolus, hypercoag and arterial dissections can all cause…

A

TIAs

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6
Q

How does a TIA present?

A

change in speech, behavior, memory
change in gait or movement
for less than 24 hours then resolves

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7
Q

What should be ruled out before Dx TIA?

A

hyperglycemia(most common)
SAH, SDH (most lethal)
seizure (also common)
less likely: carotid dissection or syncope

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8
Q

What is the treatment for TIA?

A

Rapid hospital transit ABCs monitor

Stroke prevention with anti coags once SAH, SDH ruled out

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9
Q

What are the diagnostics for diagnosing TIA

A

rule out hyperglycemia: glucose stick
CBC and coag studies
serum electrolytes: rule out cardiac involvement
IMAGING: MRI diffusion weighted within 24 hours

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10
Q

What are possible causes of hemmoragic stroke?

A

intraparenchymal hemorrhage, SAH, Av malformations

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11
Q

What percentage of strokes do intraparenchymal hemorrhages cause?

A

15% of all strokes

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12
Q

How does and intraparenchymal (intracerebal) hemorrage present?

A

acute onset
headache, nausea
neuro signs dependent on location of bleed
rapidly progressing (lose consciousness in <1day

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13
Q

What would you see on imaging of intrparenchymal hemorrhage?

A 
CT scan (fresh blood high signal)
midline shift of tentorium cerebri
wouldn't see blood in sinuses initially because breaks through ventricle then goes to subdural sinuses
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14
Q

What is the mortality rate for intraparenchymal hemmorrage?

A

40%, worse if intraventricular (xanthoid CSF-blood in CSF)

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15
Q

What is the number one cause of intrparenchymal hemorrage in young people?

A

sympathomimetric (cocaine) drugs

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16
Q

What is the most common cause overall for intraparenchymal hemorrhage?

A

HTN 50-60% can be chronic or acute elevation

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17
Q

What are less common causes of intraparnechymal hemmorage?

A

head trauma, vascular abnormalities

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18
Q

What is the treatment for IPH?

A

CT scan to diagnose
early decompress surgery for large cerebellar hematomas
mannitol
hyperventilation for HTN
extraventricular drain to prevent hydrocephalus

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19
Q

What are some complications to consider in IPH?

A

edema
hemisphere herniation
issues with anticoagulants (dont want anticaogs right now)

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20
Q

How do you prevent IPH?

A

manage HTN

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21
Q

What is the most common population for SAH?

A

elderly and alcoholics

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22
Q

What is the etiology of SAH?

A

non trauma= rupture sac aneurysm (MC)
aneurysm of perimesencephalic vessels in ambient cistern 10%
AV malformation 5%

trauma

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23
Q

What are 85% of SAH caused by?

A

aneurysmal bleed

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24
Q

What is seen on SAH imaging?

A

star shaped man

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25
Q

What are some risk factors for aneurysm?

A

genetics, age, toxins

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26
Q

What are some comorbidities for anerurysms?

A

polycystic kidney disease
ehlers-dahlos IV
neurofibromatosis I
Amyloidosis causes vessels to be friable (#1 cause of SAH in elderly)

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27
Q

What populations are more like to get both SAH and IPH?

A

asian and african

hispanics likely to get SAH too

28
Q

What is the mortality for SAH?

A

40%

29
Q

How does SAH present?

A 
stiff neck
worst head ache out of the blue
depression of arousal
seizure-blood as irritant
>72 hours after SAH vasospasm and infarct
30
Q

What is the diagnosis gold standard for aneurysm?

A

digital sub angiography

31
Q

What is the diagnostic test for SAH?

A

CT-DX 90% od SAH

only 10% need Lumbar puncture (see xanthoid CSF)

32
Q

What is pathonomonic for SAH?

A

xanthoid CSF, star sign on imaging, worst headache of your life out of the blue

33
Q

What is the treatment for SAH

A

40% mortality in less than 24 hours
surg repair of aneurysm
drain and shunt
Triple H therapy: hemodilution, HTN, hypervolemia

34
Q

What are some prevention measures for SAH?

A 
smoking cessations (toxins), decrease hypertension, decrease alcohol
assess for comorbidities: polycystic disease, ehlers Danos IV, neurobiromatosis I
35
Q

What can lead to stoke but can also present as seizure?

A

TIA, SAH, AV malformation

36
Q

What are the 2 types of vascular malform that are problematic (can lead to hem stroke?

A

angiovenous and cavernous

37
Q

How does an AV or cavernous malformation present?

A 
silent throughout life
headache
focal seizure 30% of cases
can rapidly progress  like intraparenchymal hem (can then enter CSF via ventricles to become SAH)
or
can resolve
38
Q

What percentage of the pop have a type of AV malformation?

A

less than 1%

39
Q

How would you treat an AV malformation?

A

conservative if not easily treated
-avoid high P
-warfarin
-regular neurovisits
If bleed and area too difficult to get to
-stereostatic angiogram: high energy causes AV to clot off and scar
If bleed and area easy to get to
-surgical removal of AV
-intercentrical neuroradiation endovascular surgery

40
Q

What is the pathology of AV or cavernous malformation that would cause hem stroke?

A

AV huge mass of arteries and veins with scarred brain tissue between from previous infarct
Cavernous: vessels lay next to each other
At anastomosis, oxygen in veins and high pressure in veins
high pressure causes hemorrage or seizure

41
Q

What does not show up on routine angiogram but can cause hemmorragic stroke?

A

cavernous Av malformation

42
Q

What is the difference between concussion and contusion?

A

Contusion implies a cerebral vessel bleed

concussion characterized by brief loss of consciousness does not include a bleed

43
Q

What is the difference between syncope and concussion?

A

syncope involves fainting not related to trauma

44
Q

What would distinguish an abcess from a stroke?

A

stroke would have irregular borders and abcess would have clear borders with a midline shift
abscess also could have multiple contractions

45
Q

where would bacteria abscess be found if it seeded hematogenously?

A

in the middle cerebral artery from the internal coratid so from the body and no right turns

46
Q

What should be evaluated first if there is a fall and loss of consciousness or onset of confusion?

A

response to verbal and painful stimuli

47
Q

What type of hematoma can have continued consciousness?

A

subdural (can be chronic)

epidural and SAH and IPH progress more rapidly

48
Q

In a patient with only medullary function (no CN reflexes, no eye reflex, unconscious) what should be evaluated?

A

respiratory and cardiac because this is all that is left and what the medulla does

49
Q

How do contusions image on CT?

A

bright white patches of petechial hemmorrages in hemispheres themselves (SAH and subdural do not show up in hemispheres)

50
Q

what causes 50% of all ischemic strokes?

A

carotid stenosis

51
Q

When a bruit in the carotid is found, what is the likelihood the carotid is stenotic?

A

1 in 3, 35%

next move is to ultrasound to find out if it is stenotic

52
Q

What is the etiology of carotid stenos?

A

atherosclerosis

53
Q

What is the presentation of an ischemic stroke?

A

85% of all strokes
focal signs dependent on location
embolic-very acute and rapidly evolve
often followed by cardiac event
thrombotic-50% have prodrome, 40% evolve slowly over the day
still considered acute event

54
Q

Why use a perfusion MRI and CT if a patient is having acute neuro focal signs?

A

ischemic events do not show up until 24 hours have passed on CT. Ischemic stroke doesnt show up for 24 hours

55
Q

What type of ischemic stroke is most common?

A

embolic

56
Q

What type of embolic stroke is most common?

A

heart to artery so want to get an echocardiogram of valves

57
Q

What can cause an embolus?

A

Valvular disease, hypertension, AFIB, carotid stenos, hyperlipidemia

58
Q

What are some risk factors for ischemic stroke?

A

HTN, afib, diabetes, smoking, carotid stenosis, hyperlipedemia

59
Q

What do 30% of all strokes involve?

A

atherosclerotic or lipohylanosis characteristics of large vessel (thrombotic)

60
Q

What type of vascular event can be chronic and present as prolonged alteration of consciousness?

A

subdural
Subarachnoid and intraparenchymal both obtund in 24 hours
epidural also has more rapid sequelae

61
Q

If a patient has carotid bruit, what are the chances that the carotid is over 50% stenotic?

A

1 in 3

62
Q

If a patient has a bruit in their carotid what is the best next step?

A

ultrasound to assess occlusion of the carotid (see if it is stenotic)

63
Q

What is the most common cause of an MCA stroke?

A

embolus

from the heart valves (assess with echocardiogram)

64
Q

after a MCA ischemic stroke what is a possible sequelae?

A

hemmorage from the infract (follow up CT shows bright white blood spreading)

65
Q

during a hemorragic stroke or intraparenchymal hemmorage what should be the first action?

A

make sure patient is not on anticoagulants(these are useful if you think patient had an thrombotic event in the past 3 hours)

Cns (12 decks)

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