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Vascular Flashcards

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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
What are some risk factors for aneurysm?
genetics, age, toxins
26
What are some comorbidities for anerurysms?
polycystic kidney disease ehlers-dahlos IV neurofibromatosis I Amyloidosis causes vessels to be friable (#1 cause of SAH in elderly)
27
What populations are more like to get both SAH and IPH?
asian and african | hispanics likely to get SAH too
28
What is the mortality for SAH?
40%
29
How does SAH present?
``` stiff neck worst head ache out of the blue depression of arousal seizure-blood as irritant >72 hours after SAH vasospasm and infarct ```
30
What is the diagnosis gold standard for aneurysm?
digital sub angiography
31
What is the diagnostic test for SAH?
CT-DX 90% od SAH | only 10% need Lumbar puncture (see xanthoid CSF)
32
What is pathonomonic for SAH?
xanthoid CSF, star sign on imaging, worst headache of your life out of the blue
33
What is the treatment for SAH
40% mortality in less than 24 hours surg repair of aneurysm drain and shunt Triple H therapy: hemodilution, HTN, hypervolemia
34
What are some prevention measures for SAH?
``` smoking cessations (toxins), decrease hypertension, decrease alcohol assess for comorbidities: polycystic disease, ehlers Danos IV, neurobiromatosis I ```
35
What can lead to stoke but can also present as seizure?
TIA, SAH, AV malformation
36
What are the 2 types of vascular malform that are problematic (can lead to hem stroke?
angiovenous and cavernous
37
How does an AV or cavernous malformation present?
``` 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
What percentage of the pop have a type of AV malformation?
less than 1%
39
How would you treat an AV malformation?
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
What is the pathology of AV or cavernous malformation that would cause hem stroke?
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
What does not show up on routine angiogram but can cause hemmorragic stroke?
cavernous Av malformation
42
What is the difference between concussion and contusion?
Contusion implies a cerebral vessel bleed | concussion characterized by brief loss of consciousness does not include a bleed
43
What is the difference between syncope and concussion?
syncope involves fainting not related to trauma
44
What would distinguish an abcess from a stroke?
stroke would have irregular borders and abcess would have clear borders with a midline shift abscess also could have multiple contractions
45
where would bacteria abscess be found if it seeded hematogenously?
in the middle cerebral artery from the internal coratid so from the body and no right turns
46
What should be evaluated first if there is a fall and loss of consciousness or onset of confusion?
response to verbal and painful stimuli
47
What type of hematoma can have continued consciousness?
subdural (can be chronic) | epidural and SAH and IPH progress more rapidly
48
In a patient with only medullary function (no CN reflexes, no eye reflex, unconscious) what should be evaluated?
respiratory and cardiac because this is all that is left and what the medulla does
49
How do contusions image on CT?
bright white patches of petechial hemmorrages in hemispheres themselves (SAH and subdural do not show up in hemispheres)
50
what causes 50% of all ischemic strokes?
carotid stenosis
51
When a bruit in the carotid is found, what is the likelihood the carotid is stenotic?
1 in 3, 35% | next move is to ultrasound to find out if it is stenotic
52
What is the etiology of carotid stenos?
atherosclerosis
53
What is the presentation of an ischemic stroke?
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
Why use a perfusion MRI and CT if a patient is having acute neuro focal signs?
ischemic events do not show up until 24 hours have passed on CT. Ischemic stroke doesnt show up for 24 hours
55
What type of ischemic stroke is most common?
embolic
56
What type of embolic stroke is most common?
heart to artery so want to get an echocardiogram of valves
57
What can cause an embolus?
Valvular disease, hypertension, AFIB, carotid stenos, hyperlipidemia
58
What are some risk factors for ischemic stroke?
HTN, afib, diabetes, smoking, carotid stenosis, hyperlipedemia
59
What do 30% of all strokes involve?
atherosclerotic or lipohylanosis characteristics of large vessel (thrombotic)
60
What type of vascular event can be chronic and present as prolonged alteration of consciousness?
subdural Subarachnoid and intraparenchymal both obtund in 24 hours epidural also has more rapid sequelae
61
If a patient has carotid bruit, what are the chances that the carotid is over 50% stenotic?
1 in 3
62
If a patient has a bruit in their carotid what is the best next step?
ultrasound to assess occlusion of the carotid (see if it is stenotic)
63
What is the most common cause of an MCA stroke?
embolus | from the heart valves (assess with echocardiogram)
64
after a MCA ischemic stroke what is a possible sequelae?
hemmorage from the infract (follow up CT shows bright white blood spreading)
65
during a hemorragic stroke or intraparenchymal hemmorage what should be the first action?
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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