Flashcards in Vascular 2 Deck (47):
complication of epidermal hematoma
CN3 compression --> IL pupillary dilation and down and out. PCA compression--> ischemia of IL visual cortex and CL VF deficit. brain stem compression --> duet hemorrhage. compression of CL cerebral peduncle- IL hemiparesis= false localizing sign
epidural hematoma tx
immediate neurosurigical evaculation. small ones can be monitored clinically and radiographically
drain from surface of brain into venous sinus. often hurt in subdural hematoma. stretched in alcoholics and elderly due to brain atrophy so at risk for subdural hematoma
uncal, central(transtentorial), cingulate (subfalcine), transcalvarial
upward (upward cerebellar or upward transtentorial), tonsilar (downward cerebellar)
anterior cerebral artery. leg weakness
reticular activation system, corticospinal tract. decorticate posturing, rostral-caudal deterioration
cerebral peduncle, CN3, PCA. hemiparesis, pubil dilatation, visual field loss
subarchnoid hemorrhage: causes
severe diffuse HA. vomit then collapses. no facal neural signs. pain when flex neck. outcome most deep on lvl of consciousness in the ER. mot common cause is trauma. non trauma- berry aneurysm. RF: drug use, polycystic kidney disease, fibromuscular dysplasia.some have sentinel HA. LP show blood in CSF. if traumatic no xanthochromia.
80% in anterior circulation. 20% in posterior circulation. rupture --> subarachnoid hematoma
common complication of SAH. can result in stroke. prevent through nimodipine= Ca ch blocker. deliver to site via angiography
yellow CSF due to breakdown of RBC in CSF. found in SAH
subarachnoid Hämorrhagie tx
neurological clipping or endovascular coiling of aneurysm. better the pt is clinically, earlier you should repair aneurysm to prevent rebleeding. nimodipine prevent vasoplasm and triple H terrify- HT,N, hypervolemia, demodulation.
often in putamen, pons, cerebellum, thalamus. most likely to need surgical intervention if in the cerebellum- occlusion of 4th ventricle- obstruct CSF --> hydrocephalus and death
repeate intracerebral hemorrhage in dif lobes. congo red stain and polarized light. amyloid deposition in walls of CNS
intracranial bleeding causes
bleeding into cavernoma, head trauma- most common cause. more progressive onset than ischemic strokes. dear lvl of consciousness and hA. often bleeds and infarct can't be distinguished clinically =why need CT.
due to rupture of small, penetrating arteries weakened by HTN= biggest RF
need urgent surgical drainage or else acute hydrocephalus due to compression of 4th V= fatal. hemorrhage often due to cerebral amyloidosis in elderly
are masses of abnormal vessels wo recognizable intervening neural tissue. often silent but can cause HA, seizures, focal neurological deficits. popcorn like mass. can tx surgically if there are repeated bleeds of intractab
anterior cerebral artery stroke sx
CL M/S deficit. leg> arm/face.
frontal lobe abn - akinetic mutism
left side-transcortical motor aphasia.
right side- neglect.
urinary incontinence -apathetic
MCA stroke sx
CL M/S deficit. face/arm> leg. Visual field deficits
eyes deviate toward lesion
CL hemianopsia (visual field deficit). broca+ weakness- superior. wernicke+ non weakness- inferior.
CL hemianopsia, alexia wo agraphia for left sided. pt may be unaware of visual field loss or perceive it as coming from only 1 eye. large lesion may cause CL M/S deficit due to involvement of midbrain or thalamus
lacunar stroke and most common areas
infarct of small vessel- 20% ischemic stroke. common areas: subcortical WM, BG/posterior limb of internal capsule, thalamus, pons, cerebellum= same areas as for hemorrhagic stroke bc biggest RF for both = HTN
changes in small arteries that result in lacunar strokes
pure motor stroke
pure sensory stroke
lacunar stroke patterns
1) pure sensory
2) pure motor
3) ataxis hemiparesis
usually no higher cortical fun ban-aphasia, neglect unless thalamic.
aka lateral medullary syndrome. occlusion of vertebral artery or PICA. features:
1) dysphagia, hoarseness, dizziness, N/V, nystagmus, balance/gait corrdination prob. intractable hiccups tx with thorazine
2) lose P/T on CL side. IL on face
cerebellum stroke area v effect
lateral- ataxia of IL arm/leg. medial- racial M and present with gait and balance prob
venous infarct; describe, deficit, sx, RF
more indolent than arterial. focal neurological deficit. present with seizure, HA or sx of incr ICP. LP show incr elevated opening P- papilledema.
RF: hypercoag state: preg/postpartum, infection, meds (OCP, smoking)
venous infarct tx
immediate heparin even if bleeding
temprory occlusion of central retinal artery that cause curtain coming down 1 eye. monocular blindness
locked in syndrome location
occlusion of tip of basilar artery = lesion in ventral pons
vertebral artery dissection
common in chiropractor twisted head. present with neck pain and sx of ischemia. hornets can occur as part o fwallenbergs
horner's syndrome due to damage to SNS
within 3hr- TPA. >3hr- aspirin
dense MCA sign
although CT normal for many hr after stroke, clot within vessel may be seen
CI: pt with minor or rapidly resolving deficits, blood glucose 185/110. INR>1,7. pot count less than 100,000. saves penumbra- ischemic but not yet infarcted tissue
CI: active bleeding, recent surgeries, coagulopathies
main risk is hemorrhage-6%
best imaging modality for acute ischemic stroke
diffusion weighted MRI. hyper intensity on dMRI with corresponding hypo intensity on ADC= restricted diffusion= characteristic of ischemia.
post stroke psych
most often depression. post stroke mania most likely due to right sided stroke
stroke pt management
goal: prevent secondary stroke
1) start on high dose statin regardless of lipid profile
2) goal BP 120/80. ***
3) blood glucose, HgBA1c- treat DM
4) smoking cessation, modify diet, physical exercise
1) anticoag or antiplatelets dep on cardioembolic or atherosclerotic event. get TEE --> clot in heart? if yes--> anticoag. EKG - fib? --> if yes, anticoag. if no I for anticoag, use anti-ply. clopidogrel more effective in presenting MI than ASA.
2) should have carotid endarectomy or carotid stent. carotid doppler or MRA--> if >70% stenosis - endarectom y in 2wks
screen by testing lupus anticoag and anticardiolipin ab. often women with spontaneous abortion. tx- warfarin. ck cocaina dn infection like syphilis HIV
inherited stroke disorder
cadasil, melas, sickle cell disease
auto dom disease with migraine, dementia and multiple lacunar strokes
mito D with stroke like epic in occipital region. present with seizures and dementia in adolescence
beads on a string.
global cerebral anoxia
loss of distinction between GM and WM. diffuse edema with sulk effacement. bilateral uncle herniation. diffuse compression of ventricular system. can't recover