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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


bridging veins

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


supratentorial herniation

uncal, central(transtentorial), cingulate (subfalcine), transcalvarial


infratentorial herniation

upward (upward cerebellar or upward transtentorial), tonsilar (downward cerebellar)


cingulate herniation

anterior cerebral artery. leg weakness


transtentorial herniation

reticular activation system, corticospinal tract. decorticate posturing, rostral-caudal deterioration


uncal herniation

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.


berry aneurysm

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.


intracranial hemorrhage

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


cerebral amyloidosis

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


cavernous malformations

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
left side-aphasia
right side-neglect
eyes deviate toward lesion
CL hemianopsia (visual field deficit). broca+ weakness- superior. wernicke+ non weakness- inferior.


PCA infarct

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

internal capsule


pure sensory stroke



lacunar stroke patterns

1) pure sensory
2) pure motor
3) ataxis hemiparesis
4) clumsy-hand/dysarthria
usually no higher cortical fun ban-aphasia, neglect unless thalamic.


wallenberg leson

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
3) horners


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


amaurosis fugax

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


carotid dissection.

horner's syndrome due to damage to SNS


stroke Tx

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
all should:
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


stoke workup

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


anti-ppl syndrome

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


vasculitis angio

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


posterior reversible encephalopathy syndrome (PRES)

usually due to sudden, drastic incr in BP. common in eclampsia. can also affect cerebellum though most often in occipital lobe. present with seizure, visual disturbances, HA, mental status changes