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Flashcards in Vascular Disease Deck (40):

The anterior circulation comes from what main arteries?

the common carotids


What areas are supplied by the ACA?

anterior medial cerebral hemispheres, caudate nuclei and basal frontal lobes


What artery connects the two ACAs?

the anterior communicating artery


True or false: the lenticulostriate arteries branches to the basal ganglia and internal capsule off the ACA.

false - they come off the MCA


What areas are supplied by the MCA?

the basal ganglia/internal capsule
lateral cerebral hemispheres superior to the sylvian fissure
temporal and inferior parietal lobes


What artery arises from the ICA after the ophthalmic and posterior communicating artery to course along the optic tract giving off branches to the globus pallidus and posterior limb of the internal capsule and then supplies the medial temporal lobe and the lateral genicular body?

the anterior choroidal artery


In general terms, the posterior circulation comes from what vessels?

the vertebral arteries off the subclavian


The intracranial vertebral arteries join to form what artery?

the basilar at the pontomedullary junction


What percentage of strokes are ischemic?



What are the three general categories of ischemic stroke/

systemic hypoperfusion


What are some causes of occlusive vascular pathologies affecting the brain?

atherosclerosis is the most common
fibromuscular dysplasia
arterial dissection


WHere do emboli causing embolic strokes typically arise from?

heart, aorta, neck arteries or intracranial arteries


In general, what will happen in a left cerebral hemisphere stroke?

right hemiparesis
right hemisensory loss
in large lesions, conjugate deviation of the eye to the left, right hemianopia or hemi-inattention


In general, what will happen in a right cerebral hemisphere stroke?

left hemiparesis
left hemisensory loss
poor drawing and copying
neglect of the left visual field
large lesions with conjugate deviation of the eyes to the right


Occlusion of what vessel will give you lateral medullary syndrome (or wallenberg syndrome?

intracranial vertebral artery occlusion


What are the signs and symptoms of lateral medullary syndrome?

ipsilateral facial pain or reduced pain and temp sensation on the ipsilateral face, or both

loss of pain and temp in the contralateral limbs and body

ipsilateral horner's syndrome


incoordination of the ipsilateral arm

leaning and veering while sitting or walking with gait ataxia

in deep lesions: dysphagia and horseness


What signs and symptoms will you see in a bilateral pontine base stroke due to basilar artery occlusion or pontine hemorrhage?


unilateral or bilateral conjugate gaze paresis, sometimes internuclear ophthalmoplegia and VIth nerve palsy

if the medial tementum is involved bilaterally, coma


What will you see in a cerebellar infarction?

gait ataxia, often inability to walk


ipsilateral arm dysmetria


What symptoms would you see in a left PCA territory stroke?

right homonymou shemianopia
at times, amnesia
alexia without agraphia when the splenium of the corpus callosum is involved


What symptoms would you see in a right PCA territory stroke?

left homonymous hemianopia
at times, left-sided visual neglect


What are the four main lacunar stroke syndromes?

pure motor
pure sensory
dysarthria-clumsy hand syndrome
ataxic hemiparesis


Where is the lesion in a pure motor stroke and what symptoms do you expect?

the posterior limb of the internal capsule with contralateral weakness of the arm, face and leg without sensory, visual or cognitive or behavioral signs


Where is the lesion in a pure sensory stroke and what symptoms do you expect?


paresthesiae of the contralateral body, limbs and face without any other deficit


WHere is the lesion in dysarthria-clumsy hand syndrome?

pons, with slurred speech and clumsiness of the contralateral hand


Where is the lesion in ataxic hemiparesis?

pons with weakness and ataxia of the contralateral limbs, often greater in the leg and foot than in the arm and hand


Patient presents with severe retro-orbital headache and horner syndrome (with preserved perspiration). What happened?

carotid dissection ipsilateral to where the pain is


Why do you get a horner syndrome with preserved perspiration with a carotid dissection?

you get horner's syndrome due to involvement of the ascending oculosympathetic tract but perspiration is preserved because sudomotor fibers ascend with the external carotid, not the internal carotid


Patient presents with neck pain and a third nerve palsy after going to the chiropractor. What happened?

vertebral artery dissection


What color will a hemorrhage be on CT? What color will infarction be on CT?

hemorrhage is white
infarction is dark


Which imaging test is more sensitive than CT to identify acute infarction?

MRI with diffusion-weighted imaging


What are the three general strategies for reperfusion?

intravenous thrombolysis with tPA
intra-arterial thrombolysis near the clot
mechanical clot retrieval


What is the time limit for tPA administration?

4.5 hours


What is the time limit for intra-arterial thrombolysis or mechanical clot retrieval?

6 hours


Prevention of further ischemia is usually necessary 24 hours after tPA administration. What should you use if the stroke was caused by lacunar infarction or atherosclerotic disease?

high-dose aspirin
or if they had been on aspirin prior to the stroke (failed aspirin), clopidogrel


What should you use to prevent further ischemia if the stroke was caused by atrial fibrillation with embolization?

heparin with eventual transition to warfarin


Subarachnoid hemorrhage is usually bleeding from where?

an aneurysm in the circle of willis


Describe management for SAH?

aneurysms can be surgically clipped or soiled

Nimodipine to minimize vasospasm and delayed brain ischemia


What is the most common cause of intracerebral hemorrhage? WHat about in the elderly?

hypertension in general

in the elderly, consider cerebral amyloid angiopathy affecting the parietal and occipital lobes


WHat are the most common locations for hypertensive intracerebral hemorrhage?

basal ganglia-internal capsule, caudate, thalamus, pons, cerebellum


What are three congenital malformations that can lead to brain bleeds?

arteriovenous malformations
developmental venous anomalies
cavernous angiomas