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Flashcards in Vascular Neurology Deck (45)
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1
Q

Enzyme in Fabry

A

alpha-galactosidase

accumulation of globotriaosylceramide in vascular SmM and EndoT –> stroke

2
Q

hemorrhage rate unruptured aneurysms

A

<10 mm = 0.05%/yr
10-25 mm = 1%/yr
>25 mm = 6%

3
Q

TCD cutoff for Exchange Transfusion in SCD>

A

200 cm/s (in MCA)

target HbS 30%

4
Q

preferred Rx of VOG malformation

A

embolization

5
Q

goal MAP in ICH w known hypertensive pt

A

130 mmHg

6
Q

PAN size arteries affected

A

small and medium sized arteries

7
Q

Recurrent bleeding rates of vascular malformations

A
DVA: 0.15%/yr
HTN: 2%/yr
Cav mal: 4.5%
AVM: 3-34% (dep. Characteristics)
CAA: 10%
8
Q

Seizure rates w acute cerebrovascular Dz

A

AIS : 6%
SAH: 5%
ICH: 30% (cortical), 5% subcortical

9
Q

peak SAH periods

A
re-bleeding = 12-48 hr
vasospasm = 3-?14 (Borsody = 4-7)
10
Q

Basic pathophys of MTHFR mutation

A

Cannot convert Hcy back to Methionine, both increase in homocystinemia

11
Q

Esoteric condition asoc w marantic endocarditis

A

AIDS, DIC, SLE

12
Q

Synonym for Factor V Leiden

A

activated Protein C resistance (Factor V Leiden resists cleavage by Protein C)

13
Q

AVM vs. CavMal vs. DVA

A

AVM = arterial-venous anastomosis, no parenchyma between vessels
CavMal (aka cavernoma/cavernous hemangioma) = abnormal venous structures, no parenchyma between vessels, +/- adj. cortical dysplasia
DVA = (aka venous angioma) = cluster of normal venous str

14
Q

Arterial layer MC involved in FMD?

A

Tunica media

Usually results in tunica medica fibroplasia

15
Q

CHADS2 components

A

CHF at onset of AF, Hypertension, Age >75, Diabetes, Stroke/TIA(+2)
Annualized stroke risks on ASA: 0 (1%), 1 (2%), 2 (4%), 3 (8%), 4 (10%), 5 (12%), 6 (14%)

16
Q

ABCD2 components

A

Age > 60 +1
BP > 140/90+1
Duration (<10 min+0, 10-59min+1, >60 min+2)
Diabetes+1
Clinical (other symptoms+0, speech disturbance wo weakness+1, unilateral weakness+2)

17
Q

Stroke recurrence rates by TOAST

A

Extracranial LAA > cardioembolic > intracranial LAA > lacunar

18
Q

size of cerebellar ICH for surgery?

A

3 cm

19
Q

re-bleeding rate SAH (first week; unsecured)

A

20%

20
Q

Sturge Weber

A

Neurocutaneous capillary malformation
leptomeningal angioma + capillary malformation (port wne stain over V1) + eye capillary malformations
MC presentation = seizure in infancy, or stroke-like episodes

21
Q

Sneddon syndrome

A

positive Lupus AC, livedo reticularis, stroke

22
Q

Blood age on MRI

A

oxyHg (hyperacute) –> deoxyHg (acute) –> intrac metHg (early subacute) –> extrac metHg (late subacute) –> hemosiderin (chronic, intra)

23
Q

Percent of CT-neg SAH?

A

5%; 70% CSF is positive for xantho within 6 hours, 90% within 12 of SAH

24
Q

CADASIL vs. MELAS

A
CADASIL = Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. NOTCH3 mutation; deposition in media of end-arteries that surround SmM cells; subcortical stroke + dementia + migraine +/-mood d;
MELAS  = Mitochondrial Encephalopathy, Lactic acidosis, Stroke-like episodes. mRNA mutations; occipital, multi-territory stroke + dementia + migraine + seizures + SN hearing loss + ret
25
Q

Gene in Pseudoxanthoma Elasticum

A

ABCC6 gene (encodes MRP6 protein, function unknown)

26
Q

MOA of aspirin?

A

irreversible inhibitition of COX production of TXA;

also inhibits vasodilatory prostacyclin production

27
Q

MOA of dipyridamole?

A

inhibition of cAMP-phosphodiesterase –> incr cAMP
blocking adenosine reuptake. Also vasodilation (HA)
end result = inhibition of platelet aggregation

28
Q

MOA of clopidogrel?

A

Blocking of adenosine diphosphate (ADP) binding to Adenosine (R)

29
Q

MOA of ticlopidine?

A

poorly understood, but inhibits platelet aggregation

30
Q

MOA of warfarin

A

inhibits Factors II, VII, IX, X, C+S

basically acts on both intrinsic + extrinsic systems

31
Q

MOA of heparins?

A

ALL: activates Antithrombin III, which then:
Unfractionated: inhibits Factor X = Factor II
Lovenox: X > II

32
Q

MOA of dabigatran?

A

direct thrombin inhibitor (Factor II)

33
Q

MOA of t-PA?

A

activates plasminogen, which turns Factor I (fibrin clot) into fibrin degradation products

34
Q

MOA of edoxaban, apixaban, rivaroxaban

A

Factor Xa inhibitors (Factor Xa activates prothrombin into thrombin)

35
Q

MOA of statins?

A

HMG-CoA reductase inhibition
inhibits enzyme that catalyzes production of mevalonic acid)
–> inhibits cell production of cholesterol

36
Q

MOA of thiazide diuretics?

A

Block reabsorption of NaCl from distal tubule
increase Ca2+
decrease K+
decreases Na+ –> hyponatremia

37
Q

MOA of furosemide?

A

Loop diuretic. Block Na+, Cl-, K+ reabsorption in Loop of Henle.
Can also cause hypoK/Na/Mg/Ca2+
Can cause hyperuricemia

38
Q

MOA of nitrates?

A

venodilation through donation of NO.

39
Q

MOA of different CCBs?

A

Dihydropyridine (-dipine): vasodilation (vessels>heart)

verapamil: cardioselective (AE = neg inotropy)
diltiazem: intermediate

40
Q

MOA of cilostazol?

A

inhibition of phosphodiesterase (platelet inhibition) + vasodilation

41
Q

MOA of abciximab/eptifibatide?

A

blocking binding of GP2a/3b with fibrinogen (humanized monoclonal ab against glycoprotein IIb/IIIa R).

42
Q

MOA of eptifibatide?

A

GP2b/3a receptor antagonist

43
Q

most common AE of clopidogrel?

A

rash

44
Q

cardioselective beta blockers

A

Eskimos (esmolol) Ate (atenolol) Ace (acebutolol) Butt (??) Meat (metoprolol)

45
Q

MOA of doxazosin

A

alpha blocker