Neuro- Cerebrovascular Disease

Front 1

What are the three main kinds of cerebrovascular disease?

Back 1

ischemic stroke

hemorrhagic stroke

subarachnoid stroke

Front 2

How do ischemic strokes normally present? What are the three main mechanisms?

Back 2

present as acute, focal, neurologic deficit due to ischemia

MOA: thrombotic, embolic, hypoperfusion

Front 3

What are the main risk factors for having an ischemic stroke?

Back 3

diabetes, hypertension, smoking, male, increased age, high choleresterol, cardiac ( a fib, MI, valve, low EF)

Front 4

Amaurosis Fugax

Back 4

A loss of vision in one eye, pull down like a curtain

indicates extracranial carotid artery disease

10%/yr stroke risk
test with ultrasound of carotid

Front 5

Transient hemispheric attacks

Back 5

Contralateral motor and sensory deficits

MCA

Front 6

Carotid artery stroke

Back 6

asymptomatic if collateral good

MCA/ MCA/ ACA stroke

Front 7

MCA stroke

Back 7

contralateral hemiparesis and sensory impairment with more arm and face involvement

homonymous hemianopsia- optic radiations

gaze preference- eyes look away from hemiplegia

Front 8

what are the differences in Left (Dominant) and right (Nondominat) MCA strokes?

Back 8

Left: Wernicke's (receptive) , Broca's (expressive) , global aphasia

Gerstmann's syndrome: left right confusion, finger agnosia, acalculia, agraphia- angular ans supramarginal gyrus

Right: ansosognosia- denial of illness
asomatosognsia- denial of body part

Front 9

ACA stroke

Back 9

contralateral hemiparesis and sensory involvement with more leg than arm involvement

urinary incontinence

abulia, slowness, frontal release signs

Front 10

Vertebral and Basilar artery stroke

Back 10

Crossed symptoms: ipsilateral CN, contralateral body

Horner's syndrome
Hoarseness, dysphagia, hiccups
Nystagmus, vertigo, nausea, vomiting
blindness- occipital lobe involvement
Diplopia/ internuclear ophthalmoplegia
gaze palsy
ipsilateral limb ataxia
eye movement abnormalities/ coma

Front 11

Lateral Medullary symptoms

Back 11

PICA stroke

contralateral: pain, temp of arm and leg (STT)

ipsilateral
decreased pain and temp of face (CN5)
Horner's (sympathetic)
Hoarseness, dysphagia, hiccups, gag (nucleus ambiguous)
nystagmus, vertigo, nausea, vomiting (vestibular nuclei)
limb ataxia (cerebellum)

Front 12

posterior Cerebral artery stroke

Back 12

homonymous hemianopsia (occipital lobe)
memory difficulties (temporal lobe)
absence of other symptoms (aphasia, hemiparesis)
prosopagnosia (inability to recognize faces)
alexia without agraphia (left occipital/splenium) - can't read but can write by hand

Front 13

Pure Motor stroke

Back 13

2/3 of all symptomatic lacunes

Symptoms: weakness of contralateral face, arm, leg

MOA: infarct of motor fibers as they ascend in the posterior limb of the internal capulse ( lenticulostriate of MCA)

Front 14

Ataxic hemparesis

Back 14

ataxia more than weakness

MOA: infarct ascending cerebellar pathways

Front 15

Pure sensory strokes

Back 15

symptoms: decreased sensation in contralateral face, arm, leg

MOA: infarct of sensory limb or internal capsule or VPM/ VPL in thalamus (thalamogeniculate of PCA)

Front 16

Mixed motor and sensory stroke

Back 16

uncommon because of different vascular distributions

Front 17

Hemiballismus small vessel stroke

Back 17

MOA: infarct of subthalamic nucleus as its medial to the internal capsule

lenticulostriate of MCA

Front 18

What are the treatments for ischemic strokes?

Back 18

Increase perfusion to the brain

anticoagulation

Antiplatelet therapy

Carotid enarterectomy

Antithrombolytics

Rehabilitation

Front 19

What is involved in increasing perfusion to brain

Back 19

flat in bed

blood pressure control- allow high blood pressure

IV fluids

Front 20

What is involved in anticoagulation therapy

Back 20

Heparin- IV

Warfarin- Oral form

cardioembolic stroke prevention as does want ischemic --> hemorrhagic stroke

Front 21

Describe antiplatelet therapy

Back 21

aspirin- non-cardioembolic ischemic stroke prevention

Clopidogrel and Dipyrimadole-Aspirin- used if person failed aspirin

Front 22

What is the role of antithrombolytics in ischemic stroke?

Back 22

if given within 3 hrs, can lyse clot that causes stroke

risk = intracranial hemorrhage

Front 23

What occurs in a hypertensive hemorrhage stroke?

Back 23

Chronic HTN damages penetrating arteries

symptoms of increased intracranial pressure- lethargy, nausea, vomiting, headache

Front 24

Hypertensive putamen stroke

Back 24

most common site

contralateral hemiplegia- adj internal capsuel

homonymous hemianopsia

headache, nausea, cognitive defects

1/3 mortality

Front 25

Thalamic hypertensive stroke

Back 25

2nd most common location

contralateral sensory and motor deficit

limit of vertical eye movement- midbrain adj

50% mortality

Front 26

Pontine hypertensive stroke

Back 26

abrupt loss of consciousness, nausea, vomit, headache before

pinpoint pupils, bilateral Horner's

72% mortality/ 100% if comatose at onset

Front 27

Cerebellar hypertensive stroke

Back 27

surgery = life saving

occipital headache, nausea, vomiting, inability to walk, vertigo, stiff neck, ataxia

Front 28

What are other causes of Intracerebral Hemorrhage

Back 28

vascular malformation

treatment with hepearin, warfarin, t-Pa

head trauma

hemoorhage into ischemic stroke, tumor, abscess

amyloid angiopathy

Front 29

What are general characteristics of subarachnoid hemorrhages?

Back 29

caused by berry/saccular aneurysm
- at birfurcation of circle of Wills
most rupture >10 mm

peak-35-65 yo

risk factors: hypertension, smoking, POLYCYSTIC KIDNEY DISEASE

Front 30

How do subarachnoid hemorrhages normally present?

Back 30

asymptomatic

acute onset of worst headache of life, confusion, loss of consciousness, coma, death

cause- while active, no localizing findings

Front 31

How do you diagnose subarachnoid hemorrhages?

Back 31

1. head CT

2. lumbar puncture if negative

3. MRA - where hemorrhage is

Front 32

What are some complications after rupture in subarachnoid hemorrhages?

Back 32

85% to hospital, 1/2 leave with good neuro

vasospasm- delayed hemiplegia because of arteries exposed to subarachnoid blood, 30% 10 days post

recurrance- 30% post 10 days

subacute hydrocephalus- 2-4 wks, occlusion of CSF pathway with blood

Front 33

How do you treat subarachnoid hemorrhages?

Back 33

prevent increased ICP

prevent vasospasm- nimodipine, IV with saline

clip aneurysm-> operation helpful