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21 Cards in this Set

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What are causes of acute cerebral ischemia?
MURAL ABNORMALITIES:
Atherosclerosis: 2/3 of CVAs
Vasculitis
Vasospasm
Compression (by tumor, aneurysm)
Fibromuscular dysplasia / Moyamoya
Dissection (spontaneous, traumatic

EMBOLISM:
Thrombus
Fat
Air

HEMATOLOGIC:
Hypercoagulable state
Sickle cell disease
Homocystinuria
Antiphospholipid antibodies
Protein C or S deficiency
What causes global ischemia?
Cardiac arrest
V.fib
Small, deep infarction involving penetrating branch of large cerebral artery.
Usually associated with chronic hypertension

What type of stroke is this?
Lacunar stroke
Neuro deficit > 24 hours but reverses within 3 weeks
RIND: Reversible ischemic neuro deficit
Motor or sensory loss in all four limbs
Ataxia
Bilateral visual field defects

Where might the stroke be?
Brain Stem / Cerebellum / Posterior Hemisphere Stroke
What tests are done to evaluate Acute Ischemic Stroke
CT w/o contrast (Only 5%visible in first 24 hours)
Electrocardiogram
Chest x-ray
CBC,platelet, PT, PTT
Lipid profile
Sed rate
Serum electrolytes
Blood glucose
Renal and hepatic chemical analyses
National Institutes of Health Scale (NIHSS) score
How do you treat A-fib medically?
Warfarin: INR 2-3
ASA: 325 mg/day

No warfarin if bacterial endocarditis due to risk of cerebral hemorrhage from septic embolization
What drugs are given to prophylax against TIA?
Aspirin
Ticlopidine – Ticlid
Clopidogrel – Plavix
How do you treat Carotid stenosis?
Asymptomatic extracranial stenosis less than 60%:
Treat with antiplatelet drugs

Extracranial stenosis more than 70% (with or without symptoms):

Do Carotid endarterectomy
When do you give TPA?
Within 3 hours of onset of ischemic stroke
What are the contra indications of TPA?
Previous CVA
Head trauma in last 3 months
H/O hemorrhage
Systolic BP’s > 185 mm Hg or diastolic BP’s > 110 mm Hg
Taking anticoagulants
Propensity to hemorrhage
Recent major surgery
Rapidly improving neurological deficit or minor symptoms
What is the treatment of cerebral edema?
Hyperventilation
Mannitol

Corticosteroids have no benefit in cytotoxic edema
BP of 250/150
Papilledema, retinal hemorrhages
CT and MRI show diffuse cerebral edema in occipital lobe

What is the diagnosis?
Hypertensive encephalopathy
What is the diagnostic test of choice for ICH?
CT
This type of aneurysm occurs with bacterial endocardits from septic emboli
Mycotic
Name the 3 types of aneurysms
Fusiform
Mycotic
Saccular
This aneurysm represents ectatic dilatations of large arteries, usually basilar or intracranial carotid
Fusiform
This aneurysm usually forms at arterial bifurcations;
80% located in anterior circulation

Higher incidence in patients with polycystic kidney disease and Marfan’s syndrome
Saccular
Describe the Hunt and Hess Classification of Subarachnoid Hemorrhage
Type I: minimal headache and slight nuchal rigidity

Type II:Moderate to severe headache, nuchal rigidity, no neuro deficit other than cranial nerve palsy

Type III: Drowsiness, confusion, or mild focal deficit

Type IV:Stupor, moderate to severe hemiparesis, possible early decerebrate ridigity and vegetative disturbance

Type V: Deep coma, decerebrate ridigity, moribund appearance
These are composed of tangles of arteries connected directly to veins

May produce headache, seizures, or hemorrhage

Account for 1% of all strokes
AVM
How does a hemorrhage appear on CT?
hyperdense (white) image

Ischemic infart shows hypodense