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21 Cards in this Set
- Front
- Back
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What are causes of acute cerebral ischemia?
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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 |
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What causes global ischemia?
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Cardiac arrest
V.fib |
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Small, deep infarction involving penetrating branch of large cerebral artery.
Usually associated with chronic hypertension What type of stroke is this? |
Lacunar stroke
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Neuro deficit > 24 hours but reverses within 3 weeks
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RIND: Reversible ischemic neuro deficit
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Motor or sensory loss in all four limbs
Ataxia Bilateral visual field defects Where might the stroke be? |
Brain Stem / Cerebellum / Posterior Hemisphere Stroke
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What tests are done to evaluate Acute Ischemic Stroke
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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 |
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How do you treat A-fib medically?
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Warfarin: INR 2-3
ASA: 325 mg/day No warfarin if bacterial endocarditis due to risk of cerebral hemorrhage from septic embolization |
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What drugs are given to prophylax against TIA?
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Aspirin
Ticlopidine – Ticlid Clopidogrel – Plavix |
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How do you treat Carotid stenosis?
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Asymptomatic extracranial stenosis less than 60%:
Treat with antiplatelet drugs Extracranial stenosis more than 70% (with or without symptoms): Do Carotid endarterectomy |
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When do you give TPA?
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Within 3 hours of onset of ischemic stroke
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What are the contra indications of TPA?
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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 |
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What is the treatment of cerebral edema?
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Hyperventilation
Mannitol Corticosteroids have no benefit in cytotoxic edema |
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BP of 250/150
Papilledema, retinal hemorrhages CT and MRI show diffuse cerebral edema in occipital lobe What is the diagnosis? |
Hypertensive encephalopathy
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What is the diagnostic test of choice for ICH?
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CT
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This type of aneurysm occurs with bacterial endocardits from septic emboli
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Mycotic
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Name the 3 types of aneurysms
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Fusiform
Mycotic Saccular |
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This aneurysm represents ectatic dilatations of large arteries, usually basilar or intracranial carotid
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Fusiform
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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
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Describe the Hunt and Hess Classification of Subarachnoid Hemorrhage
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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 |
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These are composed of tangles of arteries connected directly to veins
May produce headache, seizures, or hemorrhage Account for 1% of all strokes |
AVM
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How does a hemorrhage appear on CT?
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hyperdense (white) image
Ischemic infart shows hypodense |
