Vascular Disease Neurology Chapter 14

Front 1

risk factors for stroke

Back 1

htn
diabetes
obesity
HL

sedentary lifestyle
cardiac disease

smoking
heavy alcohol use

Front 2

the carotid circulation supplies the cerebral hemispheres except for

Back 2

medial temporal lobes
a portion of the occipital lobes

Front 3

vertebro-basilar circulation supplies

Back 3

brainstem
thalami
cerebellum
posterior portions of the cerebral hemispheres

Front 4

brachiocephalic artery divides into

Back 4

right common carotid artery
right subclavian artery

Front 5

left common carotid artery arises from

Back 5

aorta

Front 6

vertebral artery arises from

Back 6

bilaterally:

the vertebral arteries arise from the subclavian arteries

Front 7

the internal carotid artery bifurcates into

Back 7

anterior cerebral
middle cerebral

Front 8

anterior cerebral arteries supply

Back 8

anterior medial cerebral hemispheres
caudate nuclei
basal frontal lobes

Front 9

MCAs give off _ branches to the __ and the __

Back 9

lenticulostriate artery branches

basal ganglia
internal capsule

Front 10

MCAs trifurcate into

Back 10

small anterior temporal branches

large superior and inferior divisions

Front 11

superior divisions of the MCA supply _

Back 11

lateral cerebral hemispheres above the sylvian fissure

Front 12

inferior divisions of the MCA supply _

Back 12

temporal and inferior parietal lobes below the sylvian fissure

Front 13

anterior choroidal arteries course along

Back 13

the optic tract

Front 14

_ arteries course along the optic tract

Back 14

anterior choroidal

Front 15

anterior choroidal arteries course along the optic tract, and supply what?

Back 15

give off branches to

-- globus pallidus
-- posterior limb of the internal capsule

and then they supply

medial temporal lobe
lateral geniculate body

Front 16

the vertebral arteries' course (3)

Back 16

they come from the subclavians

transverse foramina of C6 or C5
course behind the atlas
enter foramen magnum

they form the basilar artery at the medullo-pontine junction

Front 17

the basilar artery runs from _ to _

Back 17

medullo-pontine junction to the pontomesencephalic junction

i.e. the basilar artery covers the length of the pons

Front 18

the intracranial vertebral arteries give off what branches?

Back 18

posterior and anterior spinal arteries
penetrating arteries to the medulla
PICAs

Front 19

the basilar artery runs along what bone?

Back 19

clivus

Front 20

branches of the basilar artery (5)

Back 20

AICA
labyrinthine artery
paramedian pontine arteries
SCA

divides into the PCAs

small penetrating arteries at the basilar artery bifurcation supply medial portions of the midbrain and thalami

Front 21

the PCAs supply what parts of the brain

Back 21

penetrating arteries to the midbrain and thalamus

supply the occipital lobes and
inferior surface of the temporal lobes

Front 22

one little detail about the PCAs course

Back 22

course around the cerebral peduncles

Front 23

each carotid artery supplies _ of the brain

the vertebra-basilar circulation supplies _

Back 23

2/5

1/5

Front 24

posterior circulation gives blood supply to what 3 major parts of the brain

Back 24

brainstem
cerebellum
visual cerebral cortex

Front 25

PICA arises from _

Back 25

vertebral arteries

Front 26

AICA arises from _

Back 26

basilar arteries

Front 27

what three major vessels arise from the basilar artery?

Back 27

AICA
SCA
PCA

Front 28

there are various kinds of strokes...

Back 28

80% are ischemic
-- thrombolic
-- embolic
-- systemic hypoperfusion

10% are subarachnoid hemorrhage
10% are intracerebral hemorrhage

Front 29

thrombosis as a cause of stroke means (in a general sense)

Back 29

an occlusive process within a vessel

the lumen is narrowed or occluded by

-- an abnormal vessel wall
-- superimposed clot

Front 30

thrombotic stroke can be caused by

Back 30

atherosclerosis

sometimes a clot forms because of a primary hematologic problem
-- polycythemia
-- thrombocytosis
-- hypercoagulability

less common occlusive pathologies include:

vasoconstriction
fibromuscular dysplasia
arterial dissection

Front 31

atherosclerosis (re: stroke) affects mostly what vessels?

Back 31

*large* neck and intracranial arteries

Front 32

less common occlusive pathologies include

Back 32

vasoconstriction
fibromuscular dysplasia
arterial dissection

Front 33

smaller, penetrating intracranial arteries can be damaged by

Back 33

most often: htn

can be obstructed at their origins by microatheromas

Front 34

stroke emboli most often come from

Back 34

heart, aorta, proximal portions of the neck or intracranial arteries

Front 35

the various kinds of stroke emboli

Back 35

from the heart
artery-to-artery emboli
systemic veins (via ASD or PFO)

occasionally: air, fat, cholesterol, bacteria, and foreign bodies

Front 36

a cause of ischemic stroke that is unlike the other causes

in turn, various things cause it

Back 36

systemic hypoperfusion

-- cardiac pump failure
-- infarction
-- arrhythmia

-- hypotension
-- blood loss
-- hypovolemia

Front 37

systemic hypoperfusion stroke affects the brain where?

Back 37

diffusely, bilaterally

most critical in watershed regions

Front 38

left cerebral hemisphere strokes

sxs

Back 38

right hemiparesis
-- often arm, hand, face > leg

right hemisensory loss

aphasia

in deep lesions or large lesions,
-- conjugate deviation of the eyes to the left;
-- right hemianopia or hemi-inattention

when caused by ICA occlusive dz,
-- transient left monocular visual loss

Front 39

unique sxs of

left cerebral hemisphere strokes vs.

right cerebral hemisphere strokes

Back 39

Left:

aphasia

in deep lesions or large lesions: can cause right hemi-inattention



Right:

poor drawing and copying

neglect of the left visual field

Front 40

sxs common to left and right cerebral hemisphere strokes

Back 40

contralateral hemiparesis
-- often arm, hand, face > leg

contralateral hemisensory loss

in deep or large lesions:
-- ipsilateral conjugate deviation of the eyes
-- contralateral hemianopia


left strokes can cause right hemi-inattention

right strokes --> neglect of the left visual field


ICA occlusive disease may -->
-- transient ipsilateral monocular visual loss

Front 41

cerebral hemisphere lesions are most often caused by

Back 41

carotid artery occlusion

embolism to the MCA or its branches

basal ganglionic intracerebral hemorrhages

Front 42

lateral medulla stroke is usually due to

Back 42

intracranial vertebral artery occlusion

Front 43

lateral medullary stroke sxs

(7)

Back 43

ipsilateral face: pain or reduced pain and temperature sensation

contralateral limbs and body: loss of pain and temperature

ipsilateral Horner syndrome

nystagmus

ipsilateral arm: incoordination

leaning and veering while sitting or walking, with gait ataxia

in deep lesions: dysphagia and hoarseness

Front 44

bilateral pontine base, and often medial tegmentum stroke

sxs

Back 44

quadriparesis

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

if medial tegmentum is involved bilaterally:
--coma

Front 45

bilateral pontine base, and often medial tegmentum stroke is usually due to

Back 45

basilar artery occlusion

pontine hemorrhage

Front 46

cerebellar infarction is usually due to

Back 46

-- embolism to the PICA

-- embolism to the SCA

-- cerebellar hemorrhage

Front 47

cerebellar infarction sxs

Back 47

gait ataxia; often inability to walk

dysarthria

ipsilateral arm dysmetria

Front 48

left PCA territory stroke sxs

right PCA territory stroke sxs

Back 48

left PCA stroke:

-- right hemianopia
-- right hemisensory sxs
-- dysmemory
-- alexia without agraphia

right PCA stroke

-- left hemianopia
-- left hemisensory symptoms
-- left visual neglect

Front 49

PCA territory infarcts are most often caused by

Back 49

embolism to the PCAs

from the heart, aorta, or vertebral arteries

Front 50

lacunar syndromes are most often due to

Back 50

occlusion of a penetrating artery

Front 51

lacunar syndromes include (4)

Back 51

pure motor

pure sensory (paresthesiae on one side)

dysarthria -- clumsy hand

ataxic hemiparesis

Front 52

in patients with ischemic stroke, you should image _______________

and you should also check some labs....

Back 52

heart, aorta, neck and intracranial arteries should be imaged by echo/ultrasound/CT or MR angiography

the blood should be checked for abnormalities of erythrocytes, leukocytes, and coagulation

Front 53

there are about 3 things you can do in ischemic stroke to make sure that the brain gets perfused

Back 53

tPA

optimize blood pressure and fluid volume to maximize cerebral blood flow


prevention of further brain ischemia:

heparin --> warfarin

Front 54

cardiac origin embolization strokes are mostly due to what?

Back 54

atrial fibrillation and myocardial infarction

Front 55

heparin and warfarin are used for patients with various kinds of strokes...

Back 55

cardioembolic

also used in some patients with
-- arterial dissection
-- acute large artery occlusions

Front 56

antiplatelet drugs are used for what kinds of strokes?

Back 56

lacunar infarction

nonocclusive atherosclerotic lesions

Front 57

antiplatelet drugs for stroke include

Back 57

aspirin
clopidogrel
dipyridamole
cilostazole

Front 58

there are several kinds of intracranial hemorrhages

Back 58

subarachnoid
intracerebral
epidural
subdural

Front 59

___ hemorrhages are almost always traumatic

Back 59

epidural
subdural