Cerebrovascular Disease

Front 1

% as a cause of death

Back 1

the 3rd leading

Front 2

types of CVD

Back 2

1-ischemic

2-heamorrhagic

Front 3

% of ischemic vs hrgic stroke

Back 3

ischemic 80 %

hrg 20 %

Front 4

ischemic stroke

definition ??

Back 4

-focal neurological deficit

-lasting > 24 hrs

-bcoz of loss of blood flow to a portion of brain

-resulted in irreversible cell death

Front 5

ischemic stroke

mechanisms

Back 5

1-large vessels atherosclerosis

2-embolic diseases

3-small vessel disease (lacunar)

4-nonatherosclerotic vasculopathy

5-hematological / coagulopathy

6-watershed infarction

7-other : drug abuse / migraine / venous infarct

Front 6

TIA's

definition

Back 6

transient focal neurological deficit caused by loss of regional blood flow

lasts < 24 hrs

typically only ( 10 - 60 ) minutes

Front 7

intracerebral hrg

definition

Back 7

bleeding into the brain paranchyma

Front 8

SAH : subarchynoid hrg

Back 8

bleeding around the brain in the subarchinoid space

Front 9

risk factors for ischemic stroke

Back 9

1-age

2-male

3-african american

4-Hypertension / DM / Dyslipedemia

5-smoking

6-obesity / sedentary life-style

7-drug of abuse

8-family Hx

Front 10

drugs of abuse that increases your risk stroke

Back 10

1-cocaine

2-amphetamine

Front 11

embolic stroke risk factors

cardiac

Back 11

1-arrhythmia

2-dilated myopathy

3-left ventricular aneurysm

4-valvular (rheumatic / prosthetic)

5-endocarditis ( infective and non-infective

6-cardiac thrombus (left vent. or atrium)

7-cardiac myxoma

8-tASD / VSD / PFO :patent foramen ovale

Front 12

types of arrythmias that increases your risk of stroke

Back 12

1-A.Fib

2-sick sinus syndrome

Front 13

TIA

duration

Back 13

usually 10 - 15 min

most resolves within 60 min

by definition up to 24 hrs

Front 14

TIA

future significans ??

life-time risk of stroke

Back 14

1-high correlation with future stroke

2-predictor of MI / vascular death

lifetime stroke risk : 33 %

Front 15

amaurosis fugax

Back 15

form of TIA

temporary monocular blindness

2ry to carotid atherosclerosis with embolization

Front 16

subarchnoid hrg

what's the subarcnoid space ??

Back 16

space between brain and pia archnoid

Front 17

mortality in SAH ??

Back 17

50 %

Front 18

one of best predictors for mortality p

Back 18

coma at presentation

Front 19

usual age for SAH ??

Back 19

35 - 65 yo

younger presentation than stroke

Front 20

provocations for SAH ??

Back 20

not specific , anytime

exertion

rest

at sleep

Front 21

complication of SAH ??

Back 21

1-re-bleeding

2-Hydroceph

3-vasospasm with late ischemic stroke

4-Hyponatremia

5-autonomic dysfunction

Front 22

re-bleeding in SAH

timing ??

mortality ??

Back 22

within 2 weeks

50 % mortality

Front 23

pathogenesis of hyponatremia in SAH

Back 23

atrial natriuretic factor

Front 24

epidural hematoma

causes

Back 24

trauma / skull Fx

Front 25

epidural hematoma

classic shape / CT

Back 25

lense shape pushing on parenchyma

Front 26

subdural hematoma

shape / CT

Back 26

cresent shape

Front 27

subdural hematoma

risk factors

Back 27

old age

on anticoagulant

with Hx of trauma

Front 28

diagnosis / evaluation of suspected CVA

Back 28

1-imaging

2-cardiac evaluation

3-coagulopathy / toxicology / blood culture

4-DDx

Front 29

DDx of stroke / TIA ??

Back 29

1-focal seizure with todd paralysis

2-complicated migraine

3-brain mass

4-periphral vestibular disorders

5-cardiac arrythmias

Front 30

imaging in CVA

Back 30

1-brain CT / CT angio

2-Brain MRI / MRA

3-carotid duplex

4-transcranial doppler

5-cerebral angio

Front 31

brain CT

advantages

Back 31

high sensetivity for blood

Front 32

MRI

advantages

Back 32

higher sensitivity to

-lacunatr

- brain stem

-post.fossa

-acute stroke

Front 33

"gold standard " for CVA evaluation ??

Back 33

Cerebral angio

Front 34

cerebral angio

advantages

Back 34

better anatomic localization

Front 35

CT angio

Risks / complications ??

Back 35

1 % risk of stroke during procesure

Front 36

cardiac evaluation in stroke ???

Back 36

1-ECG (rhythm / old CAD)

2-Echo (trans-esophageal / thrombus / valves)

3-Holter monitoring

Front 37

when to evaluate for coagulopathy ??

Back 37

young pt

Front 38

ischemic stroke

manegment ??

Back 38

1-supportive

2-vitals / blood sugar goals monitoring

3-brain edema

4-antiplatelet

4-anti-coagulation

6-thrombolytics

7-carotid endartrectomy / stenting

Front 39

stroke admission order ??

Back 39

-admit to

-observe vitals Q

-Glucocheck Q

-aspiration precautions

-seizure precautions

-pressure sores / change posision Q

-activity

-dysphagia screen / NG tube / mouth care

-NPO / diet / via NG

-foley's

-Keep BP : sys (( 120 - 220)) / dias ((60 - 120))

-keep B.Sugar

-Keep Temp.

-Labs : CBC / KFT / TSH (arrythmia) /LP / HbA1c

drug screen / cardiac panel / thrombophila

screening

-ECG +/- echs

-imaging : CT / MRI / MRA / carotid doppler...

-consultation : cardiac / physio / speech therapiest

-monitor for hyponatremia

Front 40

stroke

medication order

Back 40

-DVT prophx

-GI prophx

-Anti-platelet

-warfarin (in A.fib / Thrombus)

-statin

Front 41

BP goals

Back 41

in acute setting

systolic : 120 - 220

Diastolic : 60 - 120

Front 42

fever manegment

Back 42

must be aggressive , fever may worsen the outcome

Front 43

blood sugar monitoring

Back 43

must be aggressive

may eorsen outcome

Front 44

cerebral edema

peak time

Back 44

48 hrs

Front 45

use of anticoagulant in stroke ??

Back 45

heparine ??? no benifite & increase bleeding risk

warfaine : if A.fib / thrombus for 2ry prevention

dabigatran (thrombin inhi) same as warfarin

Front 46

advantage of warfarin over thrombin inhib / dabigatran

Back 46

can be reversed by FFP

Front 47

thrombolytics therapy

which one is approved ??

Back 47

only tPA

only in acute stroke

Front 48

thrombolytic therapy

criteria

Back 48

1-acute / ischemic stroke

2-administration / window : 3 hrs ((4.5 may))

3-no contraindications for thrombolytics therapy

Front 49

thrombolytics therapy

exclusion

Back 49

time of onset : unkown or > 3 hrs

minor stroke

resolving symptoms

suggested / waitnessed seizure

BP > 185 / 110

CT scan : lesion/mass , early hypodensitiy

Front 50

tPA protocol for stroke

Back 50

1-dose / kg , 10 % bolus , 90% over 1 hr

2-no invasive procedures within 24 hrs

3-BP keep < 180/110

Front 51

tPA dose / administration

Back 51

0.9 mg / kg

10 % bolus

90% over 1 hr infusion

___________________________-

max dose = 90 mg

Front 52

carotid atherosclerosis

ttt options

Back 52

1-observation

2-surgical endartrectomy

3-stenting

Front 53

carotid endartrectomy

indications

Back 53

- > 70 % symptomatic stenosis

- 50 - 70 % symptomatic , modest benefit , individualized ttt

Front 54

carotid stenting

Back 54

endartrectomy is better

Front 55

carotid art stenosis % and Rx for each

Back 55

< 30 % = antiplatelet

50 - 70 % = modest benefit from endartrectomy

> 70 % endartrectomy

Front 56

Rx for vertebrobasilar disease

Back 56

antiplatelet

Front 57

Rx of lacunar infarction

Back 57

antiplatelet

Front 58

cardiac embolism Rx

Back 58

warfarin

Front 59

endocarditis Rx

Back 59

ttt of it

no warfarin : high bleeding risk

Front 60

fibromuscular dysplasia Rx

Back 60

antiplatelet

Front 61

arterial dissesection causing stroke

Rx

Back 61

antiplatelet

Front 62

antiphospholipid synd

Back 62

anti-coagulation

Front 63

watershed area infarction Rx

Back 63

water repletion

Front 64

cerebral vein thrombosis

Back 64

anti-coagulation

Front 65

whats watershed infarction

Back 65

infarction 2ry to hypotension/shock

Front 66

watershed infarction

presentation

Back 66

bilateral proximal weakness of both arms / legs

Front 67

causes of non-atherovascular vasculopathy

Back 67

1-fibromuscular dysplasia

2-arterial sissection

3-vasculitis

Front 68

how to suspect arterial dissection

Back 68

neck pain

hx of trauma / exercise

stroke

Front 69

what's the location of embolism in brain imaging

Back 69

gray-white junctionw

Front 70

whats lacunar infarction

Back 70

atherosclerosis of small penetrating vessels

Front 71

lacunar infarctions

risk factors

Back 71

1-HTN

2-DM

Front 72

lacunar infarct

presentation

Back 72

pure motor ipsilateral

pure sensory ipsilateral

Front 73

pure sensory ipsilateral lacunar infarction

lacunar infarction

Back 73

thalamic lesionp

Front 74

pure motor ipsilateral

lacunar infarction / location

Back 74

internal capsule

or

the pons

Front 75

carotid atherosclerosis (intra/extracranial

presentation

Back 75

1-aphasia / dysarthria

2-ipsi (face / hand) numbness /weakness

3-amaurosis fugax

Front 76

vertibrobasilar disease

presentation

Back 76

5 D's :

_________________________

Dysarthria

Disphagia

Diploapia

Dizziness

Drop attacks / ataxia

Front 77

epiduarl hrg

cause

Back 77

trauma

Front 78

epidural hrg

presentation

Back 78

headache

decrease LOC

Front 79

epidural hrg

Dx

site

Back 79

CT : lense blood sign

between dura and skull pusj=hing on parynchyma

Front 80

epidural hrg

Rx

Back 80

urgent surgical evacuation

Front 81

subduaral hrg

cause

Back 81

trauma ( often mild) in elderly

Front 82

subdural hrg

presentation

Back 82

headach

confusion

seizure

Front 83

subdural hrg

Dx

Back 83

CT : concave/cresent

may mass effects

Front 84

subdural hrg

ttt

Back 84

supportive

consider surgiacl evacuation

Front 85

subarchnoid hrg

causes

Back 85

1-aneurysm

2-AVM

Front 86

subarchnoid hrg

presentation

Back 86

siudden severe headach / the worst ever

meningismus

decreased LOC

focal deficit is possible

oculomotor palsy

Front 87

severe headache with oculomotor palsy ???

Back 87

subarchnoid hrg

Front 88

subarchnoid hrg Dx

Back 88

CT : most sensitive

MRI : insensitive

cerebral angio : for aneurysm

Front 89

CT sensetivity in hrg ??

Back 89

> 90 %

Front 90

if negative CT for SAH with high suspicion ??

Back 90

do LP :

__________________________

1-xanthochromia

2-RBC's in tube 1 + 4

Front 91

ttt of SAH ??

Back 91

-supportive

-NIMOdipine for associated vassospasm

-early surgical clipping

-endovascular therapy

Front 92

early surgical clipping

when ??

Back 92

if minor defecit

Front 93

endovascular therapy types

Back 93

-coiling

Front 94

intracranial hrg

cause / etiology ??

Back 94

1-chronic HTN

2-AVM

2-tumor

3-drugs

4-other : vasculiis /coagulopathy/endocarditis / low plt

cerebral amyloid angiopathy

Front 95

most common cause of ICH ??

%

Back 95

HTN

50 -80 %

Front 96

whats cerebral amyloid angiopathy ??

Back 96

old pt with alzheimer disease

Front 97

tumors that commonly cause hrg ???

Back 97

renal cell ca

choriocarcinoma

melanoma

glioma

Front 98

drugs increasing risk of intracerebral hrg

Back 98

cocain

amphetamine

phynolpropranolamine

Front 99

intracranial hrg

presentattion

Back 99

headach

vomitting

coma

seizure

sudden or gradual

Front 100

intracerebral hrg

most locations

Back 100

1-lobar = most

2-basal ganglia/thalamus

3-cerebellum

4-pons

Front 101

how to detect AVM ??

Back 101

MRI with gadolinium

or cerebral angio

Front 102

ICH

when LP is contraindicated

Back 102

when mass effect

Front 103

intracerebral hrg

Rx

Back 103

BP control

ventilation / airway protection

manegment of increaed ICH

surgical evacuation if possible

Front 104

Rx of increased intracerebral pressure in ICH

Back 104

1-elevat the head of the bed

2-avoid hypotonic fluid

3-??? mannitol

4-hyperventelation