Chapter 4 - Cerebrovascular Disease Flashcards Preview

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Flashcards in Chapter 4 - Cerebrovascular Disease Deck (26)
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1
Q

It is a clinical term applied to any abrupt nontraumatic brain insult— literally “a blow from an unseen hand.”

A

Stroke

2
Q

This is a permanent injury which occurs when tissue perfusion is decreased long enough to cause necrosis, typically due to occlusion of the feeding artery.

A

Infarction

3
Q

These are classically defined as transient neurologic symptoms or
signs lasting less than 24 hours, which may serve as a “warning sign” of an
infarction occurring in the next few weeks or months.

A

Transient ischemic attacks (TIAs)

4
Q

Etiologies of ischemic stroke (2)

A
  1. Thrombi(2/3)
  2. Emboli (1/3)

Vasculitis, vasospasm, coagulopathies, global hypoperfusion and venous thrombosis - 5% or fewer of acute strokes

5
Q

Percentage of total cardiac output the brain consumes in order to maintain its minute-to-delivery of glucose and oxygen.

A

20%

6
Q

Differential diagnosis of ischemic stroke in pediatric age group (7)

A
  1. Congenital heart disease
  2. Blood dyscrasias
  3. Meningitis
  4. Arterial dissection
  5. Trauma
  6. ECMO (extracorporeal membrane oxygenation)
  7. Venous thrombosis
7
Q

Differential diagnosis of ischemic stroke in young adult age group (7)

A
  1. Cardiac emboli
  2. Atherosclerosis
  3. Drug abuse
  4. Arterial dissection
  5. Coagulopathy
  6. Vasculitis.
  7. Venous thrombosis
8
Q

Differential diagnosis of ischemic stroke in elderly age group (6)

A
  1. Atherosclerosis
  2. Cardiac emboli
  3. Coagulopathy
  4. Amyloid
  5. Vasculitis
  6. Venous thrombosis
9
Q

Why are gray matter more susceptible to ischemia?

A

Gray matter normally receives three to four times more blood flow than white matter, and is therefore more likely to suffer under conditions of oligemia.

10
Q

Why are watershed zone prone to infarction?

A

Cells served by penetrating end-arteries or those residing in the watershed zone between major territories have no alternate route for perfusion

11
Q

What is the “insular ribbon sign”?

A

Blurring of the gray-white layers of the insula due to early edema.

12
Q

Hyperintense signal on diffusion-weighted images (DWIs) (“light-bulb sign”) precedes T2 hyperintensity, typically develops at what time?

A

Develops 6 to 12 hours post ictus.

13
Q

What disease is responsible for the majority of ischemic events in the ICA territory?

A

Atherosclerotic disease

14
Q

Other causes of significant internal carotid artery narrowing?
(Other than atheroscleroticdisease)

A
  1. Arterial dissection
  2. Trauma
  3. Fibromuscular dysplasia
  4. Tumor encasement
  5. Prior neck radiotherapy
  6. Connective tissue disease
15
Q

Hemodynamic effects to be seen in ICA when there is stenosis of what degree?

A
  1. > 80% reduction in area
    Or
  2. > 60% decrease in diameter
16
Q

Gold standard for preprocedure carotid artery evaluation

A

Selective common carotid angiography

  • But is being replaced by noninavsive studies in many centers.
17
Q

The anterior cerebral artery is divided into three subgroups.

Which are?

A
  1. Medial lenticulostriates serve the rostral portions of the basal ganglia
  2. Pericallosal branches supply the corpus callosum
  3. Hemispheric branches serve the medial aspects of the frontal and parietal
    lobes
18
Q

The medial lenticulostrates supplies what area?

A
  1. Anterior-inferior aspect of the internal capsule
  2. Putamen
  3. Globus pallidus
  4. Caudate head
  5. Portions of the hypothalamus
  6. Optic chiasm
19
Q

What supples the head/anterior internal capsule region?

A

Recurrent artery of Heubner

20
Q

Symptoms of medial lenticulostriate territory infarction.

A
  1. Problems in speech production (motor aphasia)
  2. Facial weakness
  3. Disturbance in mood and judgment
21
Q

Unilateral damage in the ACA hemispheric branches will cause what?

A

Preferential leg weakness on the opposite side of the body.

22
Q

Bilateral AVA infarction lead to what?

A

Incontinence and an awake but apathetic state known as akinetic mutism.

23
Q

Triggering evens of watershed infarction (4)

A

Episodes of transient global hypoperfusion -

  1. Cardiac arrest
  2. Massive bleeding
  3. Anaphylaxis
  4. Surgery under general anesthesia
24
Q

Characteristic clinical findings of watershed infarct

A
  1. Weakness isolated to the upper arms (man in a barrel syndrome)
  2. Cortical blindness
  3. Memory loss
25
Q

Small subcortical infarcts - 2 to 5 mm cavities left in the brain as a result of occlusion of a penetrating artery causing infarction and ensuing encephalomalacia

A

Lacunes

26
Q

Characteristic locations of lacunar infarcts

A
  1. Lenticular nucleus (37%)
  2. Pons (16%)
  3. Thalamus (14%)
  4. Caudate (10%)
  5. Internal capsule/corona radiata (10%)