Brain and Behavior: Cerebrovascular Disease

Stroke risk factors: … (8)

hypertension, diabetes, obesity, hyperlipidemia, sedentary lifestyle, smoking, cardiac disease, heavy alcohol use

…: rapidly developing clinical signs or symptoms of local and at times global loss of cerebral function , lasting more than 24 hours, or that lead to death with no apparent cause other than vascular

stroke

…: acute focal neurological dysfunction caused by focal infarction at single or multiple sites of brain or retina, evidence can be symptoms lasting longer than 24 hours or using neuroimaging

cerebral ischemic stroke

…: acute neurological dysfunction caused by hemorrhage within the brain parenchyma or in the ventricular system

intracerebral hemorrhage

…: acute neurological dysfunction caused by subarachnoid hemorrhage

subarachnoid hemorrhage

Stroke has a …; showing up as a blocked blood vessel on CT, dark area on later CT

radiological footprint

…: a transient episode of focal neurological dysfunction caused by focal brain or retinal ischemia without acute infarction in the clinically relevant area of the brain or retina, symptoms should resolve in 24 hours

transient ischemic attack

Symptoms pointing to TIA: … (5)

focal cerebral/ retinal symptoms lasting <1hr, motor weakness in two limbs or 1 limb and face, sensory deficit in two limbs or 1 limb and face, visual-field defects, aphasia

Possible TIA: … (4)

unsteady gait, diplopia, vertigo, dysphagia

The anterior (carotid) circulation supplies the … except for the medial temporal lobes and a portion of the occipital lobes

cerebral hemispheres

The posterior (vertebrobasilar) supplies the … (4)

brainstem, thalami, cerebellum, posterior portions of the cerebral hemispheres

…: is caused by perforator arteries being occluded, cause devastating neurological deficits as they supply critical brain regions

lacuna stroke

Mechanisms of ischemic stroke: … (3)

thrombosis, embolism, decreased systemic perfusion

Extent of an infarction depends on: … (4)

site of occlusion, rate of occlusion, collaterals, resistance to ischemia

white plaques are treated with …

antiplatelets

red plaques are treated with …

anticoagulants

Atheroembolic stroke risk factors: … (2)

atrial fibrillation, large vessel stenosis

Rare atheroembolic risk factors: … (3)

large vessel dissection, endocarditis, left ventricular thrombus

Large vessel strokes affect the cortex and its functions: … (60

inattention, neglect, dysphasia, dyslexia, dysgraphia, dyspraxia

…: material is formed elsewhere and lodges in an artery and blocks flow

cerebral embolism

MRI scan that shows bilateral damage and plaques that is an … indication

emboli

Hyaline arteriolosclerosis risk factors: … (4)

age, hypertension, genetic conditions, vasculitis

Lacunar syndromes: … (5)

pure motor hemiparesis, hemisensory loss, sensorimotor stroke, ataxic hemiparesis, dysarthria clumsy hand syndrome

…: most important cause of vascular dementia (frontal dysexecutive syndrome gait apraxia, urinary incontinence)

small vessel disease

Decreased systemic perfusion can be caused by: … (2)

cardiac pump failure, systemic hypotension

Intracranial hemorrhages that are strokes: … (2)

subarachnoid, intracerebral

Intracranial hemorrhages that are not strokes: … (2)

subdural, epidural

Potential causes of primary intracerebral hemorrhage: … (7)

hypertension, hyaline arteriolosclerosis, microaneurysm, cerebral amyloid angiopathy, anticoagulants, vascular malformations, recreational drugs

…: aneurysms that occur in small blood vessels → burst causing hemorrhage

Charcot Bouchard aneurysms

Locations of primary hypertensive ICH: … (3)

brainstem, cerebellum, basal ganglia

…: found in the circle of willis → subarachnoid hemorrhage

berry aneurysm

…: full recovery from early diagnosis, subacute onset with headache, vomiting, visual symptoms, seizures and focal neurological deficits, due to raised ICP

venous stroke

Processes that raise ICP and cause venous stroke: … (3)

obstruction, venous infarction, venous hemorrhage

Causes of cerebrovascular venous sinus thrombosis: … (8)

infective, inherited thrombophilia, acquired thrombophilia, dehydration, inflammation, hematology, malignancy, trauma

Differential diagnosis of stroke: … (8)

hypoglycemia, migraine, MS, epilepsy, tumor, syncope, CNS infections, head injury

with stroke the symptoms don’t spread they come on …

simultaneously

In stroke the symptoms are …

negative

Left cerebral hemisphere strokes lead to: … (5)

right hemiparesis, right hemisensory loss, aphasia, conjugate eye deviation to the left, right hemianopia

If the cerebral hemisphere stroke is caused by internal carotid artery occlusive disease patient may exhibit …

amaurosis fugax

Right cerebral hemisphere strokes: … (6)

left hemiparesis, left hemisensory loss, poor drawing, left visual field neglect, conjugate deviation of eyes to right, left hemianopia

Cerebral hemispheric strokes are caused by: … (3)

carotid artery occlusion, embolism to MCA, basal ganglion ICHs

…: weakness of the contralateral arm, face, and leg without sensory, visual, cognitive, or behavioral abnormalities

pure motor stroke

Pure motor stroke indicates injury to: … (3)

posterior limb of IC, basilar part of pons, corona radiata

…: paresthesia of the contralateral body, limbs and face without motor, visual or cognitive abnormalities

pure sensory stroke

Pure sensory stroke indicates damage to: … (4)

contralateral thalamus, internal capsule, corona radiata, midbrain

…: slurred speech and clumsiness of the contralateral hand

dysarthria-clumsy hand syndrome

Dysarthria-clumsy hand syndrome indicates damage to: … (6)

basilar part of pons, anterior limb of IC, corona radiata, basal ganglia, thalamus, cerebral peduncle

…: weakness and ataxia od the contralateral limbs, often leg and foot (more than arm and hand)

ataxic hemiparesis

Ataxic hemiparesis indicates damage to: … (6)

posterior part of IC, basilar part of the pons, corona radiata, red nucleus, lentiform nucleus, SCA/ACA infarcts

Vertebrobasilar strokes: … (6)

bilateral weakness/sensory loss, ataxia, diplopia, dysarthria, dysphagia, impaired consciousness

…: presents with sever retro-orbital headache ipsilateral to the lesion, associated with stroke in the anterior circulation

carotid dissection

Signs of carotid dissection: …

ipsilateral horners syndrome

…: produced by neck manipulation or trauma, associated with ipsilateral neck pain and stroke in the posterior circulation

vertebral artery dissection

treatment of TIA: … (4)

aspirin, clopidogrel, statins, heparin (AF)

In patients with ischaemic stroke … should be adminstered as soon as possible and withing 4.5 hours of symptoms and if ICH has been excluded by imaging

intravenous alteplase

Mechanical thrombectomy in ischemic stroke patients within 6 hours if confirmed occlusion is of the …

proximal anterior circulation

…: used to pinpoint time of stroke, presents usually 4-6 hours after stroke

DWI-FLAIR mismatch

Surgical treatment for ischemic stroke: …

craniotomy

venous thrombosis treatment: …

anticoagulants for 6 months

COmmon locations for hypertensive ICH: … (5)

basal ganglia/internal capsule, caudate nucleus, thalamus, pons, cerebellum

Amyloid angiopathy cuases ICH in the elderly preferentially affecting the … (2)

parietal, occipital

…: contain arteries that empty into arterialized veins, no recognizable capillary bed, gliotic parenchyma can be found between the component vessels

arteriovenous malformations

Treatment of SAH: …

embolization