quiz #3- cerebrovascular disease

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quiz #3- cerebrovascular disease
2011-04-25 12:05:39
clinical neurology

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  1. Strokes are the ____ leading cause of death in the US
  2. What are some random facts about strokes?
    • every 40 seconds someone has a stroke
    • strokes kill more women than breast cancer yearly
    • leading cause of long term disability
  3. What are the two different types of CVAs and their difference?
    • hemorrhagic: 13% of CVAs- arterial blood bleeds out
    • occlusive: 87% of CVAs- blockage of arterial blood
  4. What are causes of hemorrhagic stroke?
    • hypertension
    • aneurysm
    • arteriovenous malformation
  5. How does hypertension cause a stroke?
    microaneurysms form and burst, leaving pockets of brain damaage
  6. What are the defecits caused by a HTN stoke like?
    defecits are minor per stroke, but they are cummulative
  7. How do aneurysms cause a stroke?
    weak arterial wall --> ballooning of wall --> rupture into arachnoid space
  8. What are some of the statistics of aneurysms?
    • 50% die within 6 months
    • 1/3 of survivors have neurological defecits
    • incidence higher in women
    • mean age is 50 years
    • 27,000/year
  9. How does arteriorvenous malformation cause a stroke?
    arterial vessels feed directly into veins and high pressure causes bleeding
  10. What are some characteristics of ateriovenous malformation?
    • 2% of hemorrhagic strokes
    • occurs between 20-40yo
    • congenital
  11. What are signs/symptoms of a hemorrhagic stroke?
    • sudden, severe headaches
    • nausea and vomitting
    • aversion to light
    • weakness/numbness in arm/leg
    • loss of consciousness
    • stiff neck
    • seizure
  12. What are the two types of blockage that can occur in occlusive strokes?
    • thrombus: vessels at site slowly build a plug
    • embolus: plus moves around and eventually gets stuck
  13. What are causes of occlusive strokes?
    • atherosclerosis
    • arteritis
  14. Where does artherosclerosis offten occur?
    • carotid arteries
    • vertebral arteries
    • middle cerebral arteries
  15. What are risk factors for atherosclerosis?
    • HTN
    • diabetes
    • obesity
    • smoking
    • AA
    • increased serum lipids
    • hypothyroid
  16. What is arteritis and when does it occur?
    • inflammation of arteries
    • occurs in lupus, syphillis, and polymyositis rheumatic
  17. What are signs and symptoms of an embolus?
    • abrupt onset
    • symptoms may improve rapidly (transient ischemic attack)
    • usually <50 yo
  18. What are signs and symptoms of a thrombus?
    • history of HTN or atheroclerotic heart disease
    • remain conscious
    • symptoms progress (tingling, weakness, dizzy, aphasia)
  19. What is a transient ischemic attack?
    • from an embolus (plaque in carotid artery)
    • puts you at risk for a major stroke
    • often in young people 30-40
  20. What are symptoms of transient ischemic attack adn how long do they last
    • usually resolve in 24 hours
    • amaurosis fugax: blind in one eye, occlusion of opthalamic artery
  21. What are characteristics of a middle cerebral artery?
    • contralateral hemianopsia
    • contralateral hemiparesis
    • possible aphasia/dysphagia
    • contralateral hemisensory loss (look by modality not dermatome)
  22. What are characteristics of anterior artery stroke?
    • only 1% of strokes
    • marked weakness in contralateral leg
    • no sensory loss b/c sesnory strip is deep
    • possible personality changes
    • expressive aphasia if in dominant hemi
    • apraxia if in non-dominant hemi
  23. What are characteristics of posterior cerebral artery stroke?
    • 3% of strokes
    • contralateral hemipareisis
    • homonymous hemianopsa (loss of visual field on same side)
    • receptive aphasia
    • possible thalamic pain
    • possible cerebellar ataxia
  24. What are characteristics of posterior inferior cerebellar artery stroke?
    • dysarthria- motor dysfunction of speech
    • dysphagia- motor dysfunction w/ swallowing
    • vertigo/nystagmus
    • ipsilateral ataxia
    • ipsilateral horners
    • contralateral loss of pain/temp in body, ipsilateral in face
  25. What are characteristics of vertebral and basilar artery strokes?
    • ipsilateral ataxia
    • vertigo
    • dysarthria
    • ipsilateral facial weakness
    • coma
    • locked in state- can only move eyes
  26. How can you diagnose a stroke?
    • history of signs/symptoms
    • blood test
    • MRI/CT scan
    • EKG
    • blood pressure
    • arteriogram
  27. How do you treat a stroke?
    • clot buster if within 6 hours
    • maintain airway if unconscious
    • control HTN
    • maintain hydration and electrolyte balance
    • prevent cerebral edema
    • bowl and bladder care
    • prevent contractures, skin ulcers, and thrombophlebitis
    • surgery
    • rehab
  28. What is the prognosis of a stroke?
    • 10% return to work
    • 40% have residual disability (may be independent at home)
    • 50% have severe disability (help with ADL)
  29. What are consequences of stroke?
    • changes in muscle tone/strength
    • synergist movement (move in patterns)
    • neglect/inattention/extinction
    • aphaisa (dominatn hemi)
    • sensory loss (check by modality)
    • incontinence
    • personality change
    • apraxia
    • ataxia