Path: Vascular Systems

Question 1

What should be your plan of action if a patient has an acute onset of stroke in the clinic?

Answer 1

Call 911
Complete a neurological exam to gather evidence and assessment for responders

Question 2

How should you act when a patient present with clear signs of a stroke but it has not been diagnosed?

Answer 2

Perform a neurology I’ll exam to confirm and refer for evaluation ASAP

Question 3

What are the two major types of vascular events in the nervous system?

Answer 3

1. Hemorrhage within the brain or spinal cord (hemorrhagic stroke)
2. Ischemic stroke

Question 4

What is an ischemic stroke?

Answer 4

An artery occlusion due to a blood clot(thrombotic) or some other material (embolism)

Question 5

By definition, an ischemic stroke results in a region of permanent tissue damage called an _______

Answer 5

Infarct

Question 6

a transient event where the artery occlusion is brief and resolves spontaneously and rapidly enough that the affected regions does not become damaged

Answer 6

Transient ischemic attack

Question 7

What is one diagnostic clue that helps decipher the difference in etiology of ischemic stroke being a thrombosis or an embolism?

Answer 7

Prodrome or lack of prodrome

Question 8

________ mechanism tends to be a recurring event, generating prodrome

Answer 8

Thrombotic

Question 9

______ tends to be a single sudden event without prodrome

Answer 9

Embolism

Question 10

Is infarction reversible or irreversible?

Answer 10

Irreversible

Question 11

An infarct is the site of what?

Answer 11

The ischemic damage

Question 12

Is the penumbra less or more ischemic than infarct?

Answer 12

Less ischemic

Question 13

Is penumbra recoverable?

Answer 13

Potentially

Question 14

What are the current interventions we have to treat ischemic stroke?

Answer 14

Tissue plasminogen activator injection

Surgical removal of clot/embolism

Question 15

What 6 examination findings can hep distinguish an ischemic stroke from a hemorrhagic stroke?

Answer 15

1. Localization of lesion to a single vascular territory
2. Acute and stable (ischemic) or acute and progressive (hemorrhagic)
3. Pain within hemorrhagic, no pain with ischemic
4. Signs of increased ICP in hemorrhagic
5. Edema
6. Radiology - CT

Question 16

What is the intervention method for treating an ischemic stroke?

Answer 16

Clot-busting TPA injection

Question 17

What is the intervention method used to treat a hemorrhagic stroke?

Answer 17

Neurosurgery to stop bleeding and remove hematoma

Question 18

How would an infarcted region appear on a CT?

Answer 18

Reduced tissue density (darker)
reflecting the tissue edem

Question 19

What are the 4 cardiac origins of an ischemic stroke?

Answer 19

1. Atrial fibrillation
2. Myocardial infarction
3. Valvular disease
4. Patent foramen ovals

Question 20

What a re the 6 vascular origins of an ischemic stroke?

Answer 20

1. Stenosis
2. Atherosclerosis
3. Artery “dissection”
4. Atheritis/vasculitis
5. Vasospasm
6. Aneurysms

Question 21

What causes carotid stenosis?

Answer 21

Build-up of atherosclerotic plaque in the wall of the common carotid

Question 22

Carotid stenosis can leas to thrombosis at stenosis site or formation of emboli which can occlude what 3 major arteries?

Answer 22

1. Middle cerebral artery
2. Anterior cerebral artery
3. Ophthalmic artery

Question 23

Carotid stenosis os often accompanied by a ________ on physical exam

Answer 23

Bruit (turbulent whooshing sound)

Question 24

What cause carotid/vertebral dissection?

Answer 24

Trauma-induced tear in the intimate lining of the vessel

Question 25

How does carotid/vertebral dissection present?

Answer 25

Pain in distribution areas

Question 26

What is temporal arteritis?

Answer 26

Temporal artery inflammatory disease within the artery wall

Question 27

Temporal arteritis can cause potential ischemia of the _________ and __________

Answer 27

Retina and optic nerve

Question 28

How does temporal arteritis (giant cell arteritis) present?

Answer 28

-Visible loss of blood perfusion in the affected side of face -visible enlargement of the artery -aches and pains in arterial distribution

Question 29

Temporal arteritis (giant cell arteritis) is a risk factor for __________ or _____________

Answer 29

Anterior ischemic optic neuropathy (AION) or retinal ischemia

Question 30

What age group and gender is temporal arteritis (giant cell arteritis) usually seen in?

Answer 30

Over age 70 Women > men

Question 31

What are the three types of hemorrhages that can originate in the meningeal layers?

Answer 31

Epidural Subdural Subarachnoid

Question 32

Bleeding from the meningeal arteries that accumulates between the skull and dura

Answer 32

Epidural hematoma

Question 33

Bleeding usually of cerebral veins that accumulates between dura and arachnoid

Answer 33

Subdural hematoma

Question 34

Bleeding between the arachnoid later and pita/brain into the CSF space

Answer 34

Subarachnoid hemorrhage

Question 35

Meningeal artery branch cross multiple sutural lines, which means there is potential for what?

Answer 35

Rupture Meningeal artery or veins

Question 36

How does a person with an epidural hermorrhage present?

Answer 36

Transient loss of consciousness after head trauma, patent feel conscious and okay. Potentially lose consciousness again after ICP increases

Question 37

Subdural hemorrhage os typically from tearing of ________

Answer 37

Bridging veins

Question 38

Bridging veins are more vulnerable to rupture in who?

Answer 38

-elderly with alcohol abused -any ocnditions involving brain atrophy

Question 39

What shape will an epidural hemorrhage appear as?

Answer 39

Lens shape s

Question 40

Wheat shape will a Subdural hemorrhage appear as?

Answer 40

Crescent shape

Question 41

Aneurysms often occur at

Answer 41

Branch points

Question 42

Aneurysms can ________ or ____________ nearby structures

Answer 42

Bleed or compress

Question 43

What is arteriovenous malformation? What fails to form?

Answer 43

Abnormal entangled connection between arteries and veins Capillary bed fails to form

Question 44

What areas of the visual pathway experience ischemia?

Answer 44

Optic nerve LGN Visual cortex/striate area

Question 45

Ischemia of anterior optic nerve is a common cause of what?

Answer 45

Sudden vision loss

Question 46

AION can result from _______ with patient noticing vision loss on walking

Answer 46

Nocturnal hypotension

Question 47

Does pain present with AION?

Answer 47

No, painless

Question 48

Anterior choroidal artery supplies __________ and __________

Answer 48

Optic tract and LGN

Question 49

Are occlusions of supply to the optic tracts likely?

Answer 49

Not very likely

Question 50

Can infarcts of the thalamus (LGN) occur?

Answer 50

Yes, thalamic infarcts can occur

Question 51

PCA stroke symptoms

Answer 51

Contralateral homonymous hemianopia with macular sparing

Question 52

What can be used in the management of hemianopsia from PCA stroke?

Answer 52

Prism glasses

Question 53

Frontal eye field vascular territory

Answer 53

Superior division of the MCA

Question 54

Vascular territories of the internal capsule

Answer 54

Lenticulostriate Anterior choroidal artery

Question 55

Vascular territories of the CN III radiations

Answer 55

Proximal PCA

Question 56

CN VI vascular territory

Answer 56

Pontine infarcts (basilar artery paramedical branches)

Question 57

Conjugate eye movements involve what areas

Answer 57

FEF Internal capsule CN III CN VI

Question 58

What other function/circuit/test is compromised by infarct of CN III?

Answer 58

Pupillary light reflex

Question 59

Pupillary dilation deficit: possible infarct sites and etiologies:

Answer 59

Lateral hypothalamus Lateral brain stem Lateral spinal cord (C1-T2) Sympathetic chain Carotid plexus Cavernous sinus Orbit and eye

Question 60

Slide 48 on vascular territories and th pupillary dilation pathway

Answer 60

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