CORE: Neuro > Stroke > Flashcards

Stroke Flashcards

(67 cards)

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1
Q

goal of stroke imaging

A

who benefits from therapy

hemorrhage precludes tPA

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2
Q

goal of stroke therapy

A

restore perfusion

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3
Q

AHA guidelines for stroke therapy

A

IV tPA within 3 hours of stroke onset

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4
Q

goal of perfusion imaging

A

characterize ischemic penumbra

perhaps predict area of vulnerable brain vs infarct core

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5
Q

insular ribbon sign

A

loss of gray-white differentiation

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6
Q

hyperdense artery sign

A

visualization of acute IV thrombus, typically in MCA

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7
Q

stroke MRI

A

restricted diffusion > mass effect/T2 and FLAIR hyperintensity > white matter changes > gyral enhancement/resolution of mass effect»_space; encephalomalacia

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8
Q

reason for restricted diffusion

A

shift from extracellular to intracellular water due to NA/K ATPase pump failure

increase viscosity of infarcted brain

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9
Q

AVM

A

congenital high flow vascular malformation

typically with seizures and bleeding

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10
Q

Spetzler Martin scale

A

evaluate AVM for surgical resection

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11
Q

AVM imaging characteristic

A

vascular nidus with multiple flow voids; adjacent gliosis, dystrophic calcifications and blood products (blooming)

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12
Q

vein of galen malformation

A

vascular malformation characterized by AV fistula from thalamoperforator branches

most common cause of extracardiac high output cardiac failure in kids

may cause parinaud in adults

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13
Q

dAVF

A

complex high flow lesions due to AV shunts between meningeal arterioles and dural venules

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14
Q

cognard classification

A

describes lesions with progressively increased risk of bleeding for dAVF

presence of cortical venous drainage and risk of hemorrhage

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15
Q

type V cognard classification

A

spinal dAVF; may cause myelopathy

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16
Q

carotid cavernous fistula

A

CCF; type of dAVF caused by trauma between cavernous carotid artery and cavernous sinus

enlargment of superior orbital vein and shunting within cavernous sinus; proptosis and CN palsy

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17
Q

low flow lesions

A

cavernous malformation/cavernoma; developmental venous anomaly; capillary telangiectasia

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18
Q

caput medusa morphology

A

developmental venous anomaly ; radially oriented vein

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19
Q

cavernoma

A

vascular hamartoma; small but definite bleed risk

can cause seizures

can be induced by radiation treatment

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20
Q

familial cavernomatosis

A

multiple cavernous malformations

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21
Q

cavernoma imaging manifestations

A

CT: hyperattenuating lesion (microcalcification within cavernoma)

MRI: popcorn like lobular mixed signal due to blood products of varying age; peripheral rim of hemosiderin (GREdark); no enhancement

CTA: occult

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22
Q

developmental venous anomaly/venous angioma

A

abnormal vein that provides functional venous drainage to normal brain

DO NOT TOUCH lesion; can cause venous infarct

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23
Q

capillary telangectasia

A

asymptomatic vascular lesion composed of dilated capillaries interspersed with normal brain

DO NOT TOUCH lesion

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24
Q

capillary telangectasia imaging

A

MRI: brush stroke like enhancing lesion in brainstem/pons; no mass effect or edema

GRE blooming

CTA/MRA: occult

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25
SAH
commonly from trauma then aneurysm thunderclap headache/meningismus
26
subarachnoid space hyperattenuation DDX
SAH, meningitis, leptomeningeal carcinomatosis, prior intrathecal contrast administration also DDX increased FLAIR in subarachnoid space + recent oxygen/propofol administration
27
SAH work-up
noncontrast CT; lumbar puncture for xanthochromia if suspicion high despite negative CT
28
SAH locations/aneurysms
anterior interhemispheric fissure: ACA suprasellar cistern: Pcomm sylvian fissure: MCA perimesencephalic cistern: basilar tip aneurysm or nonaneurysmal perimesencephalic SAH
29
grading scales for SAH
Hunt and Hess (clinical; no imaging/headaches) Fisher: thickness of SAH
30
compliciations of SAH
vasospasm (peak 7 days after ictus) acute hydrocephalus due to arachnoid granulations >> vetriculostomy supericial siderosis: iron overload of pial membranes to to repeat bleeds; sensorineural deafness/ataxia
31
perimesencephalic SAH
nonaneurysmal SAH; occult venous bleeding sandard care is to perform catheter angiography 2x, 1 week apart mild to moderate vasospasm, better prognosis
32
reversible cerebral vasoconstriction syndrome
nontraumatic nonaneurysmal SAH and ischemia thunderclap headache; prolonged but reversible vasoconstriction
33
saccular aneurysm
focal outpouching of arterial wall; typically at branch points; neck:body ratio affects treatment sizes: small <1 cm, medium <2.5; giant >2.5 cm may be caused by Takayasu/giant cell arteritis, HTN, marfan, ehlers-danlos, PCKD, NF1 (connective tissue diseases)
34
fusiform aneurysm
segmental arterial dilation without neck; due to atherosclerosis do not occur at branch points
35
mycotic/infectious aneurysm
septic emboli; form in distal arterial circulation beyond circle of Willis fragile; high risk of rupture
36
oncotic aneurysm
aneurysm caused by neoplasm benign left atrial myxoma may peripherally embolize and cause distal oncotic aneurysm
37
traumatic pseudoaneurysm
do not contain all 3 layers of vessel wall; abnormal luminal narrowing proximal occur distally arteries close to bony structures (basilar/vertebral) prone to dissecting
38
dural sinuses
superior sagittal sinus > torcular herophili/confluence of sinuses transverse sinus (left is usually hypoplastic) sigmoid sinus < jugular bulb
39
deep cerebral veins
internal cerebral veins, basal vein of rosenthal, vein of galen venous angle: septal/thalamostriate vein intersection (foramen of Monro)
40
superficial cerebral veins
vein of Trolard (superficial cortical to SSS) vein of Labbe(drains temporal convexity to transvers/sigmoid sinus)
41
risk factors for venous thrombosis
pregnancy, OCP, thrombophilia, malignancy, infection
42
more common cause of stroke in younger patients
cortical vein thrombosis/deep venous sinus thrombosis
43
empty delta sign, cord sign, findings on MR venogram
cord sign: increased density in thrombosed sinus/cortical vein empty delta sign: filling defect in SSS MR venogram: lack of flow in thrombosed vein/dural venous sinus
44
thrombosis in SSS, deep venous system, transverse sinus >> venous infarction
superior sagittal sinus thrombosis: infarction of parasagittal high convexity cortex deep venous system thrombosis: infarction bilateral thalami transverse sinus thrombosis: infarction posterior temporal lobe
45
stages of iron in hemoglobin
intracellular oxyhemoglobin -> deoxygenation --> intracellular deoxyhemoglobin --> oxidation --> intracellular methemoglobin --> cell lysis --> extracellular methemoglobin --> chelation --> hemosiderin/ferritin
46
risk of posterior fossa hemorrhage >3cm
brainstem compression or hydrocephalus from 4th ventricular obstruction
47
hyperacute hematoma: blood product stage, T1/T2 signal
0-6 hrs intracellular oxyhemoglobin T1 isointense, T2 iso/hyperintense peripheral rim on GRE
48
acute hematoma: blood product stage, T1/T2 signal
6-72 hrs intracellular deoxyhemoglobin T1 isointense, T2 dark
49
early subacute hematoma: blood product stage, T1/T2 signal
3 days -1 week intracellualr methemoglobin T1 hyperintense, T2 dark
50
late subacute hematoma: blood product stage, T1/T2 signal
1 week - months extracellular methemoglobin T1/2 bright
51
chronic hematoma: blood product stage, T1/T2 signal
extracellular iron/ferritin/hemosiderin | T1/2 dark
52
most common cause of spontaneous hemorrhage
chronic hypertension
53
common locations for hypertensive hemorrhage
basal ganglia, thalamus, cerebellum
54
imaging findings suggestive of hypertensive microangiopathy
periventricular white matter disease, prior lacunar infarcts microhemorrhages on T2* in basal ganglia/brainstem
55
cerebral amyloid angiopathy
amyloid in small and medium artery walls that cause vessel weakness --> hemorrhage; can also cause occlusion and contribut to microangiopathy exclusively in elderly adults (whites)
56
primary imaging feature of cerebral amyloid angiopathy
hematoma: lobar/cortical (parietal/occipital lobes) multiple microhemorrhages seen on T2*; seen in cortex, not basal ganglia
57
aneurysmal hemorrhage
most common cause of nontraumatic SAH
58
AVM malformation hemorrhage
rupture of AVM; parenchymal hematoma congenital abnormal high flow AV connection without intervening normal brain tends to affect younger patients
59
dural AV fistula hemorrhage
fistulous connection between meningeal artery and venous sinus/cortical vein most common types: cavernous-carotid fistula or posterior fossa dAVF
60
venous thrombosis hemorrhage
thrombosis of cortical veins/deep venous sinuses lead to venous hypertension which can cause infarction and parenchymal hemorrhage
61
hemorrhagic neoplasms in the brain
glioblastoma, mets (choriocarcinoma, melanoma, thyroid carcinoma, RCC; breast/lung based on most common) pts treated with bevacizumab (Avastin)
62
cavernous malformation
vascular hamartoma that consists of low-flow endothelial lined blood vessels; no intervening brain popcorn like lobular mixed high T1/2 signal; dark hemosiderin rim however, once it bleeds hematoma is nonspecific
63
hemorrhagic transformation of infarct: risk factors
thrombolytic therapy, large region of hypoattenuation, dense artery sign
64
vasculitis hemorrhage
vasculitis typically causes cerebral ischemia, less likely frank emorrhage
65
moya moya
nonatherosclerotic vasculopathy; progressive stenosis of intracranial ICA --> proliferation of fragile lenticulostriate collaterals susceptible to aneurysms in posterior circulaton; decreased flow in affected vascular regions
66
puff of smoke, ivy sign
puff of smoke: enlarged basal perforating arteries ivy sign: FLAIR MRI; tubular branching hyperintense structures within sulci
67
types of intraparenchymal hemorrhage in elderly
hypertensive hemorrhage, amyloid angiopathy
CORE: Neuro
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