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CM Neuro Stroke

Stroke

QuestionAnswer
Most common presentation that can look like stroke metabolic disorders
Stroke definition Acute neurological deficit of vascular etiology with symptoms lasting longer than 24 hours
Stroke differential Diagnosis Infection, autoimmune, metabolic, neoplastic, trauma, epilepsy, demyelinating dz, psychiatric dz
80-85% of all strokes are ischemic (presents with acute focal neurological deficit that can be traced back to anatomy). 15-20% are hemorrhages
Most scommon cause of Ischemic stroke Atheroembolic (50%)
Primary Parenchymal ICH Presentation older man, hx of htn, severe HA, left hemiparesis, hemisensory deficit progressing over 2 hours, present wtih BP 240/140. Hemorrhages on fundoscopic
Name the typical locations for Striae blood vessel hemorrhages in Primary Hypertensive ICH Thalamus, Basal Ganglia, Pons, Cerebellum
A contraleteral motor/sensory deficit can be caused by lesion in the thalamus/basal ganglia
An ipsilateral ataxia can be casued by lesion in the cerebellum
3 things that are white on CT rocks, blood, contrast
Amyloid Agiopathy Presentation 75 yo man, dementia, episodic worsening, no hx of htn, acute right arm weakness, bp 130/80mmHg.
Cerebral Microhemorrhages can be found in amyloid angiopathy. Amyloid weakness the vessels and causes them to leak.
Amyloid Hemorrhage CT More likely to have lobar hemorrhages
Venous infarction presentation 25 yo female, Oral Contraceptives, Smoker, HA, focal neurological sx: aphasia, right arm weakness. (coagulopathy in the venous sinuses)
Anuerysmal Subarachnoid Hemorrhage Presentation 40 yo woman, abrupt, severe HA, meningismus, depressed consciousness, non-focal neurological exam
Where is it common for subarachnoid aneurysms occur? locations where large vessels bifucate. No blood in the brain parenchyma, rather outlining the brain.
Classic method for diagnosing aneurysmal subarachnoid hemorrhage catheter angiogram
Atheroembolic Stroke Characteristics Single vascular territory, warning signs, stepwise progression
Atheroembolic Presentation Right handed 65 year old man, hx of htn, hx of CAD, transient language disturbance, transient right arm weakness, normal head CT scan. (temporary problems with speech and weakness on one side of the body)
Compromise to the Anterior Cerebral Artery will have what presentation? Motor and Leg deficiencies
Compromise to the Middle Cerebral Artery will have what presentation? Face and Arm deficiencies
What presents with body weakness on one side of the body, and EOMs on the other side of the body? Brainstem problem (3rd nerve compromised). Contralateral after medulla. (AKA Weber syndrome)
Cortical vs subcortical infarction presentations Deeper (subcoritcal) you go in the brain, the more likely that face, arm and leg are all affected equally. The more cortical lesions have clearer gradations between face, arm and leg
Normal calcified structure of the brain that is central? pineal gland
Neuroimaging for atheroembolic stroke Neuroimaging, carotid ultrasonography, MR angiograpy (MRA), CT angiography, Catheter angiography
Cardioembolic Presentation Right handed 65 yo, hx of atrial fibrillation, aphasia, right hemiparesis/hemisensory deficit affecting face and arm, carotid US normal
Maximal deficit at onset with multiple vascular territoies, cardioembolic source and hemorrhagic infarction suggests Cardioembolic stroke
Cardioembolic sources Atrial Fibrillation (most common), cardiomyopathy, acute myocardial infarction, valvular heart disease
When brain dies and blood vessels die due to infarction, what occurs? endothelial of vessels breaks down and blood leaks out into the surrounding brain. Primary injury is ischemic and then bleeding follows
acute focal neurological deficit, SS resolve within 24 hours, ischemic etiology, no neuroimaging clues TIA (transient ischemic attack)
What is the likelihood of a pt who has a TIA to have a stroke within the first month following their TIA? 85%
Created by: ltm12
 

 



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