1. Cephalad
    Towards the top of the head
  2. Caudad
    Towards the feet
  3. Ipsilateral
    Same side
  4. Contralateral
    Opposite side
  5. Visual Field
    Everything a person can see when the eyes are fixed. AKA Field of Vision
  6. Episode
    Noteworthy event or series of events
  7. Amaurosis Fugax
    Sudden temporary blindness

    Episodic Monocular Blindness: A shade being pulled down over one eye or FOV
  8. What is the most common cause of Amaurosis Fugax?
    Plaque embolus or thromboembolus from the ipsilateral ICA
  9. What is Hollenhorst Plaque?
    Bright plaque within the vessels of the retina

    Cholesterol crystals are contained within the atheromatous
  10. Diplopia
    Double vision
  11. Homonymous Hemianopsia
    bilateral blindness in half of each eye
  12. Monocular Blindness
    Temporary blindess in one eye; Amaurosis Fugax
  13. If there is damage to the left side of the brain, where will vision be affected?
    Right side of each eye
  14. Dysarthria
    Poor articulation, slurred speech
  15. Dysphasia
    Impairment of speech. The patient knows what he/she wants to say, but can't speak easily
  16. Aphasia
    Loss of expression of speech and comprehension of language
  17. Dysphagia
    Difficulty swallowing
  18. Paresis
    Partial or incomplete paralysis (weakness)
  19. Hemiparesis
    Partial or incomplete paralysis affecting only one side of the body
  20. Plegia
    Complete paralysis or stroke
  21. Hemiplegia
    Paralysis of one half of the body
  22. Paresthesia
    Numbness, tingling or lack of feeling
  23. Monoparesis
    Partial paralysis in one limb
  24. Ataxia
    Failure of muscular coordination
  25. What are two other stroke symptoms?
    Confusion and headaches
  26. Dizziness
    Feeling a tendency to fall
  27. Vertigo
    Sensation of moving around in space
  28. Nausea
    An unpleasant sensation usually preceding vomiting
  29. Syncope
    Pass out
  30. Drop attacks
    Failure of a part to maintain its normal position
  31. What are the two types of stroke?
    Hemorrhagic and Ischemic
  32. Brain Hemorrhage
    The rupture of an aneurysmal artery
  33. What are the causes of brain hemorrhage?
    • AV Malformation
    • Trauma
    • Atherosclerosis
    • Inflammation
  34. What happens to a patient with a hemorrhagic stroke?
    • Blood flows into or out of the brain
    • 30-50% of patients die
  35. Types/Locations of Intracranial Hemorrhage (ICH)
    • Epidural: between dura mater and skull
    • Subdural: between dura and arachnoid mater
    • Subarachnoid (SAH): between arachnoid and pia mater
    • Intraparenchymal: Within the brain
  36. Approximately how many strokes occur as a result of subarachnoid bleeds?
  37. Epidural, Subdural, and Intraparenchymal Hemorrhage account for ___% of stroke?
  38. Ischemic stroke is responsible for ___% of stroke
  39. How are ICHs treated?
    To prevent further bleeding, the ruptured vessel needs to be occluded by surgical clip/repair, embolic therapy, or thrombus formation
  40. What are three other ICH concerns?
    • Pressure from bleed and resultant hematoma
    • Vasospasm
    • Hydrocephalus
  41. Pressure from bleed and resultant hematoma
    When an aneurysm ruptures, blood extravasates under arterial pressure into the subarachnoid space and quickly spreads through the cerebrospinal fluid around the brain and spinal cord. Blood released under high pressure may directly cause damage to local tissue.
  42. True/False: The damage caused by ICH is proportional to the volume of blood that extravasates from the ruptured vessel
  43. Vasospasm
    The pathophysiology of vasospasm is unclear
  44. Spasm rarely occurs before the ___ day after the hemorrhage
    3rd day
  45. Vasospasm induced by SAH
    Depends on amount of blood around the brain and resultant hematoma

    Usually very ill patients already in the hospital

    Many times the patients have involuntary movements

    Usually agressively treated with drugs
  46. SAH Grade 1
    Neurologic status intact

    Mild headache

    Slight nuchal rigidity (involuntary sustained muscle contraction)
  47. SAH Grade 2
    Neurologic deficit evidenced by cranial nerve involvement

    moderate to severe headache with pronounce meningeal signs

    (Photophobia, nuchal rigidity)
  48. SAH Grade 3
    Drowsiness and confusion with or without focal neurologic deficits

    Pronounced meningeal signs
  49. SAH Grade 4
    • Stuporous with pronounced neurologic deficits
    • (Hemiparesis, dysphagia)

    Nuchal rigidity
  50. SAH Grade 5
    Deep coma state with decerebrate posturing and other brain stem dysfunction
  51. ICH clinical manifestations
    Sudden throbbing, or explosive headache

    Nausea or vomiting

    Visual disturbances

    Motor deficits

    Loss of consciousness
  52. Ischemic stroke: lack of oxygen to the brain cells due to...
    Atheroembolus: A fragment of plaque travels to the brain and occludes a small artery that feeds brain cells

    Thromboembolus: A fragment of thrombus travels to the brain and occludes a small artery that feeds brain cells
  53. Stroke facts
    Cerebrovascular disease is the 3rd leading cause of death in the US

    Heart disease is the leading cause

    Cancer (trachea, bronchus, and lung) are second

    75% of the brain's substance is fed by blood
  54. Stroke facts
    Most common cause of arterial stenosis is atherosclerosis

    Intracranial disease is less common than extracranial in the US

    Opposite for Asian and African origins
  55. Rates of stroke
    700,000 Americans will have had a stroke in 2006, 157,000 of them will die

    Strokes cost about $43 million per year
  56. Cerebral vascular accident (CVA)
    Stroke brain cell infarction has occurred
  57. Focal neurologic deficit
    A focal neurological impairment of the functional capacity of that part of the brain

    The deficit effect becomes the SYMPTOM of stroke or TIA
  58. Stroke symptoms never resolve completely
    A true stroke results in a permanent neurologic deficit
  59. Acute stroke
    Sudden onset of symptoms
  60. Stroke in evolution
    Symptoms come and go, unstable
  61. Completed stroke
    No progress or resolution of symptoms, stable
  62. TIA (not CVA, results in a focal neurological deficit)
    Average TIA lasts from seconds to 30 minutes

    Symptoms always resolve in under 24 hours

    Usually embolic from heart or carotid
  63. TIA
    Caused by temporary loss of blood supply

    Permanent cell damage may occur if TIA lasts for hours
  64. RIND - Reversible Ischemic Neurologic Deficit
    Neurologic deficit that lasts longer than 24 hours with symptoms resolving in time, in a way similar to that of a TIA

    Less than a week, less than three days

    Invariably produces brain cell infarction
  65. Uncontrollable risk factors
    Age - increasing age

    Sex - men over women, women are more likely to die from stroke

    Heredity and Race - more likely if a family member has had a stoke. Africans have a higher risk of death, and Asians have a greater risk of intracranial generated stroke

    Prior stroke or heart disease
  66. Controllable risk factors
    High Blood Pressure - atherosclerosis



    A fib - prevent clots with anticoagulants

    Blood cholesterol

    Obesity and inactivity 

    Excessive alcohol
  67. Causes of ischemic stroke

    Heart embolus




  68. Atherosclerosis
    Intimal damage and collagen exposure

    Severe stenosis damages the intima to rupture

    Blood hemorrhages into the plaque (ulceration)

    Collagen fibers exposed and a thrombus forms
  69. TIA followed by CVA (stroke) in 33% of patients within 5 years
  70. Embolus from the heart
    Left atrium

    A fib can dislodge thromboembolus
  71. Previous MI
    damage to endothelium stimulates thrombus formation
  72. Bacterial endocarditis
    Effects the mitral valve where a thrombus may form
  73. Hypertension
    Elevated blood pressure can contribute to heart disease

    Worsens atherosclerosis of large arteries

    Injures small vessels of kidney and brain - hyaline (glassy) arteriolar sclerosis

    Advances to occlusion of arteriole and can cause infarction
  74. Dissection
    Occurs between vessel layers

    Effects patients between 20 and 50

    Caused by hypertension, trauma, and FMD

    Occurs commonly distal to the bifurcation, below base of skull

    Leads to hemorrhage and thrombus between endothelium and media - two distinct lumens
  75. Prethrombotic States
    Abnormalities in blood coagulation

    Usually in veins

    Also in arteries
  76. Posterior branch is the...
    Internal carotid artery

    70-80% of CCA flow will pass through the ICA
  77. The ECA has ___ branches
    8 - outside the cranium 

    • Anterior
    • Posterior
    • Medial 
    • Terminal
  78. Cervical portion of the ICA
    Extracranial ICA
  79. Petrous portion of the ICA
    Carotid canal/foramen, enters the cranium
  80. Cavernous portion of the ICA
    Carotid siphon
  81. Supraclinoid portion of the ICA
    Terminal ICA at bifurcation
  82. First ICA branch
    Opthalamic Artery

    • -Lacrimal A branch
    • -Supraorbital A branch
    • -Frontal A branch
  83. Lacrimal Artery
    Anastomoses with branches of the middle meningeal artery (of the internal maxillary A)
  84. Supraorbital Artery
    Arises from the mid part of the opthalmic artery and passes through the supraorbital notch where it anastomoses with the frontal branch of the superficial temporal artery and the facial atery
  85. Frontal Artery
    Passes to the forehead where it anastomoses with branches of the superficial temporal artery and the facial artery
  86. The ICA terminates by bifurcating into the...
    Anterior cerebral and Middle cerebral arteries
  87. Anterior cerebral artery
    Passes above the optic nerve to the fissure between the two hemispheres, then around the Corpus Collosum where it gives blood to the frontal lobes
  88. Vertebral arteries
    Originate from the subclavian arteries

    Pass into the sixth cervical vertebra

    Goes into the foramen magnum where they join to form the basilar artery

    Right is usually smaller than left vertebral
  89. Intracranial vertebral artery
    Gives off the posterior inferior cerebellar artery (PICA)
  90. Circle of Willis includes
    Anterior cerebral arteries

    Middle cerebral arteries

    Posterior cerebral arteries

    Communicating arteries
  91. The ICA is connected to the...
    Posterior cerebral artery by the posterior communicating artery
  92. General Cerebrovascular Considerations
    Four main vessels feed the brain:

    • -Right and left ICAs
    • -Right and left vertebral arteries
  93. Only the MCA, ACA, and PCA are considered main channels of the Circle of Willis
  94. Alternate collaterals of the Circle of Willis make it possible for a patient to have unilateral or bilateral occluded ICAs, yet have no symptoms
  95. Anomalies of the Cirlce of Willis
    • Acom might not be present
    • Pcoms might not be present

    Most common is one or both Pcoms missing
Card Set
Test 1