ABPN Vascular Neurology flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Circle of Willis function

The anastomotic ring at the brain base connects internal carotid and vertebrobasilar circulations; communicating arteries provide collateral flow when a major vessel occludes.

Cerebral perfusion pressure formula

CPP equals mean arterial pressure minus intracranial pressure. Normal target varies, but cerebral blood flow depends on adequate CPP and autoregulation.

MCA stroke syndrome

Contralateral face and arm weakness, sensory loss, aphasia with dominant hemisphere involvement, and neglect with nondominant involvement; leg weakness is less prominent than in ACA stroke.

Lacunar stroke mechanism

Occlusion of small penetrating arteries, often from lipohyalinosis or microatheroma, causes small deep infarcts presenting as pure motor, pure sensory, sensorimotor, ataxic hemiparesis, or dysarthria-clumsy hand.

Ischemic penumbra

Hypoperfused brain tissue with impaired function but preserved cellular viability; salvage depends on rapid reperfusion and lies between the infarct core and benign oligemia.

IV thrombolysis window

Intravenous alteplase or tenecteplase may be given within 4.5 hours of last known well to eligible patients without hemorrhage on imaging or major contraindications.

Thrombolysis blood pressure limits

Blood pressure must be below 185/110 mmHg before intravenous thrombolysis and maintained below 180/105 mmHg for at least 24 hours afterward to reduce hemorrhagic risk.

Large vessel occlusion imaging

CT angiography rapidly identifies proximal intracranial occlusion; perfusion imaging or MRI mismatch selects patients for thrombectomy in delayed time windows.

Post-thrombolysis antiplatelet timing

Aspirin or other antiplatelets are generally withheld for 24 hours after intravenous thrombolysis and started after follow-up imaging excludes hemorrhagic transformation.

Malignant MCA infarction

Large hemispheric infarction causes progressive edema, midline shift, and herniation; decompressive hemicraniectomy improves survival in selected patients, especially younger adults, when performed early.

Stroke mimic examples

Hypoglycemia, seizure with postictal deficit, migraine aura, conversion disorder, and toxic-metabolic encephalopathy can mimic stroke; glucose and history testing guide immediate decisions.

ICH blood pressure target

For spontaneous intracerebral hemorrhage, rapid lowering of systolic pressure to about 140 mmHg is reasonable when presenting pressure is high, while avoiding excessive hypotension.

Warfarin hemorrhage reversal

Vitamin K plus prothrombin complex concentrate rapidly reverses warfarin anticoagulation in intracranial hemorrhage; fresh frozen plasma is an alternative when PCC is unavailable.

SAH sentinel headache

A sudden severe headache days before aneurysm rupture can signal a small sentinel bleed; negative early CT may require lumbar puncture or vascular imaging to exclude subarachnoid hemorrhage.

Nimodipine in SAH

Oral nimodipine 60 mg every four hours for 21 days reduces delayed cerebral ischemia and poor outcome after aneurysmal subarachnoid hemorrhage, despite limited effect on angiographic vasospasm.

ICH score components

The ICH score combines Glasgow Coma Scale, hematoma volume, intraventricular hemorrhage, infratentorial origin, and age 80 years or older to estimate mortality risk.

Cerebellar hemorrhage surgery

Cerebellar hematoma larger than 3 cm, brainstem compression, or hydrocephalus generally warrants urgent surgical evacuation rather than observation alone.

Symptomatic carotid stenosis

Carotid endarterectomy benefits selected patients with recent symptomatic 70-99% stenosis; surgery should occur soon after the event, generally within two weeks, after multidisciplinary assessment.

AF anticoagulation choice

Direct oral anticoagulants are preferred over warfarin for most patients with atrial fibrillation and stroke, except mechanical valves and moderate-to-severe mitral stenosis.

High-intensity statin target

After atherosclerotic ischemic stroke, high-intensity statin therapy lowers LDL cholesterol substantially; an LDL goal below 70 mg/dL is commonly used, with lower targets for very high risk.

Dual antiplatelet therapy duration

Aspirin plus clopidogrel for 21 days is used for minor ischemic stroke or high-risk TIA, then changed to single antiplatelet therapy to limit bleeding.

Asymptomatic carotid stenosis

Carotid endarterectomy may be considered for asymptomatic 60-99% stenosis in low-surgical-risk patients with good life expectancy, after shared decision-making about modest benefit.

RCVS features

Reversible cerebral vasoconstriction syndrome causes recurrent thunderclap headaches with segmental arterial narrowing; it often occurs postpartum or after vasoactive triggers and usually resolves spontaneously.

CADASIL genetics

CADASIL is an autosomal dominant small-vessel disease caused by NOTCH3 mutations, producing migraines, lacunar strokes, white-matter changes, and cognitive decline.

Cervical artery dissection

Dissection causes neck pain, Horner syndrome, or posterior circulation ischemia in young adults; antithrombotic therapy is used for several months, with stenting reserved for recurrent ischemia.

CVST anticoagulation

Cerebral venous sinus thrombosis is treated with anticoagulation even when hemorrhagic infarction is present; treatment reduces thrombus propagation and improves outcomes.

Spinal dural AV fistula

A spinal dural arteriovenous fistula causes progressive myelopathy from venous congestion, often with T2 cord hyperintensity; catheter angiography confirms and enables embolization.

ASPECTS score

The Alberta Stroke Program Early CT Score grades early ischemic changes on noncontrast CT; lower scores indicate larger established infarction and influence reperfusion decisions.

CT perfusion core-penumbra

CT perfusion estimates infarct core and hypoperfused tissue; a small core with a large penumbra supports thrombectomy in extended time windows.

TCD vasospasm threshold

Transcranial Doppler mean flow velocity above 120 cm/s in the middle cerebral artery suggests vasospasm after subarachnoid hemorrhage; the Lindegaard ratio helps distinguish hyperemia.

Increased ICP management

Elevate the head, maintain oxygenation and blood pressure, and use hypertonic saline or mannitol for cerebral edema; hyperventilation is a temporary bridge for impending herniation.

Basilar artery occlusion

Basilar occlusion can cause fluctuating consciousness, cranial nerve deficits, quadriparesis, and coma; urgent vascular imaging and thrombectomy are indicated for eligible patients.