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Neuro DRx > 03a: Stroke > Flashcards

03a: Stroke Flashcards

1
Q

TIA is defined by time frame of under:

A

24 hours

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2
Q

List the 5 major modifiable risk factors for stroke.

A
  1. A-fib (4-10x)
  2. HT (3-5x)
  3. Smoking (2x)
  4. Diabetes (2x)
  5. Hyperlipidemia/obesity (1.5x)
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3
Q

T/F: Majority of strokes are hemorrhagic.

A

False - ischemic (85%)

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4
Q

T/F: Majority of ischemic strokes are thrombotic.

A

True - 40%

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5
Q

What are examples of hemorrhagic stroke etiologies?

A

Subarachnoid or intracerebral hemorrhages

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6
Q

Which structures tend to be affected by small vessel (lacunar) strokes?

A

Subcortical structures:

  1. Internal capsule
  2. Basal ganglia
  3. Pons
  4. Thalamus
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7
Q

(X)% of ischemic strokes are cardio-embolic in origin.

A

X = 25

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8
Q

Medial and basal temporal cortex supplied by (X) a.

A

X = posterior cerebral

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9
Q

T/F: Lateral surface of all cortical lobes are supplied by MCA.

A

False - occipital lobe lateral surface by PCA

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10
Q

(Ipsi/contra)-lateral weakness of face/upper limb seen in (upper/lower) MCA infarction.

A

Contralateral;

Upper

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11
Q

Visual field defect seen in (upper/lower) MCA infarction.

A

Lower

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12
Q

“Locked in” syndrome is a result of (X) infarction and impairs which tracts?

A

X = bilateral basal pons

Corticospinal and corticobulbar

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13
Q

“Locked in” syndrome differs from basilar a occlusion in that (X) symptoms are (present/absent).

A

X = oculomotor and reticular activating system deficits

Absent

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14
Q

Complete (pupil-involved) CN III palsy should be attributed to (X) until proven otherwise!

A

X = PCOM aneurysm! (compression)

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15
Q

Incomplete (pupil-spared) CN III palsy should be attributed to (X) until proven otherwise!

A

X = PCOM aneurysm! (compression)

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16
Q

Weber test: if sound is perceived to be louder in R ear than in the L ear, then this means…

A

EITHER:

Conductive hearing loss in R ear OR sensorineural hearing loss in L ear

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17
Q

Retrocochlear hearing loss typically involves defect in:

A

CN VIII (somewhere between inner ear and brain)

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18
Q

What is Presbycusis?

A

sensorineural hearing loss that occurs with aging

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19
Q

(X) is the perception of sound within the human ear in the absence of a corresponding external sound.

A

X = tinnitus

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20
Q

Patient has nystagmus where eyes have quick phase/beat to left, then slow reset toward right. This is (R/L) nystagmus.

A

L (defined by quick phase)

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21
Q

Moderate to severe virtigo is classically associated with (central/peripheral) cause of dizziness such as dysfunction in:

A

Peripheral

Labyrinth/vestibular n

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22
Q

Continuous (as opposed to recurrent) nystagmus is classically associated with (central/peripheral) cause of dizziness such as dysfunction in:

A

Central

Cerebellum/brain stem

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23
Q

85% of cases of peripheral vestibular dysfunction are attributed to which 3 disorders?

A
  1. BPPV (Benign paroxysmal positional vertigo)
  2. Labrynthitis
  3. Meniere’s disease
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24
Q

Episodic, positional vertigo classically seen in (BPPV/Labrynthitis/Meniere’s).

25
Episodic, non-positional vertigo classically seen in (BPPV/Labrynthitis/Meniere's).
Meniere's
26
Non-episodic, non-positional vertigo classically seen in (BPPV/Labrynthitis/Meniere's).
Labrynthitis
27
(BPPV/Labrynthitis/Meniere's) is, by definition, more than 1 episode of vertigo that don't necessarily last for a long period of time.
Meniere's
28
Patient complains of vertigo and feeling unsteady when standing after moving his head (ex: rolling over in bed). Lasts about an hour. Reports some nausea/vomiting, but no change in hearing/tinnitus.
BPPV
29
Starting 2 days ago, patient reports onset of sudden violent spinning sensation, to the point where she can't stay standing. Reports some loss of hearing, nausea, and ringing in her ear. No prior episodes.
Labrynthitis
30
(X) vestibular disorder is similar to labyrinthitis, but different because it lasts longer (weeks to months) and lacks which Sx?
X = vestibular neuritis Hearing loss
31
Meniere's disease triad:
Vertigo (episodic), sensorineural hearing loss (fluctuating), and tinnitus
32
List some causes of Meniere's.
1. Overproduction/retention of endolymph 2. Allergy 3. Migraine/stress 4. High sugar/salt intake 5. Trauma 6. Infection
33
Initial Rx of Meniere's.
salt restriction diet, diuretics
34
After diet/diuretic Rx for Meniere's, which meds are tried?
1. Vasodilators 2. CCBs 3. ACEi
35
Non-positional, non-episodic vertigo should make you consider which 3 key disorders?
1. Labyrinthitis 2. Acoustic neuroma 3. Cerebral hemorrhage
36
(X) Labyrinthitis is a medical emergency.
X = Purulent (bacterial) Hospitalize, hydrate, vestibular suppressants, and IV antibiotics
37
Acoustic neuroma, aka (X), typically causes patient to come in with which key complaint?
X = vestibular schwannoma Asymmetric (sensorineural) hearing loss (and/or tinnitus)
38
If patient can tell you when seizure is coming on, aka they have a(n) (X), that tells you they have (simple/complex) (Y) seizure.
X = aura Simple Y = partial (focal in origin)
39
Tonic versus clonic seizure type:
Tonic: rigid Clonic: jerky
40
Grand mal (convulsive) seizure is (tonic/clonic/atonic).
Tonic and clonic
41
Febrile seizures are seen in (kids/elderly) and (X)% continue on to develop epilepsy.
Kids (age 3-5); | X = 10
42
"Salaam" posture is (flexion/extension) of trunk, (flexion/extension) of arms, and drawing up of legs. Characteristic of (X) epileptic syndrome.
Flexion; extension; X = West
43
Patient is infant that has episodes of head nodding with giggling and flushing. This sounds like (X) epileptic syndrome.
X = West
44
Infant with West Syndrome will have (X) EEG pattern.
X = hypsarrhythmia
45
Triad of intractable seizures, mental retardation and developmental delay with EEG pattern of (X). Which epileptic syndrome?
X = slow spike and wave Lennox Gastaut Syndrome
46
Lennox Gastaut syndrome: seizures are (tonic/clonic/atypical absence/myoclonic/atonic).
Can be any of those!
47
15 year old patient presents with seizures that occur as soon as she wakes up. Sometimes they're clonic, sometimes tonic. Diagnosis is (X) and pattern on EEG is (Y).
``` X = juvenile myoclonic epilepsy Y = spike and wave ```
48
(X) epilepsy disorder is trigged by sleep depriavtion and EtOH.
X = juvenile myoclonic epilepsy
49
T/F: 25% of epilepsy has unknown etiology.
False - 25% known, 75% unknown
50
Rx for epilepsy: start with (one/combo) drug(s). If that fails, then:
One; | Add a second one
51
In addition to meds, refractory epilepsy may be improved or controlled by:
1. VNS (vagal nerve stimulator) implant | 2. Lobectomy, collosotomy ("split brain surg"), hemispherectomy
52
What's status epilepticus?
Continuous seizure activity or recurrent seizures without regaining of consciousness in between the seizures.
53
Seizures lasting longer than (X) are medical emergencies and require immediate medical attention/treatment.
X = 5 min
54
Steps to treating Status Epilepticus:
1. Examine patient (pupils, resp, airways) 2. Maintain airway/vital fxn 3. Labs (establish ppt factor) 4. Benzos (diazepam)
55
Status Epilepticus: if benzos don't work, try (X) then (Y).
``` X = phenytoin Y = phenobarbitol ```
56
T/F: EEG monitoring is vital in status epilepticus and should be in place before Rx initiation.
Partly false - monitoring is vital, but start treatment ASAP if EEG not available right away
57
Hormone influence on epilepsy: estrogen is (pro/anti)-convulsant. And progesterone?
E: pro-convulsant P: anti-convulsant
58
T/F: SUDEP is generally defined as the death of a person with epilepsy related to status epilepticus.
False - unrelated to status epilepticus; without any discernable structural or toxicological cause

Neuro DRx (10 decks)

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