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BMB Test 3 > B7-063 Stroke Cases > Flashcards

B7-063 Stroke Cases Flashcards

1
Q

sudden onset of focal brain deficits from blockage or rupture of cerebral blood vessel

A

stroke

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2
Q

3 common causes of ischemic stroke

A

large vessel artherosclerosis
cardiogenic emboli
small vessel disease

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3
Q

is hemorrhagic or ischemic stroke more common?

A

ischemic

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4
Q

cardiogenic emboli usually consists of […] clot

A

red

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5
Q

irregularly irregular rhythm on EKG

A

a-fib

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6
Q

diagnostic test for cardiogenic emboli [3]

A

continous EKG (a-fib)
TTE
TEE

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7
Q

primary source of cardiogenic embolism

A

non-valvular a-fib

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8
Q

mainstay of therapy for patients with a-fib

A

anticoagulation to prevent ischemic stroke

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9
Q

direct oral anticoagulants

A

apixaban
edoxaban
dabigatran
rivaroxaban

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10
Q

in patients with a-fib and strong contraindication for anti-coagulation, what is an alternate therapy?

A

watchman device inserted to left atrial appendage

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11
Q

most common mechanism of ischemia from large vessel artherosclerosis

A

artery to artery emboli

(like at carotid bifurcation)

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12
Q

diagnostic tests for artherosclerosis based stroke [2]

A

angiography (usually CT)
carotid US

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13
Q

risk factors for artherosclerosis based stroke

A

hypertension
smoking
hyperlipidemia
diabete mellitus

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14
Q

prevention of artherosclerosis based stroke [3]

A

treat risk factors
antiplatelets (no anti-coagulation)
carotid endarterectomy/stenting

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15
Q

anti-platelet medications [3]

A

aspirin
clopidogrel
ticagrelor

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16
Q

is diabetes a modifiable risk factor for stroke?

A

no, blood sugar control has not been shown to decrease risk

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17
Q

when is carotid endarterectomy indicated?

A

symptomatic (stroke) patients with greater than 70% occulsion

(risk of perioperative MI is too high in asymptomatic, or symptomatic patient with only moderate stenosis)

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18
Q

common mechanisms of penetrating artery occlusion leading to small vessel strokes [2]

A

lipohyalinosis
microatheroma

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19
Q

risk factors for lacunar strokes

A

hypertension
maybe DM

poorly studies

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20
Q

[…] are assumed to be effective for prevention of lacunar strokes

A

anti-platelets

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21
Q

most common cause of ischemic stroke

A

cryptogenic

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22
Q

unusual causes of ischemic stroke [2]

A

aterial dissection
drug abuse (cocaine, meth)

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23
Q

thrombolytics [2]

A

TPA (IV alteplase)
tenecteplase

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24
Q

thombolytics are effective up to […] are onset of ischemic stroke

A

4.5 hours

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25
Q

catheter thrombectomy is effective up to […] after onset of ischemic stroke

A

24

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26
Q

catheter thrombectomy is only effective for […] occlusion

A

proximal large vessel

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27
Q

are thrombolytics or catheter thrombectomy more effective?

A

catheter thombectomy (if the patient is a candidate)

NNT for TPA=8
NNT for catheter thrombectomy=2

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28
Q

causes of intracerebral intracranial hemorrhage [3]

A

hypertension
amyloid angiopathy
coagulopathy

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29
Q

common cause of subarachnoid intracranial hemorrhage

A

ruptured berry aneurysm

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30
Q

thunderclap headache

A

subarachnoid intracranial hemorrhage

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31
Q

patients with AD can have amyloid angiopathy, causing

A

lobar intracerebral intracranial hemorrhage

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32
Q

amyloid angiopathy causes intracerebral intracranial hemorrhage where in the brain?

A

lobar (cortical)

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33
Q

hypertension causes intracerebral intracranial hemorrhage where in the brain?

A

deep (subcortical)

(thalamus, cerebellum, pons, basal ganglia)

34
Q

two types of vascular dementia

A
  1. history of clinical strokes correlated with onset of cognitive deficits
  2. no history of clinical strokes, but diffuse subcortical disease on imaging (binswanger disease)
35
Q

no history of clinical strokes, but diffuse subcortical disease on imaging

A

binswanger disease (subtype of Vascular dementia)

36
Q

most ischemic strokes are caused by

A

emboli

37
Q

red clot

A

cardiogenic emboli

38
Q

most common cause of cardiogenic emboli

A

non-valvular a fib

39
Q

most effective way to prevent strokes in patients with atrial fibrillation

A

anticoagulation

40
Q

biggest modifiable risk factor for strokes

A

hypertension

41
Q

occlusion of the lenticulostriate artery supplying the posterior limb of the internal capsule would cause

A

contralateral hemiplegia

42
Q

non-cortical infarcts characterized by the absence of cortical signs

A

lacunar stroke

43
Q

pure motor stroke indicates […] artery supplying the […] is affected

A

lenticulostriate
posterior limb of internal capsule

44
Q

pure sensory stroke indicates what structure is affected?

A

thalamus

45
Q

contralateral hemiparesis and sensory impairment […] artery supplying the […] is affected

A

lenticulostriate
posterior limb of internal capsule

(can also present with purely motor symptoms)

46
Q

Infarction of the […] is the most common type of lacunar stroke and may manifest clinically with pure motor stroke, pure sensory stroke (rare), sensorimotor stroke, dysarthria-clumsy hand syndrome, and/or ataxic hemiparesis.

A

posterior limb of the internal capsule

47
Q

a berry aneurysm is also called a […] aneurysm

A

saccular

48
Q

typically occur at bifurcations in the circle of Willis

A

berry aneurysm

49
Q

most common location of berry aneurysm

A

junction of anterior communicating artery and ACA

50
Q

what two congentital diseases are associated with berry aneurysm?

A

Ehlers-Danlos
autosomal dominant polycyctic kidney disease

51
Q

berry aneurysm causes […] hemorrhage

A

subarachnoid

52
Q

compression of the […] due to berry aneurysm causes bitemporal hemianopia, visual acuity deficits, and ischemia in the ACA distribution

A

anterior communicating artery

53
Q

rupture of the […] due to berry aneurysm causes ischemia in the MCA distribution

A

MCA

54
Q

compression of the […] due to berry aneurysm causes ipspilateral CN III palsy (mydriasis, ptosis, down and out eye)

A

posterior communicating artery

55
Q

what symptom can differentiate proximal vs distal MCA occlusion?

A

if leg is spared = distal

proximal, leg will be equally affected with face and arm

56
Q

monotonous but clear speech indicates

A

loss of parosody (emotional tone) and recognition of parosody

(non-dominant hemisphere function)

57
Q

what type of stroke is characterized by the absence of cortical signs and hemiplegia/hemisensory loss face=arm=leg

A

lenticulostriate

58
Q

supplies the basal ganglia structures

A

lenticulostriate arteries

59
Q

can’t feel number traced on palm

A

graphesthesia

indicates **cortical sensory loss*

60
Q

superior quadrantanopia/homonymous hemianopia
wernickes if dominant
left-sided neglect if non-dominant
cortical sensory loss

A

inferior MCA

61
Q

Broca’s
gaze preference (FEF involvement)
hemiparesis face=arm > leg
foot is spared

A

superior MCA

62
Q

contralateral weakness/numbness and UMN signs confined to the leg
fluent speech
no gaze preference
no visual defect

A

unilateral ACA

63
Q

subfalcine herniation can cause bilateral […] occlusion

A

ACA

64
Q

paraplegia of lower extremity sparing face and hands
incontinence
abullia

A

bilateral ACA

65
Q

dense right visual field defect
poor short term memory
fluent speech
no gaze preferences
normal strength, sensation, reflexes

A

PCA

66
Q

supplies blood to the thalamus

A

PCA

67
Q

contralateral loss of all sensory
dense unilateral visual field defect with macular sparing [2]

A

occlusion of the PCA at thalamus
inferior MCA

68
Q

inferior MCA occlusion can affect which visual radiation?

A

both

69
Q

occlusion of […] can affect the RAS

A

PCA

70
Q

occlusion of the ophthalmic artery can cause

A

amaurosis fugax

71
Q

episodic unilateral vision loss
like a “shade” pulled over the eye

A

amaurosis fugax

(due to occlusion of the ophthalmic artery)

72
Q

would occlusion of the MCA or PCA cause monocular blindness?

A

no

73
Q

pure hemiplegia without cortical findings

A

lacunar infarct- lenticulostriate artery

74
Q

Wernickes aphasia
visual field cut

A

inferior MCA

75
Q

sudden contralateral leg weakness and sensory loss to all modalities

A

ACA

76
Q

Brocas
weakness of contralateral face and arm
no visual field cut

A

superior MCA

77
Q

bilateral visual loss (cortical blindness)

A

PCA-MCA watershed region

with signs of systemic hypoperfusion (e.g., tachycardia, low blood pressure, pallor, sweating)

78
Q

proximal limb weakness with sparing of the face, hands, and feet (“man-in-the-barrel syndrome”)

A

ACA-MCA watershed region

with signs of systemic hypoperfusion (e.g., tachycardia, low blood pressure, pallor, sweating)

79
Q

most likely mechanism of stroke with risk factors and non-flow limiting stenosis on the carotid arteries

A

artery-to-artery emboli

80
Q

does unilateral carotid stenosis typically cause loss of consciousness?

A

no, would have to be bilateral to impair the RAS or cortex bilaterally

81
Q

no risk factors or imaging evidence of atherosclerosis or lacunar disease

what’s the mechanism of the stroke?

A

cryptogenic

82
Q

[…] is not indicated for the secondary prevention of ischemic stroke from atherosclerosis

A

warfarin

BMB Test 3 (18 decks)

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