Buzz Words Flashcards
ipsilateral CN III palsy and contralateral hemiplegia
Weber’s syndrome (midbrain lesion)
limited upgaze, convergence retraction nystagmus, light-near dissociation, lid retraction, skew deviation of eyes
Parinaud’s syndrome (lesion affecting quadrigeminal plate, dorsal midbrain)
Gerstmann’s syndrome (4 signs, lesion location)
- finger agnosia
- right-left disorientation
- agraphia
- acalculia
lesion of dominant inferior parietal lobe near angular gyrus
vascular supply to bilateral medial thalami
artery of Percheron (normal variant, arising from P1)
“man in a barrel” syndrome - proximal weakness
watershed infarcts
cerebral amyloid angiopathy
lobar hemorrhages
microhemorrhages on MRI gradient echo
congo-red positive - apple-green birefringence
moya moya disease
bilateral stenosis of distal ICAs and intracranial arteries of circle of willis. –> extensive collaterals –> “puff of smoke”
vascular supply of thalamus (4 arteries)
- tuberothalamic (from Pcomm) - supplies anterior thalamus - ventral anterior nucleus
- paramedian (from P1) - medial thalamus - dorsomedial nucleus
- thalmogeniculate (from P2) - lateral - ventral lateral nuclei
- posterior choroidal (from P2) - posterior - pulvinar
anterior limb of internal capsule - vascular supply
recurrent artery of Heubner (ACA)
superior division MCA stroke
hemiparesis of arm and face
gaze deviation (frontal eye fields)
Broca’s aphasia (dominant inferior frontal gyrus)
inferior division MCA stroke
Wernicke’s aphasia
lenticulostriate artery infarct
pure motor - affects posterior limb of IC
clumsy hand-dysarthria syndrome
lacunar stroke of paramedian pons contralateral to the clumsy hand
what does anterior choroidal artery supply (name 4)
it’s a branch of ICA that suppliesPOSTERIORLIMBOFINTERNALCAPSULE, choroid plexus, Gpi and geniculocalcarine tract
hyperdense MCA sign
atheroembolic occlusion of MCA. poor prognosis
ABCD2 score
predict stroke risk after TIA
Age > 60
Bp > 140/90
Clinical sx
Duration sx
Diabetes
lateral medullary syndrome
PICA stroke
vertigo, nystagmus, N/V, ipsi face pain&Tloss,contra-body-pain&Tloss
tPA exclusion criteria for 3-4.5 hours
NIHSS > 25
age > 80
hx stroke and DM
any anticoag use
AICA stroke vs PICA stroke sx
AICA –> unilateral hearing loss
labyrinthine artery is a branch of AICA
ventral cerebellum
PICA –> dysphagia
dorsal cerebellum
CN III palsy + contralateral tremor/chorea
ventral mesencephalic tegmentum stroke
localizes to side of CN III palsy
alexia without agraphia
L occipital infarct involving splenium
complete periph facial palsy with contralateral hemiplegia of arm/leg
Millard Gubler syndrome
stroke to ventrocaudal pons
affects corticospinal tract (sparing face), CN 6 and 7 fascicles –> diplopia, can’t abduct ipsi eye, ipsi peripheral facial palsy
ipsilateral peripheral CN 7 palsy, gaze paresis, contralateral hemiparesis
Foville syndrome-medial-pontine
hits ipsi PPRF –> horiz gaze palsy
ipsi CN 7 –> LMN face palsy
internuclear ophthalmoplegia
contralateral body weakness
tongue weakness + contralateral arm/leg weakness, contralateral loss of touch/vibr/proprio
medial medullary syndrome (Dejerine syndrome)
- vert or medial branch of vert is occluded (ant spinal artery)
- stroke to pyramid (weakness), medial lemniscus (vibr/proprio), hypoglossal fibers (tongue)
who needs oral AC to prevent stroke?
cardioembolic source-
- intracardiac thrombus
- anterior wall akinesis and dec EF
- a fib
- mechanical valves
where does anterior choroidal artery branch off from
internal carotid artery
where does posterior choroidal artery branch off of
PCA
risk factors for CVST
prothombotic state: birth control, cancer, pregnancy, antiphospholipid syndrome, heme disorders, trauma, protein C/S deficiency, prothrombin mutation, Factor V Leiden, antithrombin deficiency, homocysteinemia
infection: middle ear infection, mastoiditis
migraines, strokes at young age, dementia
CADASIL
Notch 3 mutation
Dx by genetics or skin biopsy
blood vessels with thick walls (arteriopathy)
what factors do you consider to determine if someone with A fib needs anticoagulation
CHADSVASc
CHF
HTN
Age > 75
DM
Stroke/TIA
Vascular dz
Sex (females higher risk)
inferior anastomatic vein
vein of Labbe
TIA + intracranial stenosis. tx?
Aspirin 325 only. May also do Plavix for 90 days
NO anticoagulation
NO stenting/EC-IC bypass - worse outcomes
lobar hemorrhages, Alzheimer’s
amyloid angiopathy
where does the Left common carotid arise from?
left common carotid is a branch of the aortic arch directly
occasionally will arise from same origin as innominate artery, or from the innominate artery itself
where does each vertebral artery arise from?
left vertebral artery arises from left subclavian artery (which comes off the aortic arch)
the right vert comes off the right subclavian which arises from the innominate (brachiocephalic) artery
where does the common carotid bifurcate (what level)
C4
spinal dural AVF
presents more commonly in men and over 50
progressive myelopathy - pain, weakness, sensory symptoms, gait disturbance
usually lower thoracic/lumbar
spinal angiogram is gold standard to find the feeding artery
tx: endovascular embolization/surgical disconnection
T2 hyperintense over several levels and perimedullary flow voids
aging blood on MRI: isointense on T1, hyperintense on T2
hyperacute (<12 hours)
mostly oxyhemoglobin
aging blood on MRI - isointense on T1, hypointense on T2
acute (12 hours to 2 days)
deoxyhemoglobin
aging blood on MRI - hyperintense on T1, hypointense on T2
early subacute (2-7 days)
intracellular methemoglobin
aging blood on MRI - hyperintense on both T1 and T2
late subacute (8 days to 1 month)
extracellular methemoglobin
aging blood on MRI - iso/hypointense on T1, hypointense on T2
chronic (>1 month, years)
hemosiderin
most common cause of nontraumatic SAH
aneurysm rupture
most common aneurysm places
A comm > P comm > MCA bifurcation > ICA bifurcation > basilar apex > pericallosal artery > PICA origin
dural AVF - what vessels involved, and what affects risk of hemorrhage?
meningeal/dural artery supply draining towards dural venous sinus
cortical venous drainage = aggressive, risk of neuro sx and hemorrhage
sx: pulsatile tinnitus, headache, seizure, deficits
“beading” on angiogram
vasculitis
also atherosclerosis, vasospasm, infectious or radiation vasculopathy
primary CNS vasculitis treatment
steroids +/- cyclophosphamide
thunderclap headache
RCVS - associated with PRES, preeclampsia , amphetamines, cocaine, triptans , more common in women
angiogram shows “beading” - should resolve in 12 weeks - follow up with TCD
tx: symptomatic, supportive, calcium channel blockers and magnesium.
avoid steroids
Sensorineural hearing loss after subarachnoid hemorrhage
Superficial siderosis- deposition of hemosiderin in brainstem from chronic slow bleeding
Worst HA of life
SAH
get CT—> if no blood get LP
if no blood think RCVS
Mets most likely to bleed
Melanoma and renal cell carcinoma
Bilateral temporal lobe hemorrhage
HSV
Is it snot or CSF?
Beta 2 transferrin assay
Raccoon eyes
Orbital plate fx
Battle sign (bruise behind ear)
Fx of petrous part of temporal bone
Time window for thrombectomy
24 hours
Tpa window
4.5 hours
Unless
- older than 80
- oral AC use
- NIHSS > 25
- hx of DM AND stroke
Then you only have 3 hours
Branch retinal artery occlusion, sensorineural hearing loss, encephalopathy. Mri looks like MS
Susac syndrome
