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Vascular Neuro > Buzz Words > Flashcards

Buzz Words Flashcards

1
Q

ipsilateral CN III palsy and contralateral hemiplegia

A

Weber’s syndrome (midbrain lesion)

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2
Q

limited upgaze, convergence retraction nystagmus, light-near dissociation, lid retraction, skew deviation of eyes

A

Parinaud’s syndrome (lesion affecting quadrigeminal plate, dorsal midbrain)

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3
Q

Gerstmann’s syndrome (4 signs, lesion location)

A
  1. finger agnosia
  2. right-left disorientation
  3. agraphia
  4. acalculia

lesion of dominant inferior parietal lobe near angular gyrus

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4
Q

vascular supply to bilateral medial thalami

A

artery of Percheron (normal variant, arising from P1)

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5
Q

“man in a barrel” syndrome - proximal weakness

A

watershed infarcts

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6
Q

cerebral amyloid angiopathy

A

lobar hemorrhages
microhemorrhages on MRI gradient echo
congo-red positive - apple-green birefringence

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7
Q

moya moya disease

A

bilateral stenosis of distal ICAs and intracranial arteries of circle of willis. –> extensive collaterals –> “puff of smoke”

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8
Q

vascular supply of thalamus (4 arteries)

A
  1. tuberothalamic (from Pcomm) - supplies anterior thalamus - ventral anterior nucleus
  2. paramedian (from P1) - medial thalamus - dorsomedial nucleus
  3. thalmogeniculate (from P2) - lateral - ventral lateral nuclei
  4. posterior choroidal (from P2) - posterior - pulvinar
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9
Q

anterior limb of internal capsule - vascular supply

A

recurrent artery of Heubner (ACA)

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10
Q

superior division MCA stroke

A

hemiparesis of arm and face
gaze deviation (frontal eye fields)
Broca’s aphasia (dominant inferior frontal gyrus)

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11
Q

inferior division MCA stroke

A

Wernicke’s aphasia

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12
Q

lenticulostriate artery infarct

A

pure motor - affects posterior limb of IC

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13
Q

clumsy hand-dysarthria syndrome

A

lacunar stroke of paramedian pons contralateral to the clumsy hand

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14
Q

what does anterior choroidal artery supply (name 4)

A

it’s a branch of ICA that suppliesPOSTERIORLIMBOFINTERNALCAPSULE, choroid plexus, Gpi and geniculocalcarine tract

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15
Q

hyperdense MCA sign

A

atheroembolic occlusion of MCA. poor prognosis

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16
Q

ABCD2 score

A

predict stroke risk after TIA
Age > 60
Bp > 140/90
Clinical sx
Duration sx
Diabetes

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17
Q

lateral medullary syndrome

A

PICA stroke
vertigo, nystagmus, N/V, ipsi face pain&Tloss,contra-body-pain&Tloss

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18
Q

tPA exclusion criteria for 3-4.5 hours

A

NIHSS > 25
age > 80
hx stroke and DM
any anticoag use

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19
Q

AICA stroke vs PICA stroke sx

A

AICA –> unilateral hearing loss
labyrinthine artery is a branch of AICA
ventral cerebellum

PICA –> dysphagia
dorsal cerebellum

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20
Q

CN III palsy + contralateral tremor/chorea

A

ventral mesencephalic tegmentum stroke

localizes to side of CN III palsy

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21
Q

alexia without agraphia

A

L occipital infarct involving splenium

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22
Q

complete periph facial palsy with contralateral hemiplegia of arm/leg

A

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

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23
Q

ipsilateral peripheral CN 7 palsy, gaze paresis, contralateral hemiparesis

A

Foville syndrome-medial-pontine

hits ipsi PPRF –> horiz gaze palsy
ipsi CN 7 –> LMN face palsy
internuclear ophthalmoplegia
contralateral body weakness

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24
Q

tongue weakness + contralateral arm/leg weakness, contralateral loss of touch/vibr/proprio

A

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)
25
Q

who needs oral AC to prevent stroke?

A

cardioembolic source-
- intracardiac thrombus
- anterior wall akinesis and dec EF
- a fib
- mechanical valves

26
Q

where does anterior choroidal artery branch off from

A

internal carotid artery

27
Q

where does posterior choroidal artery branch off of

A

PCA

28
Q

risk factors for CVST

A

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

29
Q

migraines, strokes at young age, dementia

A

CADASIL
Notch 3 mutation
Dx by genetics or skin biopsy
blood vessels with thick walls (arteriopathy)

30
Q

what factors do you consider to determine if someone with A fib needs anticoagulation

A

CHADSVASc

CHF
HTN
Age > 75
DM
Stroke/TIA
Vascular dz
Sex (females higher risk)

31
Q

inferior anastomatic vein

A

vein of Labbe

32
Q

TIA + intracranial stenosis. tx?

A

Aspirin 325 only. May also do Plavix for 90 days

NO anticoagulation
NO stenting/EC-IC bypass - worse outcomes

33
Q

lobar hemorrhages, Alzheimer’s

A

amyloid angiopathy

34
Q

where does the Left common carotid arise from?

A

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

35
Q

where does each vertebral artery arise from?

A

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

36
Q

where does the common carotid bifurcate (what level)

A

C4

37
Q

spinal dural AVF

A

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

38
Q

aging blood on MRI: isointense on T1, hyperintense on T2

A

hyperacute (<12 hours)

mostly oxyhemoglobin

39
Q

aging blood on MRI - isointense on T1, hypointense on T2

A

acute (12 hours to 2 days)

deoxyhemoglobin

40
Q

aging blood on MRI - hyperintense on T1, hypointense on T2

A

early subacute (2-7 days)

intracellular methemoglobin

41
Q

aging blood on MRI - hyperintense on both T1 and T2

A

late subacute (8 days to 1 month)

extracellular methemoglobin

42
Q

aging blood on MRI - iso/hypointense on T1, hypointense on T2

A

chronic (>1 month, years)

hemosiderin

43
Q

most common cause of nontraumatic SAH

A

aneurysm rupture

44
Q

most common aneurysm places

A

A comm > P comm > MCA bifurcation > ICA bifurcation > basilar apex > pericallosal artery > PICA origin

45
Q

dural AVF - what vessels involved, and what affects risk of hemorrhage?

A

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

46
Q

“beading” on angiogram

A

vasculitis

also atherosclerosis, vasospasm, infectious or radiation vasculopathy

47
Q

primary CNS vasculitis treatment

A

steroids +/- cyclophosphamide

48
Q

thunderclap headache

A

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

49
Q

Sensorineural hearing loss after subarachnoid hemorrhage

A

Superficial siderosis- deposition of hemosiderin in brainstem from chronic slow bleeding

50
Q

Worst HA of life

A

SAH
get CT—> if no blood get LP
if no blood think RCVS

51
Q

Mets most likely to bleed

A

Melanoma and renal cell carcinoma

52
Q

Bilateral temporal lobe hemorrhage

A

HSV

53
Q

Is it snot or CSF?

A

Beta 2 transferrin assay

54
Q

Raccoon eyes

A

Orbital plate fx

55
Q

Battle sign (bruise behind ear)

A

Fx of petrous part of temporal bone

56
Q

Time window for thrombectomy

A

24 hours

57
Q

Tpa window

A

4.5 hours

Unless
- older than 80
- oral AC use
- NIHSS > 25
- hx of DM AND stroke
Then you only have 3 hours

58
Q

Branch retinal artery occlusion, sensorineural hearing loss, encephalopathy. Mri looks like MS

A

Susac syndrome

Vascular Neuro (1 decks)

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