Cerebral Arterial Dissections and Moyamoya Disease Flashcards
Following statements are correct except?
● A. Cerebral arterial dissection can be spontaneous, post-traumatic, or iatrogenic
● B. Dissection means extravasation of blood between the intima and media, creating luminal narrowing or occlusion
● C. Dissecting aneurysm is dissection of blood between the media and adventitia or at the media causing aneurysmal dilatation which may rupture into the subarachnoid space
● D. Pseudoaneurysm is rupture of artery with subsequent encapsulation of the extravascular hematoma, and may or may not produce luminal narrowing
● E. Cerebral arterial dissection may present with TIA or Horner syndrome but never present with pain
E. Cerebral arterial dissection may present with TIA or Horner syndrome but never present with pain
The lesion common to all dissections is hemorrhage outside of the vascular lumen due to pathological transintimal extravasation of blood from the true lumen into the vessel wall. What is the most common site of spontaneous intracranial dissection?
● A. Basilar artery
● B. Vertebral artery
● C. Internal carotid artery
● D. Middle cerebral artery
● E. Anterior cerebral artery
B. Vertebral artery
Cerebral arterial dissection may cause symptoms by embolization secondary to platelet aggregation, dislodged thrombus causing reduced distal flow, or subarachnoid hemorrhage. The most common presentation in patients with age less than 30
years is due to dissection of which artery?
● A. Vertebral artery
● B. Basilar artery
● C. Internal carotid artery
● D. Posterior cerebral artery
● E. Anterior cerebral artery
C. Internal carotid artery
What is the definitive diagnostic study for cerebral arterial dissection?
● A. CT of brain with IV contrast
● B. CT angiogram of brain
● C. Catheter angiography of brain
● D. MRI of brain with IV contrast
● E. Plain CT of brain
C. Catheter angiography of brain
What is the most common clinical feature of spontaneous internal carotid artery dissection?
● A. Focal cerebral ischemia
● B. Headache
● C. Oculosympathetic palsy
● D. Bruit
● E. Amaurosis fugax
A. Focal cerebral ischemia
Traumatic dissections of vertebral artery tend to occur where it crosses bony prominences, for example, at the c1–c2 junction or where it enters the foramen transversarium usually at c6. Whereas spontaneous VA dissections are associated with fibromuscular dysplasia, migraine, and oral contraceptive pills. What is the prominent early finding in spontaneous extradural dissection of VA?
● A. TIAs or stroke
● B. Cerebellar infarction
● C. Neck pain over posterior cervical region or over occiput
● D. Lateral medullary syndrome
● E. Dysphagia
C. Neck pain over posterior cervical region or over occiput
Moyamoya disease looks like “puff of cigarette smoke” due to secondary formation of an anastomotic collateral capillary network at the base of the brain. Progressive spontaneous occlusion of which arteries lead to this disease?
● A. Vertebral arteries
● B. Basilar arteries
● C. Both internal carotid arteries
● D. Posterior inferior cerebral arteries
● E. None of the above
C. Both internal carotid arteries
Intracranial aneurysms are frequently associated with moyamoya disease. It may be as a result of increased flow through dilated collaterals or it may be that patients with moyamoya may also have a congenital defect in the arterial wall that predisposes them to aneurysms. What are the types of aneurysms that are associated with moyamoya disease?
● A. Aneurysms at the circle of Willis
● B. Aneurysms in the peripheral portion of cerebral arteries, for example, posterior/anterior choroidal or Heubner’s artery
● C. Within moyamoya vessels
● D. All of the above
D. All of the above
What is the most common presentation of moyamoya disease?
● A. Ischemic infarcts/TIAs
● B. Hemorrhage
● C. Aneurysms
● D. Ischemic infarcts/TIAs in children and hemorrhage in adults
● E. None of the above
D. Ischemic infarcts/TIAs in children and hemorrhage in adults
Medical treatment for moyamoya disease includes antiplatelet drugs, anticoagulation, or vasodilators while surgical option includes revascularization. Cerebral angiography is necessary to delineate the degree of stenosis as well as to evaluate potential extracranial donor vessels for revascularization. Which of the following is the angiographic finding in the moyamoya disease (Suzuki stages)?
● A. Stage 1 is stenosis of suprasellar ICA, usually bilateral
● B. Stage 2 is development of moyamoya vessels at the base of brain. ACA, MCA, and PCA are dilated
● C. Stage 3 is increasing ICA stenosis and prominence of moyamoya vessels (most cases diagnosed at this stage). Maximal basal moyamoya
● D. Stage 4 is entire circle of Willis and PCAs occluded, extracranial collaterals start to appear, and moyamoya vessels begin to diminish
● E. Stage 5 is further progression of stage 4 with intensification of ECA collaterals and reduction of moyamoya-associated vessels
● F. Stage 6 is occlusion of ICA and major cerebral arteries and complete absence of moyamoya vessels
● G. All of the above
G. All of the above
Which of the following is the most common vessel involved in cerebral arterial dissection?
● A. Basilar artery
● B. Vertebral artery
● C. Internal carotid artery
● D. External carotid artery
● E. Common carotid artery
B. Vertebral artery
The angiographic radiologic signs for cerebral arterial dissection include all of the following except?
● A. String and pearl
● B. Wavy ripple
● C. Sunburst
● D. String of beads
● E. Double lumen
C. Sunburst
Which of the following is the most common site of pain in spontaneous ICA dissections?
● A. Orbital or periorbital
● B. Auricular or mastoid
● C. Frontal
● D. Temporal
● E. Over carotid artery
A. Orbital or periorbital
For vertebral artery dissection, oral anticoagulation should be continued for how long?
● A. 24 hours
● B. 21 days
● C. 1 month
● D. 6 months
● E. 1 year
D. 6 months
Which of the following is the most common initial symptom of spontaneous internal carotid artery dissection?
● A. Unilateral headache
● B. Seizures
● C. Altered level of conscious
● D. Facial palsy
● E. Proptosis
A. Unilateral headache
