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Deja reivew USMLE 2 > Cerebral Vasculature > Flashcards

Cerebral Vasculature Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the two main classifications of stroke and what is their relative incidence?

A
  1. Ischemic: >85% of cases
  2. Hemorrhagic: 15% of cases
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2
Q

What are the most common causes of ischemic stroke?

A
  1. Atherosclerotic complications
  2. Atrial fibrillation (emboli from clot formation)
  3. Endocarditis (septic emboli)
  4. Sickle cell disease
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3
Q

Describe the artery that has been occluded in each of the following stroke syndromes:

Paresis and sensory loss of contralateral lower extremity

A

Anterior cerebral artery (ACA)

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4
Q

Describe the artery that has been occluded in each of the following stroke syndromes:

Hemiparesis, contralateral hemisensory loss, homonymous hemianopsia, aphasia

A

Middle cerebral artery (MCA) supplying the dominant hemisphere

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5
Q

Describe the artery that has been occluded in each of the following stroke syndromes:

Altered mental status, memory deficits, hemisensory loss, homonymous hemianopsia with macular sparing

A

Posterior cerebral artery (PCA)

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6
Q

Describe the artery that has been occluded in each of the following stroke syndromes:

Amaurosis fugax

A

Ophthalmic artery

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7
Q

Describe the artery that has been occluded in each of the following stroke syndromes:

Vertigo, cranial nerve (CN) palsies, impaired level of consciousness, dysarthria

A

Basilar artery

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8
Q

Describe the artery that has been occluded in each of the following stroke syndromes:

  1. Ataxia
  2. Nystagmus
  3. Paresis of conjugate gaze
  4. Horner syndrome
  5. Contralateral decreased pain/temp in face and body
  6. Decreased proprioception in LE>UE
  7. Dizziness
  8. N/V
A

Superior cerebellar artery (lateral medullary syndrome)

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9
Q

Describe the artery that has been occluded in each of the following stroke syndromes:

Urinary incontinence, suck and grasp reflexes

A

MCA or ACA supplying the frontal lobe

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10
Q

Describe the artery that has been occluded in each of the following stroke syndromes:

  1. Ipsilateral nystagmus
  2. Facial paralysis
  3. Conjugate gaze paralysis
  4. Deafness
  5. Tinnitus
  6. Ataxia
  7. Decreased facial sensation
  8. Contralateral decreased pain and temp
  9. N/V, vertigo
A

Anterior inferior cerebellar artery

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11
Q

Describe the artery that has been occluded in each of the following stroke syndromes:

  1. Ipsilateral loss of pain and temp in face
  2. Contralateral loss of pain and temp in body
  3. Ipsilateral laryngeal/pharyngeal paralysis
  4. Ipsilateral Horner syndrome
  5. Vertigo
  6. Ipsilateral ataxia
  7. Nausea
A

Posterior inferior cerebellar artery (Wallenberg syndrome)

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12
Q

Describe the artery that has been occluded in each of the following stroke syndromes:

Wernicke aphasia (fluent speech without meaning; poor comprehension and word repetition)

A

Dominant inferior MCA

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13
Q

Describe the artery that has been occluded in each of the following stroke syndromes

Broca aphasia (nonfluent speech with poor repetition and normal comprehension)

A

Superior dominant MCA

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14
Q

What is the most common site for ischemic/embolic stroke?

A

MCA

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15
Q

What is the most common source of emboli that result in stroke?

A

Carotid atheroma

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16
Q

Name the term used to describe the infarction of white matter commonly associated with hypertension, diabetes, and carotid atherosclerosis:

A

Lacunar infarction

17
Q

Name the term used to describe the infarction of gray matter commonly associated with sustained hypotension:

A

Watershed infarction (occurs at the margin of arterial territories)

18
Q

What is the peak period for cerebral edema after a stroke?

A

2-5 days

19
Q

Name three noninvasive, non-pharmacologic interventions for lowering intracranial pressure (ICP) that can be used in the setting of stroke or trauma:

A
  1. Elevate the head of the bed at least 30° (maximize venous drainage).
  2. Maintain normothermia.
  3. Maintain PCO2 ≤35.
20
Q

Name six medical or surgical interventions for lowering ICP that can be used in the setting of stroke or trauma:

A
  1. Light sedation (ie, benzodiazepines, narcotics, propofol)
  2. Osmotic diuresis (mannitol, hypertonic saline)
  3. Cerebrospinal fluid (CSF) diversion (ventriculostomy)
  4. Chemical paralysis (non-depolarizing muscle relaxants)
  5. Barbiturate coma
  6. Decompressive craniectomy
21
Q

Name the term used to describe a neurologic deficit caused by ischemia that resolves within 24 h

A

Transient ischemic attack (TIA)

22
Q

What is the primary radiologic study necessary in the workup (w/u) of stroke?

A

Computed tomographic (CT) scan of the head without contrast

23
Q

What radiologic study may be useful in determining the etiology of an ischemic stoke?

A

Cerebral angiography

24
Q

What radiologic study can provide useful information about the anatomy of a stroke if angiography is contraindicated?

A

Magnetic resonance angiography (MRA)

25
Q

What oral medications have been shown to improve outcome in patients with acute ischemic stroke?

A

Aspirin, clopidogrel, ticlopidine, and Aggrenox

26
Q

What type of therapy is indicated in a patient at risk for cardioembolic stroke?

A

Anticoagulation with heparin followed by Coumadin

27
Q

What medical intervention has been shown to improve outcome in embolic stroke when administered within 3 h?

A

Tissue plasminogen activator (tPA)

28
Q

What surgical intervention is indicated for patients with symptomatic carotid stenosis causing >70% compromise of the carotid lumen?

A

Carotid endarterectomy

29
Q

What primary preventative measures are recommended in a patient at risk for ischemic stroke?

A

Smoking cessation, antihypertensive therapy, glycemic control in diabetics, and cholesterol lowering therapy

Deja reivew USMLE 2 (14 decks)

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