Cerebrovascular Flashcards
Which finding on clinical exam can distinguish a third cranial neuropathy that is caused by an aneurysm from that caused by diabetic neuropathy?
a. double vision
b. ptosis
c. pupillary dilation
d. pain
e. miosis
c. pupillary dilation
What is the maximal total dose of IC rtPA that can be administered for acute ischemic stroke
a. 0.8 mg/kg
b. 0.9 mg/kg
c. 1 mg/kg
d. 0.7 mg/kg
e. 1.1 mg/kg
b. 0.9 mg/kg
What is the most likely appearance of a chronic subdural hematoma on MRI?
a. Hyperintense on T1 and hypointense on T2
b. Hypointense on both T1 and T2
c. Hypointense on T1 and hyperintense on T2
d. Hyperintense on both T1 and T2
e. Isointense on both T1 and T2
d. Hyperintense on both T1 and T2
What is the most appropriate management of a fusiform 4-mm M3 unruptured mycotic aneurysm which is found in a patient with bacteremia and fever?
a. Antibiotics for 4-6 weeks
b. Observation
c. Direct surgical clipping
d. Endovascular coiling
e. Vascular bypass surgery
a. Antibiotics for 4-6 weeks
What is the mechanism of action of clopidogrel (Plavix)?
a. Direct inhibition of thrombin
b. Activation of antithrombin III
c. Inhibition of plasminogen
d. Direct inhibition of factor Xa
e. Inhibition of the adenosine diphosphate (ADP) chemoreceptor, P2Y
e. Inhibition of the adenosine diphosphate (ADP) chemoreceptor, P2Y
According to the International Study of Unruptured Intracranial Aneurysms, what is the 5 year cumulative rupture rate of a 10 mm posterior communicating aneurysm?
a. 14.5%
b. 4.5%
c. 19.5%
d. 9.5%
e. 0%
a. 14.5%
What is the Fisher score in a patient with a 2 mm thick subarachnoid hemorrhage with no intraventricular or parenchymal extension?
a. I
b. II
c. V
d. III
e. IV
d. III
During clipping of an anterior communicating artery aneurysm, an artery arising at the junction of the A1 and A2 segments was inadvertently occluded. This resulted in expressive aphasia and mild hemiparesis. The artery was most likely the:
a. Frontopolar artery
b. Orbitofrontal artery
c. Right A2
d. Anterior choroidal artery
e. Recurrent artery of Heubner
e. Recurrent artery of Heubner
A 76-year-old female with a history of diabetes mellitus and hypertension has asymptomatic atrial fibrillation. What medical management paradigm would best reduce her future risk of stroke?
a. Warfarin
b. Aspirin
c. Clopidogrel
d. Aspirin and clopidogrel
e. Warfarin and clopidogrel
a. Warfarin
Mutation of which of the following genes has been linked to cerebral amyloid angiopathy?
a. Apoliporprotein E
b. KRIT-1
c. Presenilin (PS)
d. Endoglin
e. Tau
c. Presenilin (PS)
A 24 year old man presents to the ER with an acute subdural hematoma (ASDH) after falling down the stairs. CT scan shows a hematoma of 13 mm thickness. What is the appropriate management?
a. Medical Management is GCS <10
b. Surgical Evacuation only if GCS>11
c. Surgical evacuation regardless of the GCS
d. Medical management if Glascow Coma Scale (GCS) >11
e. Surgical Evacuation only if GCS<10
c. Surgical evacuation regardless of the GCS
A 34-year-old female presents with spontaneous proptosis and chemosis of the left eye. Cerebral angiography (left common carotid injection) is shown. What is the best management option?
a. Transvenous embolization
b. Transarterial carotid sacrifice
c. Ventriculoperitoneal shunt
d. Optic nerve sheath fenestration
e. Craniotomy
a. Transvenous embolization
A 44 year old man with a history of blunt head trauma 4 days earlier presents with a progressively swollen and red right eye, headache, and double vision. What is the most likely cause?
a. Indirect, low flow lesion between meningeal ICA branches and cavernous sinus
b. Vertebral artery dissection
c. Cervical internal carotid dissection
d. Direct, high flow lesion between ICA and cavernous sinus
e. Indirect, low flow lesion between both ICA and ECA meningeal branches and the cavernous sinus
d. Direct, high flow lesion between ICA and cavernous sinus
A 60 year old male was found to have a 10 mm internal carotid artery aneurysm. The patient underwent surgical clipping of the aneurysm after which he experienced right hemiplegia, hemihypesthesia and homonymous hemianopsia. Which artery was most likely occluded?
a. Left A1
b. Recurrent artery of Heubner
c. Left middle cerebral artery
d. Anterior choroidal artery
e. Anterior communicating artery
d. Anterior choroidal artery
A 65 year old woman on warfarin for her chronic atrial fibrillation, has been diagnosed with an intracerebral hemorrhage after presenting to the emergency room. Her INR was found to be 6. What is the best next step in the management of the patient?
a. Ultrasound of the liver and liver function tests
b. Administer Fresh Frozen Plasma
c. Administer Factor VIII
d. Administer cryoprecipitate
e. Observe the patient closely
b. Administer Fresh Frozen Plasma
To what structure does the arrow point?
a. Caroticotympanic artery
b. Persistent otic artery
c. Vidian artery
d. Persistent stapedial artery
e. McConnel’s Capsular artery
c. Vidian artery
A 70-year-old female reports that she felt like a curtain dropped over her right eye and made her lose vision. CTA showed 70% stenosis in her right petrous intracranial carotid artery. Her most recent LDL level is 190 mg/dl and blood pressure 120/75 mmHg. What is the best next step in managing the patient?
a. Aspirin, clopidogrel, rosuvastatin
b. Vessel Bypass
c. Percutaneous carotid artery stenting
d. Discharge home and re-evaluate if symptoms recur
e. Carotid Endarterectomy
a. Aspirin, clopidogrel, rosuvastatin
What is the vascular malformation demonstrated in this figure?
a. Cavernous malformation
b. Capillary telangiectasis
c. Arteriovenous fistula
d. Arteriovenous malformation
e. Venous angioma
e. Venous angioma
What is the most common presentation of an adult patient with moyamoya disease?
a. Dystonia
b. Ischemic infarcts/transient ischemic attacks
c. Seizure
d. Intracranial hemorrhage
e. Gait disturbances
d. Intracranial hemorrhage
According to AHA guidelines for early ischemic stroke management, IV tPA should be administered within what time frame after the onset of symptoms?
a. 5.5 hours
b. 4.5 hours
c. 1.5 hours
d. 2.5 hours
e. 3.5 hours
b. 4.5 hours
A 28-year-old male presents with acute onset facial asymmetry, diplopia, and hemifacial numbness. The patient’s MRI is shown. What is the molecular mechanism for disease pathogenesis?
a. Mutation of BRAF V600 E
b. Activation of AKT1 signaling
c. Activation of ERK/MAPK signaling
d. Activation of SMO signaling
e. Activation of MEKK3 signaling
e. Activation of MEKK3 signaling
A 54-year-old man presents with acute onset of right neck pain radiating to his jaw. He denies any other symptoms. His clinical findings are demonstrated on the photograph below. Which of the following would be the most appropriate imaging study to order?
a. CT angiogram of the head
b. MRI of the cervical spine
c. MRI of the brain and orbits
d. CT scan of the chest
e. CT angiogram of the neck
e. CT angiogram of the neck
Which factor has been strongly associated with increased hemorrhage rate after radiosurgery of an arteriovenous malformation (AVM)?
a. Margin dose
b. Number of feeding arteries to the AVM
c. Number of prior hemorrhages
d. Superficial AVM location
e. Target volume
c. Number of prior hemorrhages
When comparing carotid endarterectomy (CEA) to carotid artery stenting (CAS), what is the main difference between the two procedures in terms of stroke and cardiovascular complications?
a. The rate of overall complications were higher in CAS than CEA
b. CEA was associated with more strokes
c. Stroke had a greater adverse effect than did myocardial infarction
d. CAS was associated with more myocardial infarction
e. CAS was associated with higher incidence of vessel rupture
c. Stroke had a greater adverse effect than did myocardial infarction
A 54-year old female presented with recurrent headaches. The patient was found to have an arteriovenous malformation with a 4 cm diameter centered in the primary motor cortex. On angiography, the arteriovenous malformation was found to have deep draining veins. What is the Spetzler-Martin grade?
a. Grade 5
b. Grade 3
c. Grade 2
d. Grade 4
e. Grade 1
d. Grade 4
A 44 year old man with a history of blunt head trauma 4 days earlier presents with a progressively pulsatile exophthalmus, headache, and double vision. A CT head performed after his initial trauma was normal. What is the most appropriate treatment for this condition?
a. Radiation
b. Delayed endovascular repair
c. A trial of manual direct compressoin of cervical carotid 3-4x daily
d. Cranitomy for open repair
e. Urgent endovascular repair
e. Urgent endovascular repair
During a pterional exposure of the sylvian fissure, you encounter significant brain swelling. In order to achieve rapid brain relaxation, identify the most appropriate point on the associated figure through which to place a ventriculosotomy and access the frontal horn of the lateral ventricle.
a. 2
b. 4
c. 5
d. 3
e. 1
a. 2
A 40 year-old woman presents with acute headache, mild right arm weakness and a CT scan showing a small hemorrhage in the left frontoparietal region. Cerebral angiogram shows a 4 cm compact, superficial AVM with superficial venous drainage and deep perforating arteries. What factor increases this patient’s surgical risk?
a. Ruptured Presentation
b. Superficial location
c. Deep perforating arteries
d. Superficial venous drainage
e. Compact architecture
c. Deep perforating arteries
A patient presents with subarachnoid hemorrhage from intracranial vertebral artery dissection. What is the definitive treatment?
a. Aspirin and clopidogrel
b. Microsurgical or endovascular intervention
c. Aspirin
d. Intravenous heparin
e. Aminocaproic acid
b. Microsurgical or endovascular intervention
What factor significantly impacts the rerupture risk of a previously treated ruptured intracranial aneurysm?
a. Degree of aneurysm occlusion
b. Hypertension
c. Age at initial rupture
d. Gender
e. Fisher score
a. Degree of aneurysm occlusion
A 38 year-old presents with a one month history of difficulty swallowing, mild hoarseness and right facial numbness and tingling. The imaging studies are shown below. What is the most likely diagnosis?
a. Cavernous angioma
b. Capillary hemangioma
c. Arteriovenous malformation
d. Medulloblastoma
e. PICA aneurysm
a. Cavernous angioma
What is the mortality rate of a MCA infarction with malignant cerebral edema managed with intensive non-operative care?
a. 20%
b. 0%
c. 60%
d. 80%
e. 40%
d. 80%
A 68-year-old man presents with progressive neurologic deficit due to a spinal dural arteriovenous fistula fed by the left L4 radicular artery. Treatment for the spinal dural AV fistula requires occlusion of which vascular structure?
a. The arterial feeder immediately proximal to the fistula
b. The draining vein in the spinal cord.
c. The L4 radicular artery
d. The anterior spinal artery
e. The draining vein immediately distal to the fistula.
e. The draining vein immediately distal to the fistula.
According to the NASCET trial, what is the best treatment for a symtpmatic carotid artery narrowing of 25%?
a. EC/IC bypass
b. Antiplatelet therapy
c. Carotid artery stenting
d. Observation
e. Carotid endarterectomy
b. Antiplatelet therapy
Based on the ISUIA study, what is the 5-year cumulative rupture risk of an unruptured 5mm middle cerebral artery aneurysm?
a. 5%
b. 7.5%
c. 2.5%
d. 0%
e. 10%
d. 0%
Anterograde blood flowing in the indicated vascular structure on this lateral projection cerebral angiogram drains into which structure?
a. Cavernous sinus
b. Inferior petrosal sinus
c. Vein of galen
d. Superior petrosal sinus
e. Inferior sagittal sinus
c. Vein of galen
A 65 year old female presents with a spontaneous basal ganglia hemorrhage. Her blood pressure is 190/110 mmHg. The patient is not exhibiting signs of intracranial hypertension. How should the blood pressure of the patient be managed?
a. Reduce her blood pressure to less than 120/80 mmHg
b. Reduce her blood pressure to less than 185/102 mmHg
c. Maintain current blood pressure
d. Reduce her blood pressure to less than 160/90 mmHg
e. Target a mean arterial pressure of 120 mmHg
d. Reduce her blood pressure to less than 160/90 mmHg
What neurological deficit may result from embolization of the artery with liquid embolics indicated on this angiogram?
a. Unilateral tongue atrophy
b. Loss of smell
c. Contralateral hemiparesis
d. Unilateral facial palsy
e. Blindess
a. Unilateral tongue atrophy
Which vein is indicated by the arrow in the figure?
a. Internal Cerebral vein
b. Vein of Trolard
c. Basal vein of Rosenthal
d. Thalmostriate vein
e. Vein of Galen
c. Basal vein of Rosenthal
What is the most common location of cranial dural arteriovenous fistulas?
a. Inferior sagital sinus
b. Superior sagital sinus
c. Straight sinus
d. Posterior cavernous sinus
e. Transverse sinus
e. Transverse sinus
A 50-year-old male patient with a history of atrial fibrillation presents with acute onset left hemiparesis and drowsiness for 24 hours. MRI of the brain is shown. The National Institute of Health Stroke Scale (NIHSS) score is 16. What treatment option has been shown to decrease mortality rates for such a patient?
a. External ventricular drainage
b. Decompressive hemicraniectomy
c. Medical management only
d. Intra-arterial tPA
e. Mechanical thrombectomy
b. Decompressive hemicraniectomy
A 44 year old man presents with seizure, headache, and left visual field cut. MRI is shown. What is the most likely benefit of embolization for this lesion?
a. Improvement of vision
b. Complete obliteration of the AVM
c. Decreased risk of seizures
d. Decreased risk of rupture before further therapy
e. Reducing AVM volume for subsequent treatment
e. Reducing AVM volume for subsequent treatment
What structure is indicated by the arrow on this lateral projection angiogram?
a. Inferior saggital sinus
b. Internal cerebral vein
c. Thalamostriate vein
d. Basal vein of Rosenthal
e. Vein of Labbe
e. Vein of Labbe
After ischemic stroke, which medication is recommended for stroke prevention?
a. Warfarin
b. Rivaroxaban
c. Aspirin
d. Dabigatran
e. Unfractionated Heparin
c. Aspirin
What is the most common presentation of a vein of Galen malformation in an adolescent patient?
a. Headache or seizure
b. Hydrocephalus
c. Focal neurological deficit
d. Heart failure
e. Hemorrhage
a. Headache or seizure
What are the standard radiographic criteria for ventriculomegaly in order to diagnose hydrocephalus?
a. Temporal horn’s width >0.5 mm
b. Temporal horn’s width >1 mm
c. Frontal horns are >30% of the brain width
d. Frontal horns are >20% of the brain width
e. Frontal horns are >50% of brain width
e. Frontal horns are >50% of brain width
According to Suzuki and Takaku classification of the angiographic appearance of moyamoya disease, what imaging findings are asssociated with stage 2 disease?
a. Near complete disappearance of the major cerebral arteries with the cerebral hemispheres receiving blood from the abnormal extracranial-intracranial anastomoses.
b. Stenosis of the carotid artery at the suprasellar portion with no moyamoya vessels
c. Diminishing moyamoya vessels with progression of extracranial circulation
d. Moyamoya vessels begin to develop at the base of the brain
d. Moyamoya vessels begin to develop at the base of the brain
Which artery is indicated by the arrow in the figure?
a. Opthalmic artery
b. Anterior chorodial artery
c. Vidian Artery
d. Bernasconi and Cassinari
e. Posterior communicating artery
d. Bernasconi and Cassinari
What is the most effective treatment in secondary stroke prevention in adults with Moyamoya disease?
a. Anticoagulation
b. Direct revascularization
c. Dual antiplatelet therapy
d. Aspirin alone
e. Indirect revascularization
b. Direct revascularization
During intraoperative aneurysm rupture, which medication can help achieve temporary flow arrest?
a. Vitamin K
b. Labetalol
c. Adenosine
d. Nimodipine
e. Protamine
c. Adenosine
A 43-year old patient experienced a visual field defect and hemisensory loss after clipping of a PCA aneurysm. What is the most likely site of injury?
a. Lateral posterior choroidal artery
b. Anterior choroidal artery
c. Superior cerebellar artery
d. Posterior communicating artery
e. Superior hypophyseal artery
a. Lateral posterior choroidal artery
How does the amount of radiation differ when standing 4 feet away from a radiation source as opposed to 1 foot?
a. 1/16
b. 1/8
c. 1/12
d. 1/64
e. 1/4
a. 1/16
An 80-year-old female presents with an occipital lobe hemorrhage on CT imaging. She has a prior history of parietal and temporal hemorrhages. What is the most likely diagnosis?
a. Vasculitis
b. Arteriovenous malformation
c. Venous angioma
d. Amyloid angiopathy
e. Coagulopathy
d. Amyloid angiopathy
What is the most common location for a hypertensive hemorrhage?
a. Cerebellum
b. Thalamus
c. Amygdala
d. Pons
e. Basal Ganglia
e. Basal Ganglia
The North American Symptomatic Carotid Endarterectomy Trial (NASCET) reported the surgical results in patients who underwent carotid endarterectomy (CEA). According to the trial, what is the rate of perioperative permanent disabling stroke and death related to CEA?
a. 10-15%
b. 20-25%
c. <5%
d. 15-20%
e. 5-10%
c. <5%
According to the North American Symptomatic Carotid Endarterectomy Trial (NASCET), symptomatic patients with 70-99% carotid stenosis are best treated by:
a. Warfarin
b. Carotid endarterectomy
c. Aspirin
d. Aspirin and clopidogrel
e. Observation
b. Carotid endarterectomy
A 50 year old male is diagnosed with an acute ischemic stroke. He is a heavy smoker and admits occasional use of marijuana and oxycodone. He has a past medical history of deep vein thrombosis and varicose veins. What risk factor most likely contributed to his stroke?
a. Opioids
b. Deep venous thrombosis
c. Varicose veins
d. Marijuana
e. Smoking
e. Smoking
What is the most significant risk factor for normal perfusion pressure breakthrough after AVM resection?
a. Single feeding artery
b. Single draining vein
c. Infratentorial location
d. Large size
e. Deep venous drainage
d. Large size
A 39-year-old female presents with subarachnoid hemorrhage. Her angiogram is shown. What is the most likely diagnosis?
a. Infundibulum
b. Saccular Aneurysm
c. Supraclinoid ICA dissection
d. Fusiform aneurysm
e. Blister aneurysm
a. Infundibulum
Occlusion of which artery causes the stroke shown in the figure?
a. Orbitofrontal Artery
b. Medial lenticulostriate perforator
c. Recurrent artery of Heubner
d. Artery of Percheron
e. Subcallosal artery
e. Subcallosal artery
A 65-year-old male with a history of hypertension and diabetes presents to the emergency room after experiencing severe headache. The Glasgow Coma Scale (GCS) is 14. On head CT scan, the patient was found to have a 2 cm acute cerebellar hematoma with no hydrocephalus. What is the most appropriate management?
a. External ventricular drainage
b. Stereotactic aspiration and infusion of thrombolytic agents
c. Medical management in an ICU setting
d. Posterior fossa craniectomy
e. Surgical evacuation
c. Medical management in an ICU setting
Which of the following cerebrovascular pathologies exhibits early venous drainage on an angiogram?
a. Cavernous angioma
b. Arteriovenous Malformation
c. Amyloid angiopathy
d. Venous angioma
e. Capillary telangiectasia
b. Arteriovenous Malformation
A 60 year old female presents with sudden onset of vertigo, headache, vomiting and imbalance. Her imaging (after 2 days) is shown. What is the cause of the patient’s symptoms?
a. Cerebellar infarction
b. Multiple sclerosis
c. Cerebellar abscess
d. Lhermitte-Duclos disease
e. Cerebellar astrocytoma
a. Cerebellar infarction
A 24 year old pregnant woman in her third trimester presents with severe headache and a non-focal neurological examination. A head CT angiogram is shown. What is the most likely diagnosis?
a. Aneurysmal subarachnoid hemmorrhage
b. Posterior reveresible encephalopathy syndrome
c. Eclampsia
d. Meningioma
e. Dural venous sinus thrombosis
e. Dural venous sinus thrombosis
A 67 year old man presents to the emergency room with worsening parasthesias of the ipsilateral face and contralateral extremity. The symptoms are provoked with head turning. Where is the most likely site of vascular compression in this patient?
a. Posterior inferior cerebellar artery
b. Carotid Bifurcation
c. Subclavian artery
d. Dominant vertebral artery
e. Basilar artery
d. Dominant vertebral artery
What is the main arterial supply of the motor tracts of the spinal cord from T8 to the conus medullaris?
a. Artery of Adamkiewicz
b. Lateral spinal artery
c. Median sacral artery
d. Posterior spinal artery
e. Medial spinal artery
a. Artery of Adamkiewicz
In the acute workup of clinically suspected subarachnoid hemorrhage what would be the most appropriate next step in evaluation following a negative head CT?
a. CT with contrast
b. MRA circle of Willis
c. MRI brain with GRE sequence
d. Lumbar Puncture for CSF analysis
e. CT angiogram
d. Lumbar Puncture for CSF analysis
What factor is most predictive of postoperative intracerebral hemorhage after carotid endarterectomy?
a. Cerebral hypoperfusion
b. Female Sex
c. Young age
d. Calcified plaque
e. Length of stenosis
a. Cerebral hypoperfusion
Which calcium channel blocker has been demonstrated to improve outcome in ptients with aneurysmal subarachnoid hemorrhage?
a. Oral nimodipine
b. IV Felodipine
c. Oral verapamil
d. Oral Felodipine
e. IV diltiazem
a. Oral nimodipine
During surgical resection of a brainstem cavernous malformation, a developmental venous anomaly (DVA) was detected. Which of the following is an appropriate step to take during surgery?
a. Preserve the associated DVA
b. Coagulate the associating DVA after removing the cavernous malformation
c. Perform an intraoperative angiogram
d. Perform indocyanine green (ICG) video angiography
e. Apply a clip to the DVA prior to removal of cavernous malformation
a. Preserve the associated DVA
A 54-year old Hispanic male was incidentally found to have two cavernous malformations located in the left frontal and right temporal lobes on CT scan. What is the best study to rule out additional cavernous malformations?
a. Gradient echo magnetic resonance imaging
b. Diffusion weighted magnetic resonance imaging
c. Contrast enhanced computed tomography
d. Computed tomography angiography
e. Digital subtraction angiography
a. Gradient echo magnetic resonance imaging
A 72-year-old female presents with an incidentally discovered lesion as shown in the figure. What is her estimated 5-year risk of hemorrhage or new neurological deficit related to this lesion?
a. 31-40%
b. 41-50%
c. 11-20%
d. 0-10%
e. 21-30%
d. 0-10%
Five days after the rupture of a saccular aneurysm in a 30 year old female, the patient experiences altered level of consciosness. Transcranial Doppler shows a Lindegaard (MCA-ICA) ratio of 5. What is the most likely diagnosis?
a. Rebleed
b. Severe Vasospasm
c. Normal Finding
d. Mild vasospasm
e. Hyperemia
d. Mild vasospasm
Which anatomic feature best predicts risk of intracranial hemorrhage related to dural arteriovenous fistulae (DAVF):
a. number of draining veins
b. number of arterial feeders
c. presence of cortical venous drainage
d. size of the fistula
e. presence of sinus drainage
c. presence of cortical venous drainage
30 year old female, 2 weeks post-partum, presents to the ED after 4 hours with acute onset right hemiplegia, lethargy and left gaze deviation. Her NIHSS score is 24. Her angiogram is shown. What is the best management option?
a. IV abciximab
b. IV tPA
c. Aspirin
d. Thrombectomy with stent-retrieval
e. EC/IC bypass
d. Thrombectomy with stent-retrieval
A 51 year old man presents with a severe thunderclap headache, meningismus, photophobia and nausea. His CT scan is shown below and his cerebral angiogram is negative. What is the appropriate treatment option at presentation?
a. Observation
b. Anticonvulsants
c. Endovascular treatment
d. Hyperdynamic therapy
e. Surgical exploration
a. Observation
According to randomized control trials of hemicraniectomy for malignant MCA infarction, what is the time frame for the performance of hemicraniectomy associated with reduced mortality?
a. 24 hours
b. 3 hours
c. 6 hours
d. 48 hours
e. 12 hours
d. 48 hours
What is the appropriate sequence of steps during AVM microsurgery?
a. nidus resection - ligation of the draining vein(s) - coagluaiton of feeding arteries
b. coagulation of feeding arteries - ligation of the draining vein(s) - nidus resection
c. ligation of the draining vein(s) – nidus resection - coagluaiton of feeding arteries
d. coagulation of feeding arteries - nidus resection - ligation of the draining vein(s)
e. ligation of the draining vein(s) - coagulation of feeding artery - nidus resection
d. coagulation of feeding arteries - nidus resection - ligation of the draining vein(s)
What is the most common presenting symptom associated with vain of Galen malformation in a newborn?
a. Seizures
b. Congestive heart failure
c. Focal neurological deficit
d. Raised intracranial pressure
e. Headache
b. Congestive heart failure
What is the mortality of acute basilar artery occlusion?
a. 90%
b.15%
c. 30%
d. 50%
e. 5%
a. 90%
In Yasargil’s classification, a type 4 vein of Galen malformation (VGA) is:
a. AVGA associated with hydrocephalus
b. A direct fistulous communication with the vein of Galen
c. A VGA associated with a cavernoma
d. A VGA associated with an aneurysm
e. A parenchymal arteriovenous malformations (AVMs) which drains into the vein of Galen
e. A parenchymal arteriovenous malformations (AVMs) which drains into the vein of Galen
A 30-year old female presented with left third nerve palsy. The patient was found to have a posterior communicating artery aneurysm and was scheduled for surgery. Which anatomic variation could result in occipital lobe infarction if the posterior communicating artery is occluded?
a. Aneurysmal size <15 mm
b. Vertebral artery hypoplasia
c. Multiple aneurysms
d. Fetal posterior cerebral artery
e. Persistent trigeminal artery
d. Fetal posterior cerebral artery
What is the most likely mechanism underlying an intracranial hemorrhage associated with an intracranial dural fistula?
a. Brain edema
b. Increased intracranial pressure
c. Venous hypertension
d. Arterial aneurysm rupture
e. Hyperemia
c. Venous hypertension
A 54 year old male presented with a ruptured anterior communicating artery aneurysm. The patient underwent surgical repair. On postoperative day 5, the patient complained of mild weakness in his left leg. Transcranial Doppler showed moderate vasospasm of the right anterior cerebral artery. What is the most appropriate initial management?
a. Statins
b. Hyperdynamic therapy
c. nimodipine
d. Intraarterial verapamil injection
e. Angioplasty
b. Hyperdynamic therapy
A 61-year-old man presents with confusion. Susceptibility-weighted MR imaging demonstrates multiple abnormalities (figure). What is the most likely diagnosis?
a. Creutzfeldt-Jakob disease
b. CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
c. Cerebral amyloid angiopathy
d. Hypertensive hemorrhages
e. Leptomeningeal carcinomatosis
c. Cerebral amyloid angiopathy
Aside from bilateral ICA occlusions, what is a typical angiographic finding in moyamoya disease?
a. Persistent fetal trigeminal artery
b. Diffuse hypertrophy of the lenticulostriate arteries
c. Bilateral giant internal carotid artery aneurysms
d. Duplication of the M1 segment of the middle cerebral artery
e. Fetal posterior cerebral artery
b. Diffuse hypertrophy of the lenticulostriate arteries
What structure does the arrow point to in the figure?
a. Superior petrosal sinus
b. Internal jugular vein
c. Inferior petrosal sinus
d. Superior ophthalmic vein
e. Cavernous sinus
d. Superior ophthalmic vein
A 40 year old patient presents with headache and aneurysmal subarachnoid hemorrhage. On physical exam she was awake, alert and nonfocal with the exception of a right third nerve palsy and evidence of nuchal rigidity. What is the Hunt and Hess grade for this patient?
a. 5
b. 1
c. 2
d. 4
e. 3
c. 2
A 45 year old man presents with sudden onset of vomiting, dysarthria and ataxia and a CT scan demonstrating a cerebellar infarction. Thirteen hours after onset of symptoms, he develops abducens nerve palsy and depressed mental status. What is the most appropriate definitive management of this patient?
a. High dose Dexamethasone
b. Barbiturate coma
c. Suboccipital craniectomy
d. Hypertonic saline
e. Intravenous tPA
c. Suboccipital craniectomy
A 55-year-old man presents to the emergency department with an acute onset of right hemiplegia that occurred 30 minutes prior. CT scan is negative for hemorrhage. What factor would contraindicate the administration of IV tPA?
a. Refractory hypertension (SBP>180mmHg)
b. Major surgery 12 months ago
c. Past medical history of bleeding stomach ulcer 2 years ago
d. Severe Symptoms (NIHSS>8)
e. INR of 1.5
a. Refractory hypertension (SBP>180mmHg)
Which one of the following is an absolute contraindication for administration of intravenous tissue plasminogen activator (tPA) for acute cerebral infarction?
a. Abdominal surgery six weeks prior to stroke onset.
b. Seizure at the onset of stroke symptoms.
c. History of aneurysm clipping six months prior to stroke onset.
d. Warfarin use with INR 1.3.
e. Platelet count of 80,000.
e. Platelet count of 80,000.
A 60 year old patient presents to the emergency department with a history suggestive of acute ischemic stroke. What is the best brain imaging modality to confirm the diagnosis?
a. CT angiography
b. PET scan
c. Magnetic resonance imaging
d. Noncontrast CT scan
e. Digital Subtraction angiography
c. Magnetic resonance imaging
In patients who receive medical therapy alone for asymptomatic carotid stenosis of 60-99%, what is the 5-year risk of stroke or death?
a. 29%
b. 5%
c. 17%
d. 23%
e. 11%
e. 11%
Twelve months after undergoing Gamma Knife radiosurgery to treat an AVM, a patient experiences headaches and a seizure. What is the underlying cause of the new onset of symptoms and edema shown on the attached CT and MRI?
a. Peri-lesional cyst
b. Hemorrhage from the nidus
c. Acute thrombosis of the draining vein
d. Radiation necrosis
e. Secondary tumor
c. Acute thrombosis of the draining vein
A pericallosal aneurysm would be found at which location on the lateral projection angiogram shown?
a. D
b. E
c. C
d. B
e. A
d. B
What is a known genetic predisposition to cavernous malformations?
a. There is no genetic predisposition
b. IDH1 gene
c. BRAF gene
d. VHL gene
e. KRIT1 gene
e. KRIT1 gene
What is the most common location of a cavernous malformation of the central nervous system?
a. Brainstem
b. Cerebellum
c. Optic Pathway
d. Cerebral hemisphere
e. Spinal cord
d. Cerebral hemisphere
