Cerebrovascular Disease

Question 1

Hypovolemic shock, insulinemia, and hypertension can all cause _______.

Answer 1

Global Cerebral Ischemia

Question 2

How does Local Cerebral Ischemia present?

Answer 2

Unilateral ischemia/infarctions

Question 3

Which type of ischemia is going to present as a watershed infarction?

The border zone is typically located between which arteries?

Answer 3

Medium Global Ischemia

Located between ACA and MCA

Question 4

Why do you not want to administer thrombolytic therapy to a patient with a hemorrhagic stroke?

Answer 4

You will INCREASE the extend of the bleeding and make the damage worse!

Question 5

Describe the normal presentation of symptoms that are accompanied by a stroke?

Answer 5

Lateral isolation of symptoms!!!

Question 6

What is the largest branch of the Internal Carotid Artery?

Answer 6

Middle Cerebral Artery

Question 7

Describe the pneumonic (CHANGes) as it relates to the signs and symptoms of stroke patients.

Answer 7

C - Contralateral paresis and sensory loss in the face and the arm

H - Homonymous Hemianopsia

A - Aphasia

N - Neglect

G - Gaze preference TOWARDS the side of the lesion

Question 8

__________ come off of the MCA and can cause damage to the basal ganglia if damaged.

Answer 8

Lenticulostriate Vessels

Question 9

_________ arteries are particularly vulnerable in babies that have an amniotic fluid emboli.

Answer 9

Lenticulostriate

Question 10

These are supplied by which artery?

1. Almost all of the motor and primary motor cortex
2. Major regions of the auditory area
3. Major regions of the speech area
4. Internal Capsule

Answer 10

Middle Cerebral Artery

Question 11

Occlusion of the proximal MCA or one of its major branches is most often due to an _______ rather than intracranial atherothrombosis.

Answer 11

Embolus

Question 12

What is the most common site for thrombosis?

Answer 12

Carotid Bifurcation

Question 13

What is the most common site for Emboli?

What is a good indicator that an emboli was present?

Answer 13

Middle Cerebral Artery

Lines of Zon!

Question 14

Where is the most common site for mural thrombi to dislodge from before they go to the MCA during an embolic stroke?

Answer 14

Left side of the heart

Question 15

What is the most common site for a Berry Aneurysm?

Answer 15

Anterior circulation of the Circle of Willis (specifically the Anterior Communicating Artery)

Question 16

Explain why reperfusion injuries are seen in embolic strokes.

Answer 16

Pooling of blood in the necrotic tissue is going to end up with more Reactive Oxygen Species!

Question 17

How do fat emboli present?

Answer 17

Little red dots that are spread in BOTH hemispheres of the brain!

Question 18

Where does the blood from a ruptured Berry Aneurysm go?

Answer 18

Subarachnoid Space

Question 19

__________ are located in the white matter of the cerebral hemispheres.

Answer 19

Arteriovenous Malformations

Question 20

Explain how you could be predisposed to developing Berry Aneurysms.

Answer 20

You could be born with a small muscular defect in the wall of an artery at a branch point.

Question 21

________ and ________ are associated with the development of Berry Aneurysms.

Answer 21

1. Marfan’s Syndrome

2. Adult Polycystic Kidney Disease (APKD)

Question 22

In regards to responding to a foreign body with the immune system, the brain is considered “_____________”.

Answer 22

Immunologically-Priviledged

Question 23

Patients with Medullablastomas require chemotherapy for the treatment of the tumor. ________ from the chemotherapy treatment can cause _______ .

Answer 23

Methotrexate

Meningitis

Question 24

_________ is reflected in certain clinical syndromes that would present with motor and sensory deficits (instead of just nuchal ridigity and headache present in normal meningitis).

Answer 24

Meningoencephalitis

Question 25

Describe how lacunar infarcts are going to present in the brain.

Answer 25

Small red dots in the Basal Ganglia (white matter) and they will not necessarily be on both sides

Question 26

Most patients with chronic meningitis are _______ .

Answer 26

Immunocompromised

Question 27

Which infectious agent typically only shows up between birth-3 months of age and causes meningitis?

Answer 27

Group B Streptococcus

Question 28

__________ is typically associated with an end-stage infection in humans and it causes meningitis in immunocompromised patients.

Answer 28

Pseudomonas aeruginosa

Question 29

Leptomeningeal opacity/exudate on the superficial cortical brain is associated with which type of meningitis?

Answer 29

Acute Pyogenic

Question 30

Neutrophilic infiltrate in the subarachnoid space, cerebritis (neutrophils extend into the virchow-robbins space) and Phlebitis (venous thrombosis and hemorrhagic infarction) are all ________ characteristics of ______ meningitis.

Answer 30

Microscopic Acute

Question 31

During acute meningitis, you can have septicemia ("blood poisoning"), hemorrhagic infarct of the adrenal glands and Cutaneous petechiae. What is this known as? This is present with which microorganism?

Answer 31

Waterhouse Freiderichesen Syndrome Neisseria meningitidis

Question 32

________ presents as gram-negative diplococci on histologic slides.

Answer 32

Neisseria Meningitidis

Question 33

Increased Lymphocytes, Normal CSF Protein (or elevated) and Normal CSF glucose is associated with _________ .

Answer 33

Viral Meningitis

Question 34

Increased Neutrophils, Increased CSF Protein and Decreased CSF Glucose is associated with _________ .

Answer 34

Bacterial Meningitis

Question 35

Increased Lymphocytes, Increased CSF Protein and Decreased CSF Glucose is associated with _______ .

Answer 35

Fungal Meningitis

Question 36

Chronic arachnoiditis is associated with ________ meningitis.

Answer 36

Bacterial

Question 37

__________ is a term that is normally used for describing fungal infections; however, it is used to describe bacterial infections in the brain.

Answer 37

Mycotic Aneurysms

Question 38

Which lobe does the Herpes virus typically infect?

Answer 38

Temporal Lobe

Question 39

Progressive Multifocal Leukoencephalopathy is due to infection of the __________ virus.

Answer 39

JC polyoma Virus

Question 40

What is the late manifestation of the measles virus?

Answer 40

Subacute Sclerosis Panencephalitis

Question 41

Intranuclear inclusions and a nucleolus pattern than is marginalized is typical of __________ .

Answer 41

Herpes Encephalitis

Question 42

__________ is known as extension of inflammatory cells into the Virchow-Robbins Space.

Answer 42

Perivascular Inflammation

Question 43

Pleomorphic CSF (Neutrophils and Lymphocytes) are characteristic of ________ meningitis.

Answer 43

Aseptic (Viral) Meningitis

Question 44

Tuberculosis, neurosyphilis, lyme disease and cryptococcus are all examples of infectious agents that can end up causing ___________ .

Answer 44

Chronic Bacterial Meningoencephalitis

Question 45

Which infectious agent will cause periventricular necrosis, severe brain destruction, and periventricular calcifications in utero?

Answer 45

Cytomegalovirus

Question 46

Large nucleus, marginal chromatin and cytoplasmic inclusions are all characteristic of _________ .

Answer 46

Cytomegalovirus Encephalitis

Question 47

Which infectious agent will cause widespread neuronal degeneration, most severe inflammation tends to be in brainstem distribution and contains Negri bodies?

Answer 47

Rabies

Question 48

After an injury to a body part, if you have parasthesias (numbness of the tissue) around the wound, where should your index of suspicion go?

Answer 48

Rabies

Question 49

Chronic inflammatory reaction, microglial nodules, multinucleated giant cells, reactive gliosis and myelin pallor are all characteristic of _________ .

Answer 49

HIV Encephalitis

Question 50

The degree of dementia in HIV encephalitis tends to correlate with the quantity of activated _________ .

Answer 50

Microglial Cells

Question 51

Which two infectious agents are associated with Ring-Like formations in the brain?

Answer 51

1. Nocardia asteroides | 2. Toxoplasmosis

Question 52

Which disease is associated with a virus that preferentially infects oligodendrocytes, demyelination occurs and occurs almost exclusively in immunosuppressed individuals?

Answer 52

Progressive Multifocal Leukoencephalopathy (PML)

Question 53

Which two fungal agents are angioinvasive?

Answer 53

1. Aspergillus | 2. Mucor

Question 54

Cerebral malaria is normally due to ___________ .

Answer 54

Plasmodium Falciparum

Question 55

Cerebral __________ is associated with brain abscesses mostly in the cerebral cortex near the gray-white junction and deep grey nuclei. It will line up in the periventricular areas.

Answer 55

Toxoplasmosis

Question 56

_______ is a protazoa that is associated with necrotizing encephalitis.

Answer 56

Naegleria Fufuri

Question 57

Which type of diseases are going to present with a "spongiform" encephalopathy?

Answer 57

Prion Diseases

Question 58

What is an Artiovenous Malformation?

Answer 58

Vessels that are tortuous and malformed that can rupture! They tend to be located in the white matter of the brain.