Cerebrovascular Disease

Question 1

Transient Ischemic Attacks

Answer 1

Sudden, focal neurological deficits which completely resolve within 24 hours

Question 2

Stroke

Answer 2

A sudden, focal neurological deficit which does not completely resolve within 24 hours, but may variably improve over several weeks to months

Question 3

What are some of the risk factors of ischemic cerebrovascular disease?

Answer 3

• Aterosclerosis
• Hypertension
• Diabetes
• Smoking
• Hyperlipidemia

Question 4

Where is atherosclerosis predominantly found in the cerebral vasculature?

Answer 4

Atherosclerotic changes predominate at the bifurcation points of large, major cervical and intracranial arteries, perhaps partly due to more turbulent blood flow at these sites.

Question 5

What are the 2 basic mechanisms of cerebral ischemic infarction?

Answer 5

• Thrombosis

- Embolism

Question 6

What do the lenticulostriate arteries supply?

Answer 6

Deep structures such as the basal ganglia, internal capsule, thalamus, and corona radiata.

Question 7

Lacunar Infarcts

Answer 7

Small lesions due to infarction of the lenticulostriate arteries

Question 8

Amaurosis Fugax (monocular blindness)

Answer 8

Carotid territory TIA involving the ophthalmic artery or its retinal branches

Question 9

What do non-ocular carotid territory TIAs cause?

Answer 9

Other carotid TIAs may cause hemispheral ischemia leading to hemiparesis or aphasia.

Question 10

What do vertebrobasilar TIAs cause?

Answer 10

Vertebrobasilar territory TIAs cause ischemia of the brain stem, cerebellum, or visual (occipital) cortex, producing symptoms of ataxia, homonymous hemianopsia, or hemiparesis associated with “crossed” brain stem syndromes.

Question 11

A hemiparesis with greater weakness of the face and upper limb suggests an infarct in…

Answer 11

Precentral MCA

Question 12

A hemiparesis with greater weakness of the lower limb suggests an infarct in…

Answer 12

Precentral ACA

Question 13

Sensory deficits limited to the face and upper limb likewise suggest an infarct in…

Answer 13

Postcentral MCA

Question 14

Sensory deficits limited to the lower limb suggest an infarct in…

Answer 14

Postcentral ACA

Question 15

Pure Sensory Stroke

Answer 15

Lacunar Syndrome of the Thalamus

Question 16

Are lacunar strokes thrombotic or embolic?

Answer 16

Almost always thrombotic

Question 17

What can improve functional recovery after stroke if administered rapidly?

Answer 17

IV tPA can be beneficial if administered within 3 hours of onset of symptoms

Question 18

What is the greatest risk with tPA use?

Answer 18

Intracranial Hemorrhage

Question 19

Why does rupture of blood into brain parenchyma cause ICP?

Answer 19

Arterial pressure is higher than ICP

Question 20

What does a deep hemorrhage hint at as the cause?

Answer 20

HTN

Question 21

What does a superficial hemorrhage hint at as the cause?

Answer 21

Head Trauma

Question 22

What is the most common cause of cerebral hemorrhage?

Answer 22

HTN

Question 23

Arteriovenous Malformations

Answer 23

AVMs are an abnormal connection of cerebral artery to vein, without intervening capillary bed, which enlarge slowly over time - risk for rupture and hemorrhage.

Question 24

What is the most common cause for bleeding into the arachnoid space?

Answer 24

Trauma

Question 25

Second to trauma what is the most common cause of subarachnoid hemorrhage?

Answer 25

Berry Aneurysm

Question 26

What in the CSF on lumbar puncture can indicated subarachnoid hemorrhage?

Answer 26

Xanthochromia from breakdown of RBCs