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NMSP Week 1 > Cerebrovascular Disease & Infections (Martin) > Flashcards

Cerebrovascular Disease & Infections (Martin) Flashcards

1
Q

What deficit is commonly seen with an Anterior Cerebral Artery occlusion?

A

Contralateral hemiplegia

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2
Q

What symptoms are commonly seen with an Middle Cerebral Artery occlusion?

A

1) Contralateral paresis and sensory loss in face and arm

2) Gaze preference toward side of lesion

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3
Q

Infarcts and ischemic events are more common in which cerebral artery?

A

MCA

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4
Q

What is the most common cerebrovascular disorder?

A

Hypertensive intraparenchymal hemorrhage

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5
Q

Where is a watershed infarct most commonly seen?

A

Between the ACA and MCA

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6
Q

ACA-MCA watershed infarct is usually seen in hypotensive patients with?

A

Carotid stenosis

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7
Q

What deficit is noted with ACA-MCA watershed infarct?

A

Proximal arm and leg weakness

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8
Q

What commonly leads to stenosis of the internal carotid artery?

A

Atherosclerosis

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9
Q

What deficit is noted with carotid stenosis?

A

Contralateral face and arm weakness

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10
Q

What are the sites of primary thrombosis?

A

1) Carotid bifurcation
2) Origin of MCA
3) Ends of Basilar artery

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11
Q

Thrombotic occlusions are mostly due to?

A

Atherosclerosis

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12
Q

Paradoxical embolus can occur when an emboli crosses?

A

Patent foramen ovale

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13
Q

Which vessel is most affected by embolic infarction?

A

MCA

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14
Q

What is the typical duration of a transient ischemic attack (TIA)?

A

10 minutes

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15
Q

Why are TIAs a neurological emergency?

A

They are warning signs for potentially larger ischemic injury to the brain

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16
Q

About 15% of TIA patients will have a stroke causing persistent deficits within?

A

3 months

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17
Q

What are hemorrhagic strokes secondary to?

What are they associated with?

A

1) Reperfusion of damaged vessels

2) Emboli

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18
Q

What are ischemic strokes associated with?

A

Thrombus

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19
Q

Lacunar infarcts are associated with?

A

Hypertensive cerebrovascular disease

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20
Q

What do lacunar infarcts most commonly involve?

A

Lenticulostriate arteries

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21
Q

Hypertensive Encephalopathy occurs do to?

A

Malignant HTN

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22
Q

Cerebral amyloid angiopathy are associated with?

A

Lobar hemorrhage

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23
Q

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) are characterized by?

It is associated with what misfolded protein?

A

1) Recurrent strokes and dementia

2) NOTCH3

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24
Q

Most common cause of spontaneous subarachnoid hemorrhage is a rupture of?

A

Saccular (berry) aneurysm

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25
Q

In the pathogenesis of saccular aneurysms, there are structural problems with the affected vessels in that there is absence of what at birth?

A

Smooth muscle or intimal elastic lamina

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26
Q

Saccular aneurysms are most often in what part of the Circle of Willis?

A

Anterior circulation

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27
Q

What is the clinical presentation of saccular aneurysm?

A

Patient presents with worst headache of life (Thunderclap headache)

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28
Q

Arteriovenous malformations are tangled vessels that bypass?

A

Capillary bed

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29
Q

Where are Arteriovenous malformations (AVM) located?

Where may they extend into?

A

1) Subarachnoid space

2) Brain parenchyma

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30
Q

What is the most common route by which microbes enters the nervous system?

A

Hematogenous spread

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31
Q

Tuberculous meningitis develops by seeding CSF from?

A

Subepidural or submeningeal granulomas

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32
Q

Herpes simplex and Zoster produce latent infection of?

They replicate in?

They ascends to the CSN within?

A

1) Sensory ganglia
2) Schwann cells
3) Sensory nerves

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33
Q

The rabies virus binds at or near what receptors?

They ascends to the CSN within?

A

1) Acetylcholine receptors

2) Motor nerves

34
Q

In regards to acute meningitis, what bacteria has basal distribution of exudate?

What has distribution over cerebral convexities near the sagittal sinus?

A

1) Haemophilus influenzae

2) Pneumococcal

35
Q

During acute meningitis, what cells fill the subarachnoid space?

A

Neutrophils

36
Q

In regards to acute meningitis, what may lead to venous thrombosis and hemorrhagic infarction of the underlying brain?

A

Phlebitis

37
Q

Leptomeningeal fibrosis can lead to?

A

Hydrocephalus

38
Q

What can cause chronic adhesive arachnoiditis?

A

Pneumococcal meningitis

39
Q

What is characterized by meningitis associated septicemia with hemorrhagic infarction of the adrenal glands and cutaneous petechiae?

A

Waterhouse-Friderichsen syndrome

40
Q

Waterhouse-Friderichsen syndrome occurs most commonly with?

A

Meningococcal and pneumococcal meningitis

41
Q

What happens to glucose levels with bacterial meningitis?

A

Decreases

42
Q

Identify the acute pyogenic (bacterial) meningitis causes by age group:

1) Neonates?
2) Adolescents?
3) Elderly?

A

1) E. coli and Group B Strep (streptococcus agalactiae)
2) Neisseria meningitidis
3) Streptococcus pneumoniae and listeria monocytogenes

43
Q

What are the most common bacteria in brain abscesses of non immunosuppressed patients?

A

1) Streptococci

2) Staphylococci

44
Q

How does the CSF present with brain abscesses?

A

1) High WBC
2) High protein
3) Normal glucose

45
Q

What type of necrosis is associated with brain abscesses?

A

Liquefactive necrosis

46
Q

How can subdural empyema cause venous occlusion and infarction of the brain?

A

Thrombophlebitis of the bridging veins

47
Q

Extradural abscess is commonly associated with?

A

Osteomyelitis

48
Q

Neisseria meningitidis spreads more commonly in?

A

Crowded populations such as dorms, barracks, or prison

49
Q

What makes up the chronic meningitis?

A

1) Tuberculosis
2) Neuroborreliosis
3) Neurosyphilis

50
Q

What complications are noted with tuberculous meningitis?

A

1) Arachnoid fibrosis producing hydrocephalus
2) Obliterative endarteritis producing arterial occlusion
3) Tuberculoma

51
Q

What stain is used to view TB?

A

Acid fast stain

52
Q

What is neuroborreliosis a manifestation of?

A

Lyme disease

53
Q

What symptoms are noted with neuroborreliosis?

A

1) Cranial nerve palsies

2) Peripheral neuropathies

54
Q

What is the clinical picture of neurosyphilis?

A

A mix of:

1) Meningovascular neurosyphilis
2) Paretic neurosyphilis
3) Tabes dorsalis

55
Q

Chronic meningitis that mainly involves the base of the brain and more variably the cerebral convexities and the spinal leptomeninges is characteristic of?

A

Meningovascular neurosyphilis

56
Q

What is clinically manifested by insidious and progressive cognitive impairment that results in mood disturbances (including delusions of grandeur) that will end in severe dementia (general paresis of the insane)?

A

Paretic neurosyphilis

57
Q

What signs and symptoms are noted with Tabes dorsalis?

A

1) Widened gait
2) Loss of pain sensation which can lead to skin and joint damage (Charcot joints)
3) Lightning pains
4) Loss of DTRs

58
Q

HSV-1 has a tropism for what lobes?

A

Temporal lobes

59
Q

Hemorrhagic lesions of the temporal lobes are characteristic of?

A

Herpes simplex virus encephalitis

60
Q

In regards to herpes zoster, the latent phase occurs in?

A

Trigeminal ganglia

61
Q

What is characteristic of cytomegalovirus infection in utero?

A

Periventricular leukomalacia

62
Q

Poliomyelitis has a tropism for what area of the spinal cord?

A

The anterior horn of motor neurons

63
Q

What symptom is diagnostic of rabies?

A

Paresthesia around wound

64
Q

What is a pathognomonic finding of rabies?

A

Negri bodies found in Purkinje cells of cerebellum

65
Q

What virus is associated with an increased incidence of primary CNS lymphoma?

A

HIV

66
Q

HIV encephalopathy is a chronic inflammatory reaction associated with what cells?

A

Microglial nodules with multinucleated giant cells

67
Q

Progressive multifocal leukoencephalopathy (PML) is caused by?

A

JC polyomavirus

68
Q

What is the principal pathologic effect of PML?

This is due to?

A

1) Demyelination

2) Oligodendroglial cells being infected

69
Q

In regards to the morphology of PML, at the edges of the lesions there are enlarged oligodendrocyte nuclei containing?

A

Glassy amphophilic viral inclusions

70
Q

What type of virus is associated with Subacute Sclerosing Panencephalitis (SSPE)?

It occurs in kids or young adults months or years after an initial infection by?

A

1) Paramyxovirus

2) Measles virus

71
Q

Mucormycosis is commonly seen in what patient population?

A

Diabetes Mellitus

72
Q

Cryptococcal meningitis is described having what appearance?

A

Soap bubbles

73
Q

Toxoplasmosis Gondii can cause brain abscesses located where?

A

1) Cerebral cortex (near the gray-white junction)

2) Deep grey nuclei

74
Q

With toxoplasmosis Gondii, what can be found at the periphery of necrotic zones?

A

Tachyzoites

75
Q

What can cause cerebral amebiasis?

A

1) Naegleria fowleri

2) Acanthamoeba

76
Q

What can cause cerebral malaria?

A

Plasmodium falciparum

77
Q

What genetic factor is protective against development of prion disease?

A

Heterozygosity at codon 129

78
Q

Rapidly progressive dementia is characteristic of what type of prion disease?

Progressive cerebellar ataxia is characteristic of what type of prion disease?

A

1) Creutzfeldt-Jakob Disease

2) Gerstmann-Straussler-Scheinker syndrome

79
Q

What is CJD positive for?

A

1) Congo Red

2) PAS

80
Q

What cells are elevated in CSF with bacterial meningitis?

What is the glucose level?

What is the protein level?

What is the gross appearance of CSF?

A

1) Neutrophils
2) Decreased
3) Increased
4) Cloudy (turbid)

81
Q

What cells are elevated with viral meningitis?

What is the glucose level?

What is the protein level?

What is the gross appearance of CSF?

A

1) Lymphocytes
2) Normal
3) Increased
4) Clear

NMSP Week 1 (13 decks)

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