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

Cerebrovascular Disease & Infections (Martin) Flashcards

(81 cards)

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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
In the pathogenesis of saccular aneurysms, there are structural problems with the affected vessels in that there is absence of what at birth?
Smooth muscle or intimal elastic lamina
26
Saccular aneurysms are most often in what part of the Circle of Willis?
Anterior circulation
27
What is the clinical presentation of saccular aneurysm?
Patient presents with worst headache of life (Thunderclap headache)
28
Arteriovenous malformations are tangled vessels that bypass?
Capillary bed
29
Where are Arteriovenous malformations (AVM) located? Where may they extend into?
1) Subarachnoid space | 2) Brain parenchyma
30
What is the most common route by which microbes enters the nervous system?
Hematogenous spread
31
Tuberculous meningitis develops by seeding CSF from?
Subepidural or submeningeal granulomas
32
Herpes simplex and Zoster produce latent infection of? They replicate in? They ascends to the CSN within?
1) Sensory ganglia 2) Schwann cells 3) Sensory nerves
33
The rabies virus binds at or near what receptors? They ascends to the CSN within?
1) Acetylcholine receptors | 2) Motor nerves
34
In regards to acute meningitis, what bacteria has basal distribution of exudate? What has distribution over cerebral convexities near the sagittal sinus?
1) Haemophilus influenzae | 2) Pneumococcal
35
During acute meningitis, what cells fill the subarachnoid space?
Neutrophils
36
In regards to acute meningitis, what may lead to venous thrombosis and hemorrhagic infarction of the underlying brain?
Phlebitis
37
Leptomeningeal fibrosis can lead to?
Hydrocephalus
38
What can cause chronic adhesive arachnoiditis?
Pneumococcal meningitis
39
What is characterized by meningitis associated septicemia with hemorrhagic infarction of the adrenal glands and cutaneous petechiae?
Waterhouse-Friderichsen syndrome
40
Waterhouse-Friderichsen syndrome occurs most commonly with?
Meningococcal and pneumococcal meningitis
41
What happens to glucose levels with bacterial meningitis?
Decreases
42
Identify the acute pyogenic (bacterial) meningitis causes by age group: 1) Neonates? 2) Adolescents? 3) Elderly?
1) E. coli and Group B Strep (streptococcus agalactiae) 2) Neisseria meningitidis 3) Streptococcus pneumoniae and listeria monocytogenes
43
What are the most common bacteria in brain abscesses of non immunosuppressed patients?
1) Streptococci | 2) Staphylococci
44
How does the CSF present with brain abscesses?
1) High WBC 2) High protein 3) Normal glucose
45
What type of necrosis is associated with brain abscesses?
Liquefactive necrosis
46
How can subdural empyema cause venous occlusion and infarction of the brain?
Thrombophlebitis of the bridging veins
47
Extradural abscess is commonly associated with?
Osteomyelitis
48
Neisseria meningitidis spreads more commonly in?
Crowded populations such as dorms, barracks, or prison
49
What makes up the chronic meningitis?
1) Tuberculosis 2) Neuroborreliosis 3) Neurosyphilis
50
What complications are noted with tuberculous meningitis?
1) Arachnoid fibrosis producing hydrocephalus 2) Obliterative endarteritis producing arterial occlusion 3) Tuberculoma
51
What stain is used to view TB?
Acid fast stain
52
What is neuroborreliosis a manifestation of?
Lyme disease
53
What symptoms are noted with neuroborreliosis?
1) Cranial nerve palsies | 2) Peripheral neuropathies
54
What is the clinical picture of neurosyphilis?
A mix of: 1) Meningovascular neurosyphilis 2) Paretic neurosyphilis 3) Tabes dorsalis
55
Chronic meningitis that mainly involves the base of the brain and more variably the cerebral convexities and the spinal leptomeninges is characteristic of?
Meningovascular neurosyphilis
56
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)?
Paretic neurosyphilis
57
What signs and symptoms are noted with Tabes dorsalis?
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
HSV-1 has a tropism for what lobes?
Temporal lobes
59
Hemorrhagic lesions of the temporal lobes are characteristic of?
Herpes simplex virus encephalitis
60
In regards to herpes zoster, the latent phase occurs in?
Trigeminal ganglia
61
What is characteristic of cytomegalovirus infection in utero?
Periventricular leukomalacia
62
Poliomyelitis has a tropism for what area of the spinal cord?
The anterior horn of motor neurons
63
What symptom is diagnostic of rabies?
Paresthesia around wound
64
What is a pathognomonic finding of rabies?
Negri bodies found in Purkinje cells of cerebellum
65
What virus is associated with an increased incidence of primary CNS lymphoma?
HIV
66
HIV encephalopathy is a chronic inflammatory reaction associated with what cells?
Microglial nodules with multinucleated giant cells
67
Progressive multifocal leukoencephalopathy (PML) is caused by?
JC polyomavirus
68
What is the principal pathologic effect of PML? This is due to?
1) Demyelination | 2) Oligodendroglial cells being infected
69
In regards to the morphology of PML, at the edges of the lesions there are enlarged oligodendrocyte nuclei containing?
Glassy amphophilic viral inclusions
70
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?
1) Paramyxovirus | 2) Measles virus
71
Mucormycosis is commonly seen in what patient population?
Diabetes Mellitus
72
Cryptococcal meningitis is described having what appearance?
Soap bubbles
73
Toxoplasmosis Gondii can cause brain abscesses located where?
1) Cerebral cortex (near the gray-white junction) | 2) Deep grey nuclei
74
With toxoplasmosis Gondii, what can be found at the periphery of necrotic zones?
Tachyzoites
75
What can cause cerebral amebiasis?
1) Naegleria fowleri | 2) Acanthamoeba
76
What can cause cerebral malaria?
Plasmodium falciparum
77
What genetic factor is protective against development of prion disease?
Heterozygosity at codon 129
78
Rapidly progressive dementia is characteristic of what type of prion disease? Progressive cerebellar ataxia is characteristic of what type of prion disease?
1) Creutzfeldt-Jakob Disease | 2) Gerstmann-Straussler-Scheinker syndrome
79
What is CJD positive for?
1) Congo Red | 2) PAS
80
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?
1) Neutrophils 2) Decreased 3) Increased 4) Cloudy (turbid)
81
What cells are elevated with viral meningitis? What is the glucose level? What is the protein level? What is the gross appearance of CSF?
1) Lymphocytes 2) Normal 3) Increased 4) Clear

NMSP Week 1 (13 decks)

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