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Res Quizzes > Cerebrovascular Diseases > Flashcards

Cerebrovascular Diseases Flashcards

1
Q

Enumerate and define the boundaries of the ACA segments

A

A1 horizontal: ICA to ACOM
A2 vertical: ACOM to callosomarginal artery
A3 callosal: distal to callosomarginal artery

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2
Q

Enumerate and define the boundaries of the ICA segments

A 
C1: cervical segment
C2: petrous (horizontal) segment
C3: lacerum segment
C4: cavernous segment
C5: clinoid segment
C6: supraclinoi) segment
C7: communicating segment
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3
Q

Enumerate and define the boundaries of the MCA segments

A

M1 horizontal or sphenoidal segment: origin to bi/trifurcation (the limen insulae)
M2 insular segment: bi/trifurcation to circular sulcus of insula where it makes hairpin bend to continue as M3
M3 opercular segment: opercular branches (those within the Sylvian fissure)
M4 cortical segment: branches emerging from the Sylvian fissure onto the convex surface

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4
Q

Enumerate and define the boundaries of the PCA segments

A

P1: basilar artery to Pcom
P2: Pcom to the posterior aspect of the midbrain
P3: posterior aspect of the midbrain to calcarine fissure
P4: distal to the anterior limit of the calcarine fissure

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5
Q

Enumerate and define the boundaries of the vertebral arteries segments

A

V1 preforaminal: origin to C6 transverse foramen
V2 foraminal: C6 to the C2
V3 atlantic or extradura): C2 to the dura
V4 intradural: dura to basilar artery

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6
Q

Branches of the A1 segment of the ACA

A

A1 (horizontal): ICA to ACOM
1 medial lenticulostriate artery
2 recurrent artery of Heubner3 Acom

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7
Q

Branches of the A2 segment of the ACA

A

A2 vertical: ACOM to callosomarginal artery
1 orbitofrontal artery
2 frontopolar artery

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8
Q

Branches of the A3 segment of the ACA

A

A3 callosal: distal to callosomarginal artery
1 pericallosal artery
2 callosomarginal artery (runs in the cingulate sulcus)

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9
Q

Segments of the ICA that has no branches

A

C1: cervical segment
C3: lacerum segment
C5: clinoid segment

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10
Q

Branches of the C2 segment of the ICA

A

C2: petrous (horizontal) segment
1 caroticotympanic artery
2 vidian artery

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11
Q

Branches of the C4 segment of the ICA

A

C4: cavernous segment
1 meningohypophyseal trunk
2 inferolateral trunk

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12
Q

Branches of the C6 segment of the ICA

A

C6: supraclinoid segment
1 ophthalmic artery
2 superior hypophyseal artery

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13
Q

Branches of the C7 segment of the ICA

A

1 Pcom
2 anterior choroidal artery
3 ACA
4 MCA

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14
Q

What is the ABCD2 scoring?

A 
1 point    age>=60
1 point    BP: S >=140 or D >=90
Clinical feature: 
2 points    unilateral
1 point       speech 
1 point      Diabetes
Duration 
2 points       >=60 mins
1 point         10-59 mins
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15
Q

ABCD2 Scores 2day Risk of stroke

A

0-3: 1%
4-5: 4.1%
6-7: 8.1%

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16
Q

CHA2DS2-VASc

A 
Congestive  Heart Failure
Hypertension
Age>75*
Diabetes
Stroke/TIA/TE*
Vascular Disease
Age>65
Sex

*2 points
score>=2 is HIGH RISK

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17
Q

HASBLED

A 
Hypertension >160
Abnormal liver renal function
Stroke
Bleeding tendency
Labile INR
Elderly>65
Drugs (alcohol)

> =3 high risk

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18
Q

Speltzer Martin Scoring

A 
size of nidus
      6cm = 3
eloquence of adjacent brain
    non-eloquent = 0
    eloquent = 1
venous drainage
    superficial only = 0
    deep = 1
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19
Q

Risk of aneurysmal rupture for ruptured?

A

3-4% first 24 hours then 1-2%/day first month, 3% per year after 3 months

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20
Q

Sensitivity of CT scan in detecting SAH in 12 hours

A

98-100%

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21
Q

Angiogram sensitivity in detecting aneurysm

A

x

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22
Q

Stroke RCT: ATC

A

Antiplatelet Trialist Collaboration

ASA vs Placebo

Odds reduction of composite outcome by 33%

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23
Q

Stroke RCT: CAPRIE

A

Clopidogrel vs Aspirin in at Risk for Ischemic Events

Clopidogrel 8.7% reduction compared to Aspirin

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24
Q

Stroke RCT: MATCH

A

Management of Atherothrombotic Risk with Clopidogrel

Clopidogrel+Aspirin vs Clopidogrel
Negative study
Higher hemorrhage in dual antiplatelet

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25
Q

Stroke RCT: CHARISMA

A

Clopidogrel for High Risk and Ischemic Stabilization Management and Avoidance

Clopidogrel+Aspirin vs Aspirin

Same

Increased hemorrhage in dual antiplatelet

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26
Q

Stroke RCT: SPS3

A

Secondary Prevention of Small Subcortical Strokes

Clopidogrel + Aspirin vs Aspirin

Same
Increased hemorrhage in dual antiplatelet

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27
Q

Stroke RCT: CSPS1

A

Cilostazol in Stroke Prevention Study

Cilostazol vs Placebo

41.7% risk reduction of recurrent ischemic strome

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28
Q

Stroke RCT: TOSS

A

Trial of Cilostazol Symptomatic Intracranial Stenosis

Cilostazol+Aspirin vs Aspirin

Progression of intracranial stenosis by MRA was less in dual antiplatelet

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28
Q

Stroke RCT: TOSS 2

A

Trial of Cilostazol in Symptomatic Intracranial Stenosis

Cilostazol+Aspirin vs Clopidogrel+Aspirin

No difference in rate of ICAS progression
But more hemorrhage in Clopidogrel

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28
Q

Stroke RCT: CATS

A

Canadian American Stroke Study

Ticlopidone vs Placebo

30% Composite outcome reduction

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29
Q

Stroke RCT: TASS

A

Ticlopidone vs Aspirin Stroke Study

Ticlopidone vs Aspirin

Reduced stroke or death by 12%
Neutropenia in Ticlopidone

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30
Q

Stroke RCT: ESPS1

A

European Stroke Prevention Study 1

Dipyrimadole+Aspirin vs placebo

33% reduction

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31
Q

Stroke RCT: ESPS2

A

European Stroke Prevention Study 2

4 arms

Dipyridamole+Aspirin vs
Dipyridamole vs
Aspirin vs placebo

Stroke reduction compared to placebo:
37.8%
18%
16%
No increased bleeding
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32
Q

Stroke RCT: ESPRIT

A

European/Australasian Stroke Prevention in Reversible Ischemia

Dipyridamole+Aspirin vs Aspirin

Dual antiplatelet 20% reduced composite outcome
No increased bleeding

33
Q

Stroke RCT: PROFESS

A

Prevention Regimen for Effectively Avoiding Second Stroke

Dipyridamole+Aspirin vs Clopidogrel

Similar rates of recurrent ischemic stroke
More hemorrhage in dual antiplatelet

34
Q

Stroke RCT: TACIP

A

Trifusal Aspirin in Cerbral Infarction Prevention

Trifusal vs Aspirin
Similar efficacy
Less hemorrhage in trifusal

35
Q

Stroke RCT: TAPIRSS

A

Trifusal vs Aspirin in the Prevention of Infarction: A Randomized Stroke Study

Trifusal vs Aspirin
No significant difference in combined endpoint
Less hemorrhage in Trifusal

36
Q

Stroke RCT: WARSS

A

Warfarin Aspirin Recurrent Stroke Study

Warfarin vs Asprin
No significant difference

37
Q

Stroke RCT: WASID

A

Warfarin Aspirin in Symptomatic Intracranial Disease

Warfarin vs Aspirin

No significant difference

38
Q

Stroke RCT: CSPS2

A

Cilostazol Stroke Prevention Study 2

Cilostazol vs Aspirin
Non inferiority

39
Q

Antidote for Dabigatran

A

Idarucizumab

40
Q

FUNC scoring

A 
Volume
Location
Age
GCS
Cognitive Impairment
41
Q

30day mortality risk ICH scoring

A 
GCS
Volume
Intraventricular Hemorrhafe
Infratentorial
Age
42
Q

FUNC scoring

A 
Volume
Location
Age
GCS
Cognitive Impairment
43
Q

30day mortality risk ICH scoring

A 
GCS
Volume
Intraventricular Hemorrhafe
Infratentorial
Age
44
Q

FUNC scoring

A 
Volume
Location
Age
GCS
Cognitive Impairment
45
Q

30day mortality risk ICH scoring

A 
GCS
Volume
Intraventricular Hemorrhafe
Infratentorial
Age
46
Q

Sensitivity of CT scan in detecting SAH in 24 hours

47
Q

Sensitivity of CT scan in detecting SAH in 6 days

48
Q

If CT Scan is unavailable, the most sensitive MRI studies for detecting SAH are?

A

T2 Gradient Echo

FLAIR

49
Q

If cerebral angiogram is negative in SAH, repeat when?

50
Q

In SAH, surgery may be delayed if there is:

A

Ischemia or severe angiographic vasospasm

51
Q

For poor grade SAH (HHIV-V), early surgery may be done if:

A

Hematoma

Hydrocephalus

52
Q

ICH lifetime risk in a patient with AVM

53
Q

Morbidity risk of AVM for each bleed

54
Q

Mortality risk of ruptured AVM for each bleed

55
Q

Bleeding risk in a patient with AVM if unruptured

A

2-4% per year

56
Q

Overall mortality rate from AVM hemorrhage for adults

57
Q

Overall mortality rate from AVM hemorrhage for children

58
Q

ICH lifetime risk in a patient with AVM

59
Q

Morbidity risk of AVM for each bleed

60
Q

Mortality risk of ruptured AVM for each bleed

61
Q

Bleeding risk in a patient with AVM if unruptured

A

2-4% per year

62
Q

Overall mortality rate from AVM hemorrhage for children

63
Q

Overall mortality rate from AVM hemorrhage for adults

64
Q

In SAH, surgery may be delayed if there is:

A

Ischemia or severe angiographic vasospasm

65
Q

For poor grade SAH (HHIV-V), early surgery may be done if:

A

Hematoma

Hydrocephalus

66
Q

Consistent risk factors that increase risk of hemorrhage in AVM

A

1 deep venous drainage
2 single draining vein
3 venous stenosis
4 high MAP in the feeding artery

67
Q

Inconsistent risk factors that increase risk of hemorrhage in AVM

A

1 intranid aneurysms
2 deep location
3 small nidus
4 venous stasis

68
Q

Potential risk factors that increase risk of hemorrhage in AVM

A 
1 hypertension
2 increasing age
3 smoking
4 pregnancy
5 vertebrobasilar supply
6 perforating supply
69
Q

AVM score for Radiosurgery

A

=0.1Volume + 0.02Age + 0.5Location

1 point if: BG, thalamus, brainstem

70
Q

Treatment of choice for cavernous malformation

A

Microsurgery

71
Q

Types CCF

A

type A: a direct connection between the intracavernous ICA and CS
type B: dural shunt between intracavernous branches of the ICA and CS
type C: dural shunts between meningeal branches of the ECA and CS
type D: B + C

72
Q

CHADS2

A 
Congestive Heart Failure
Hypertension
Age>75
Diabetes
Stroke/TIA/TE
73
Q

Fisher Grading

A

1: no subarachnoid (SAH) or intraventricular haemorrhage (IVH) detected
2: diffuse thin (1 mm in thickness +/- intracranial haemorrhage (ICH) or IVH
4: no or thin SAH + ICH or IVH

74
Q

WFNS Classification

A 
GCS 15
GCS 13-14 without deficit
GCS 13-14 with focal neurological deficit
GCS 7-12 
GCS
75
Q

Absolute Contraindications to rTPA

76
Q

In cerebral infarction, there is a early ___1_____ diffusivity followed by later ___2_____ diffusivity on MRI

A

1 Reduced

2 Elevated

78
Q

Brainstem syndromes

79
Q

In cerebral infarction, there is a early ___1_____ edema followed by later ___2_____ edema on MRI

A

1 cytotoxic

2 vasogenic

80
Q

Mode of action of Citcoline

81
Q

High risk cardioembolic source 9

A 
1 AF
2 recent MI
3 Atrial myxoma
4 Rhematic MS
5 Prosthetic valves
6 Infective Endocarditis
7 Marantic Endocarditis
8 dilated CM
9 Left thrombus
82
Q

low risk cardioembolic source 6

A 
1 PFO
2 Mitral annular calcification
3 Mitral valve prolapse
4 Mitral valve strands
5 Aortic stenosis
6 Atrial septal aneurysm
83
Q

Exclusion criteria for rtpa treatment with time window of 4.5 hours (4)

A

1 >80 years old
2 anticoagulant use
3 NIHSS>25
4 history of both ischemic stroke and diabetes

Res Quizzes (18 decks)

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