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BRAIN BATTACK > CH33: Stroke > Flashcards

CH33: Stroke Flashcards

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1
Q

Most readily recognized factor in the genesis of primary intracerebral hemorrhage (p. 801)

A

Hypertension

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2
Q

Simple measures such as the use of this drug for blood pressure control may be overall the most effective (p. 801)

A

Hydrochlorothiazide

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3
Q

The presence of atrial fibrillation increases the incidence of stroke how many times? (p. 801)

A

6x

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4
Q

The presence of Rheumatic Valvular disease increases the incidence of stroke how many times? (p. 801)

A

18x

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5
Q

Most common cause of ischemic strokes and all the types of stroke (p. 802)

A

Cerebral embolism

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6
Q

Most common vessel involved in cerebral embolism (p. 802)

A

Middle Cerebral Artery

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7
Q

Atheramotaois plaques in the ascending aorta greater than this thickness is found to be associated on a statistical basis with stroke (p. 803)

A

4mm

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8
Q

Migrating or traveling embolus syndrome most evident in cases of which artery (p. 803)

A

Posterior cerebral artery occlusion

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9
Q

Risk of stroke with PFO alone (p. 804)

A

2%

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10
Q

Risk of stroke with PFO + atrial septal aneurysm (p. 804)

A

15%

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11
Q

Most common sites of atheromatous plaques (p. 805)

A
  1. ICA at the origin from the common carotid
  2. Cervical part of the vertebral arteries or at their origins at the subclavian vessels and their junction from basilar artery.
  3. Stem or at the main bifurcation of the MCA
  4. Proximal posterior cerebral artery as they wind around the midbrain
  5. Proximal anterior cerebral arteries
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12
Q

TIAs that occur with exercise or the assumption of upright posture are particularly suggestive of (p. 807)

A

stenosis of aortic branches

dissection of the carotid artery

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13
Q

TIAs that occur with hyperventilation are particularly suggestive of (p. 807)

A

moyamoya disease

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14
Q

At this pressure, small pial vessels are able to dilate and to constrict in order to maintain cerebral blood flow (p. 810)

A

50 to 150mmHg

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15
Q

Critical level for infarction is approximately (p. 810)

A

23ml/100g/min

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16
Q

At this level, regardless of its duration, decreased CBF causes infarction (p. 810)

A

10-12ml/100g/min

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17
Q

At this level marked ATP depletion, increase in extracellular K, increase in intracellular Ca, cellular acidosis (p. 811)

A

6-8 ml/100g/min

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18
Q

Swelling of capillary endothelial cells which prevents the restoration of circulation (p. 811)

A

no-reflow phenomenon

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19
Q

Role of excitatory neurotransmitters which are formed by glycolytic intermediates of Krebs cycle (p. 811)

A

glutamate and aspartate

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20
Q

one of several calcium channels that open under conditions of ischemia and set in motion a cascade of cellular events eventuating in a neuronal death (p. 811)

A

NMDA channel

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21
Q

Vitamin K dependent protease that is in combination with its cofactors protein S and antithrombin III which inhibits coagulation (p. 811)

A

Protein C

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22
Q

Syndrome wherein a hypercoagulatble state does not often produce in situ arterial occlusion but it does lead to thrombotic vegetation on heart valves that precipitate strokes (p. 811)

A

Trosseau syndrome

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23
Q

Bruit: angle of the jaw

A

Proximal internal carotid

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24
Q

Bruit: lower in the neck

A

Common carotid or subclavian artery

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25
Q

Bruit: posteriorly in the neck

A

vertebral arteries

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26
Q

Transient monocular blindness occurs prior to the onset of stroke in how many percent of cases of symptomatic carotid occlusion (p. 815)

A

10% to 25%

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27
Q

Contralateral hemiplegia, hemihypoesthesia, homonymous sectorial hemianopia (p. 820)

A

Anterior choroidal artery syndrome

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28
Q

T/F Despite the small caliber of the vessel and its blood supply of deep structures, the most common cause of occlusion of the anterior choroidal artery is embolic. (p. 821)

A

TRUE

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29
Q

Third nerve palsy + contralateral hemiplegia (p. 824)

A

Weber syndrome

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30
Q

Third nerve palsy + contralateral ataxic tremor (p. 824)

A

Claude syndrome

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31
Q

Third nerve palsy + contralateral hemiplegia + ataxic tremor (p. 824)

A

Benedikt syndrome

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32
Q

Patient is unaware of being blind and denies the problem even when it is pointed out to him (p. 825)

A

Anton syndrome

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33
Q

Numerical segments of the vertebral artery (p. 825)

A

V1 from origin to the first entry into the cervical transverse foramen
V2 from the transverse foramen to the uppermost foramen
V3 dural penetration at the foramen magnum
V4 dural entry to the junction with the opposite vertebral artery and the origin of the basilar artery

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34
Q

Declares itself by cervicooccipital pain ipsilateral to the dissection and deficits of brainstem function (p. 826)

A

Dissection of the vertebral artery

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35
Q

Most frequent feature of lateral medullary syndrome (p. 827)

A

Vertigo

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36
Q

Tinnitus may be overwhelming called ‘screaming’ by some of our patients (p. 830)

A

Anterior inferior cerebellar artery infarction

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37
Q

When the position sense, two-point discrimination, and tactile localization are affected relatively MORE than pain or thermal and tactile sense (p. 831)

A

Cerebral lesion (if opposite, brainstem localization)

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38
Q

4 lacunar syndromes (p. 831)

A

Pure motor
Pure sensory
Clumsy hand- dysarthria
Ipsilateral hemiparesis-ataxia

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39
Q

Dysarthria and clumsiness syndrome (p. 831)

A

Paramedian midpons, posterior portion of the internal capsule apposite the affected limb

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40
Q

According to NIH study, when giving tPA, what is the risk of symptomatic cerebral hemorrhage? (p. 833)

A

6%

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41
Q

According to NIH study, when giving tPA, what is the risk of insignificant cerebral hemorrhage? (p. 833)

A

4%

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42
Q

Patients taking this medication seem to display angioneurotic edema as a side effect of tPA (p. 834)

A

ACE inhibitor

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43
Q

Heparin drip dose (p. 835)

A

100U/kg bolus then continuous drip (1,000 U/h)

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44
Q

An advantage in survival favoring the group operated (hemicraniectomy) are those operated within ___ (p. 837)

A

48 hours

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45
Q

SE: Neutropenia (p. 839)

A

Ticlopidine

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46
Q

SE: TTP (p. 839)

A

Clopidogrel

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47
Q

What does symptomatic TIA mean? (p. 841)

A

large or small strokes, or TIAs

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48
Q

Maximum benefit is accrued if CEA is performed within __ of a TIA or minor stroke (p. 841)

A

2 weeks

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49
Q

CEA for symptomatic lesions causing degrees of stenosis greater than ____ in diameter reduces the incidence of ipsilateral hemispheral strokes and shows greater benefit with increasing degrees of stenosis (p. 841)

A

70% to 80%

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50
Q

Most common symptom of hyperperfusion syndrome (p. 842)

A

Unilateral severe headache

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51
Q

Asymptomatic carotid stenosis should be more than ___ to be operated? (p. 843)

A

60% to 70%

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52
Q

Found in some patients with fibromuscular dysplasia (p. 846)

A

phosphatse and actin regulater 1 gene variant (PHACTR1)

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53
Q

CT scan findings in Fibromuscular dysplsia (p. 846)

A

series of transverse constrictions; irregular string of beds or a smooth tubular narrowing; bilateral carotid in 75% of cases

54
Q

Why is there diltations in FMD?(p. 846)

A

Atrophy of the coat of the vessel wells

55
Q

Is FMD ammenable to endarterectomy? (p. 846)

A

No

56
Q

Diseases associated with vascular dissection (p. 846)

A

Ehlers Danlos, Mrfan syndrome, osteogenesis imperfecta, Loeys Dietz syndrome, alpha1- antitrypsin deficience

57
Q

T/F Painful Horner syndrome is usually due to a underlying structual lesion (p. 847)

A

TRUE

58
Q

Elongated but variable length, irregular narrow column of dye 1.5 to 3cm above the carotid bifurcation extending to the base of the skull (p. 848)

A

string sign

59
Q

Most identifiable cause of vertebral artery dissection (p. 848)

A

Rapid and extreme rotational movement of the neck

60
Q

Carotid dissection most commonly originatees in which segment (p. 848)

A

C1 and C2 where it is mobile but thethered as it it leaves the transverse foraen of the axis and turns sharply to enter the cranium

61
Q

T/F Re:Cervical artery dissecion, If the dissection has produced complete occlusion of the vessel, the role of anticoagulation is les clear (p. 849)

A

T

62
Q

In older patients, this is the most common initial manifestation of Moyamoya (p. 849)

A

SAH

63
Q

Describes the imaging appearance of hypointense periventricular tissues in Biswanger Disease (p. 851)

A

leukoariois

64
Q

Main features of Biswanger cases (p. 851)

A

Dementia, pseudobulbar state, gait disorder

65
Q

Recurrent small strokes beginning in early childhood, subcortical dementia, migraine headaches (p. 852)

A

CADASIL

66
Q

CADASIL+early alopecia and lumbar spondylosis with white matter changes (p. 851)

A

CARASIL

67
Q

Pathology findings in CADASIL (p. 851)

A

small vesels n the regions of infarctions, 100 to 200mm in diameter containing basophilic granular deposits in the media with degeneration of smooth muscle fibers

68
Q

CADASIL vs Binswanger disease (p. 851)

A

Anterior temporal changes are typicl of Binswanger. Migraine headaches are not a component of Binswanger.

69
Q

Gene responsible for CADASIL (p. 851)

A

chromosome 19 of the NOTCH3 gene

70
Q

Gene responsible for CARASIL (p. 851)

A

HTAR1 gene

71
Q

pathologic findings in CARSAIL (p. 851)

A

duplication of internal elastic lamina of the cerebral vessels with narrowing of their lumens

72
Q

T/F Use of progestin- only pills or of subcutneously implanted capsules of progestin has nt been associated with stroke (p. 855)

A

TRUE

73
Q

When is stroke in pregnancy increased? (p. 855)

A

6 week post partum than during pregnancy itself

74
Q

Appearance of contrast within the hemorrhage during CT angiography associated with high rate of hematoma expansion (p. 857)

A

spot sign

75
Q

Etiology of ring of enhancement in CTof ICH (p. 857)

A

hemosiderin- filled macrohages and the reacting cells that form a capsule for the hemorrhage

76
Q

Massive ICH means how much? (p. 857)

A

More than 50ml

77
Q

Pathologic findings of ICH (p. 857)

A

segmental lipohyalinosis and false aneurysm

78
Q

Giving of this anti-hypertension causes increased ICP in some studie (p. 862)

A

Nifedipine

79
Q

Treatment of tpa related bleeds (p. 863)

A

Factor VII within 4 hours of spontaneous cerebral hemorrhage

80
Q

Surgical evacuation of cerebellar hematoma. Size cut off (p. 863)

A

4cm

81
Q

Incidence of unruptured aneursms in routine autopsies (p. 864)

A

2 pecent

82
Q

Aneurysyms are multiple in how many percent of cases (p. 864)

A

20%

83
Q

An accompanying saccular aneursm is found in approximately ___% of cases of cerebral AVM (p. 864)

A

5%

84
Q

How many percent of sacular aneurysms lie on the anterior part of the circle of Willis (p. 865)

A

90-95%

85
Q

Most common syndrome of ruptured aneurysm (p. 865)

A

severe generalized headache in the same instantaneous manner but remains relatively lucid with varying degreees of stiff neck

86
Q

Convulsive seizures happen in how many percent of SAH (p. 865)

A

20 to 25%

87
Q

Localized cranial pain. Aneurysm in first part of MCA (p. 865)

A

orbit

88
Q

Localized cranial pain. Aneurysm in first part of PICA or AICA (p. 865)

A

occipital or cervical pain

89
Q

Important in differentiating SAH from traumatic tap (p. 867)

A

increased pressure as high as 500mm H2O but usually closer to 250mm in SAH

90
Q

Important in differentiating SAH from traumatic tap (p. 867)

A

Aside from xanthrochromia, clearing of blood as one continues to collect fluid and a marked reduction in the number of RBC in spinal fluid in traumatic tap

91
Q

Most sensitive means of demonstrating an aneurysm (p. 867)

A

DSA with bilateral carotid and vertebral contrast injections

92
Q

Percent of patiens with SAH due to aneurysmal rupture but will not have an aneurysm evident (p. 867)

A

5 to 10%

93
Q

Most severe vasospasm occurs in arteries that are surronded by collections of clotted subarachnoid blood after __h (p. 868)

A

24 hours

94
Q

velocity that suggests a focal vasospasm is occuring (p. 869)

A

over 175cm/s

95
Q

Single bedst index of outcome in aneurysmal SAH (p. 870)

A

state of consciousness at the time of arteriography

96
Q

Leading cases of morbidity and mortlity in those who survive the initial hemorrhage (p. 870)

A

vasospasm and rebleeding

97
Q

Patients who are HH1 and HH2 should be operated within (p. 871)

A

24 hours

98
Q

Current operative mortality of aneurysmal SAH (p. 871)

A

2 to 3 percent

99
Q

Location of this unruptured intracranial aneurysms have bleeding rate many times higher than the others (p. 872)

A

vertebrobasilar and posterior cerebral aneurysms

100
Q

Cut off size for giant cerebral aneurysms (p. 872)

A

2.5 cm

101
Q

AVM and saccular aneurysm are asocaited in approximately in how many percent of cases (p. 873)

A

5%

102
Q

T/F A systolic bruit heard over the carotid in teh neck or over the mastoid process or the eyeeballs in a young adult is suggestive of AVM (p. 874)

A

T

103
Q

Risk of bleeding from a known AVM is approximately (p. 874)

A

3% a year

104
Q

ARUBA findings (p. 874)

A

stroke occured in 10% of expectant managemetn group compared to 31%of group that had intervention

105
Q

Types of complications of radiation occur in radiation (p. 876)

A

delayed radiation necrosis

venous congestion

106
Q

Dural fistula presentation (p. 877)

A

fluctuating ischemic like deficit appropriate to the cerebral or spinal location underlying the lesion or at some distance from it

107
Q

Dural lesions (AVF) with the most risk of bleeding are found where? (p. 877

A

Anterior cranial fossa and tentorial incisura

108
Q

A posible causative in familal cavernoma (p. 877)

A

KRIT1

109
Q

Most common cerebral vascular malformation estimated to occur in almsot 3%of large autopsy series (p. 878)

A

Deep venous anomaly

110
Q

Nex to HPN, what is the msot common cause of cerebral hemorrhage (p. 879)

A

Anticoagulant use

111
Q

Top three secondary brain tumors that bleed (p. 880)

A

choriocarcinoma, melanoma, renal cell carcinoma

112
Q

Basic neuropathologic changes in hypertensive encephalopathy (p. 882)

A

clustering of multiple micorinfarcts and petechial hemorrhages

113
Q

Cocaine hydrochloride vs crack cocaine stroke manifestations (p. 884)

A

cocaine hydrochloride: prone to cause cerebral hemorrhage due to acute hypertension

crack cocaine: ischemic usually large artery occlusion

114
Q

Pulseless disease (p. 887)

A

Takayasu Disease

115
Q

Bsis in distinguishing polyarteritis vasculitis from Churg Strauss graulomatous angitis (p. 888)

A

sparing of the lungs

116
Q

Subacutely evolving vasclitis with necrotizing granuloms of the upper and lower respiratory tracts followed by necrotizing glomerulonephritis are its main features (p. 888)

A

Wegener Granulomatosis

117
Q

Relatively specific nd sensitive for WEgene disease but may be alpresent in intravascular lymphoma (p. 888)

A

cytoplsmic antineutrophil cytoplasmic antibodies (CANCA)

118
Q

Sensitive indicator of SLE(p. 889)

A

anti- dsDNA

119
Q

microangiopathy affecting mainly the brain and retina (p. 889)

A

Susac Syndrome

120
Q

Psychiatric symptoms, headache, dementia, sensorineural deafness, vertigo, impariment of vision (p. 889)

A

Susac Syndrome

121
Q

Relapsing iridocyclitis, recurrent oral and genitalulcers (p. 889)

A

Behcet Disease

122
Q

Formation of sterile pustule t the site of needle prick in Behcet diseae (p. 890)

A

Pathergy test

123
Q

Essential pathologic finding in DIC (p. 892)

A

widespred fibin thrombi in smll vessels resulting in neumerous small infarctions of many organs including the brain (p. 893)

124
Q

Antibodies in APAS (p. 893)

A

Lupus anticoagulant, anticoardiolipin, b2- glycoprotein 1

125
Q

Most specific antibody in APAS (p. 893)

A

b2- glycoprotein

126
Q

Antibody which correlates the risk of thrombosis and specificit for the syndrome is higher for IgG than for IgM autoantbodies (p. 890)

A

anticardiolipin antibody

127
Q

Most frequent neurologic abnormality in APAS (p. 893)

A

TIA

128
Q

Arteriopathy producing deep blue-red skin lesions of livedo reticularis and livedo racemosa in assocation ith multiple ischemic strokes (p. 893)

A

Sneddon syndrome

129
Q

TTP is caused by acquired circulating IgG inhibitor of the VWF cleaving protease called (p. 894)

A

ADAMTS13

130
Q

A high proportion of patients with polycythemia vera will have mutations in (p. 894)

A

JAK2

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