Chapter 57. Vascular Disease of the Nervous System Chapter 57 A. Ischemic Cerebrovascular Disease Flashcards
Question 57A-1: The figure shows an unenhanced CT of a patient with left-sided weakness. What is the affected vessel?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery
Answer 57A-I: A. The image shows lucency in the distribUlion of the anterior cerebral artery. The patient had abulia in addition to left-sided weakness. (p1204)
Question 57A-2: Which of the following are recognized lacunar syndromes? 1. Pure motor stroke 2. Pure sensory stroke 3. Dysarthria-clumsy hand syndrome 4. Hemianopia Select A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All
Answer 57A-2: A. The first three suggest lacunar stroke. In addition, sensory-motor stroke and ataxic hemiparesis are lacunar syndromes, although these presentations can also be from cortical lesions. (p1205)
Question 57 A-3: A man presents with left Horner’s syndrome loss of pain and temperature sensation of the face on the left, and loss of pain and temperature sensation of the right side of the body. In addition he has left sided appendicular ataxia which appears to be cerebellar. Which blood vessel occlusion can produce this findings ? 1. Basilar artery 2. Posterior inferior cerebellar artery 3. Posterior cereblar artery 4. Vertebral artery Selet A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E : All
Answer 57 A-3: C. This patient has the lateral medullary syndrome, which is commonly produced by occlusion of the vertebral artery, but can also be produced by occlusion of the posterior inferior cerebellar artery. (p1207)
Question 57A-4: The image is from a CT of a patient who presents for evaluation of memory loss. Which of the following fmdings would be expected from the location of the lesion? 1. Right hemianopia 2. Aiexia 3. Anterograde amnesia 4. Agraphia Select: A = I. 2, 3. B= I, 3.C=2,4. D =4 only. E=AII
Answer 57A-4: A. this patient has right hemianopia, anterograde amnesia, and alexia, but not agraphia. The left occipital location typically produces alexia without agraphia. (p1208)
Question 57A-5: Which of the following predispose to watershed infarction? 1. Cardiac arrest 2. Prolonged hypoxia 3. Cardiac surgery 4. Cardiac valvular disease Select: A = 1,2,3. B = 1,3. C = 2, 4. D = 4 only. E = All
Answer S7A-5: A. Hypotension is the most common cause of watershed infarction, with prolonged hypoxemia being another important cause. Cardiac valvular disease can be an important cause of large vessel infarction, but would generally not predispose to watershed infarction. (p1209)
Question 57 A-6: The figure shows a left carotid angiogram of a patient with TIA affecting the right arm and leg. What is the finding on the angiogram? A. Left ICA dissection B. Left ICA intraluminal thrombus C. Left ECA stenosis D. Left ECA dissection
Answer 57 A-6: B. The angiogram shows severe stenosis of the lCA as indicated by the white arrow. The solid arrow shows intraluminal thrombus in the proximal portion of the ICA. (p1211)
Question 57A-7: The image is the AP view of a left carotid angiogram of a patient with small stroke with right hemiparesis. What is shown in the angiogram? A. Dissection B. Intracranial carotid stenosis C. Moya-moya disease D. Vasculitis
Answer 57A-7: C. The figure s~ows moyamoya disease, with intracranial occlusion of the supraclinoid internal carotid artery division. This develops from progressive bilateral stenosis of the distal internal carotid arteries. (p1217)
Question 57A-8: Which of the following are autosomal dominant causes of thromboembolic disease? 1. Activated protein C resistance 2. Protein S deficiency 3. Protein C deficiency 4. Antithrombin-III deficiency Select: A = 1.2,3. B = 1,3. C = 2. 4. D = 4 only. E = All
Answer 57A-8: E. All of these are causes of hyper coagulable states which can be autosomal dominant, although there are acquired causes of most of these. (p1226-1227)
Question 57A-9: What is the risk of stroke in patients with Primary antiphospholipid antibody syndrome without other underlying disease? A. Little or no increased risk of stroke B. Moderate increase in stroke risk, although not as much as with associated autoimmune disorder C. Marked increase in stroke risk
Answer 57 A-9: A. Patients with primary APAS, with no underlying condition such as autoimmune disease or neoplasia, have only a rare association with cerebrovascular disease. (p1227)
Question 57A-10: A patient presents to the ED with right Hemiparesis and aphasia. The symptoms were present upon awakening, less than an hour ago. Routine laboratory studies including coagulation studies are nonnal CT is normal. which is the best approach to treannent? A. Intravenous t-PA B. Intra-arterial t-PA C. Neither
Answer 57A-I0: C. Neither of these, since the time of onset of the stroke is unknown. Evidence indicates that tP A must be given within 3 hours from when the patient was last seen to be normal, and in fact recent evidence indicates that even within this three-hour rime window. patients treated within one or two hours appear to have better comes than patients treated in the third hour. This patient awoke with the deficit, so we do not know whether the stroke occurred immediateiy after going to sleep or immediately before awakening. (p1238)
Question 57A-11: A 38-year-old female is admitted because of Headache, vomiting, transient visual obscurations and she then develops seizures. MRI shows multifocal venous infarctions and MRV shows venous thrombosis. There is a small amount of petechial blood in some of the areas of infarction. Which is the best management option? A. Heparin intravenously B. Low molecular weight heparinoid C. Warfarin D. No anticoagulation
Answer 57A-11: A. Heparin is indicated for patients with cerebral venous thrombosis, even if there is some intracranial hemorrhage. (p1245)
