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Clinical Neurology > Core Diagnoses > Flashcards

Core Diagnoses Flashcards

1
Q

Demographic stroke risk factors

A

Age (2/3 happen in those >65)
M>F
Black>Latino>White
Genetic conditions (like VHL)

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2
Q

Modifiable stroke risk factors

A 
HTN (Systolic or Diastolic)
Atrial fibrillation
Diabetes
Dyslipidemia
Physical Inactivity
Effing smoking, dude
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3
Q

Four key features of stroke

A

Sudden onset
Focal involvement of the CNS
Lack of rapid resolution
Vascular cause

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4
Q

Time course of a TIA

A

Neurologic deficits resolve completely in a short period (usually within 1 hour)

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5
Q

Time course of a stroke-in-evolution

A

Also known as a progressing stroke.

Deficits worsen as the patient is seen

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6
Q

Time course of a Completed stroke

A

Deficits persist.

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7
Q

Ischemic stroke

A

Occlusion of a blood vessel interrupts the flow of blood to a region of the brain
Neurologic deficits appear in those regions

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8
Q

Hemorrhagic stroke

A

Less predictable focal involvement. Complications, such as ICP, cerebral edema, parenchymal compression, blood vessel compression, and/or dispersion of blood through subarachnoid space or ventricles can impair sites remote from the hemorrhage

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9
Q

What affects the brain in a more diffuse fashion, producing global cerebral dysfunction?

A

Global cerebral ischemia (usually from cardiac arrest)

Subarachnoid hemorrhage

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10
Q

Structures supplied by the anterior circulation

A

Carotid arteries supply:

Most of the cerebral cortex & subcortical white matter
Basal ganglia
Internal capsule

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11
Q

Vessels in the anterior circulation

A

Internal carotid

Branches:
Anterior choroidal
Anterior cerebral
Middle cerebral
Lenticulostriate (deep penetrating, off of the MCA)
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12
Q

Symptoms commonly associated with anterior circulation strokes

A

Hemispheric dysfunction.

Aphasia
Apraxia
Agnosia

Less specific:
Hemiparesis
Hemisensory disturbances
Visual field defects

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13
Q

Aphasia

A

No talky good

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14
Q

Apraxia

A

No motor planny good

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15
Q

Agnosia

A

No recognizey good

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16
Q

Structures supplied by posterior circulation

A 
Brainstem
Cerebellum
Thalamus
Portions of occipital lobes
Portions of temporal lobes
17
Q

Posterior circulation vessels

A

Vertebral arteries
Basilar artery

Branches off these structures:
PICA
AICA
SuCeA
PCA
Branches:
Thalamoperforate, thalamogeniculate
18
Q

Anterior Choroidal Territory

A

Hippocampus
Globus pallidus
Lower internal capsule

19
Q

ACA Territory

A

Medial frontal cortex
Medial parietal cortex
Subjacent white matter
Anterior corpus callosum

20
Q

MCA Territory

A 
Lateral frontal cortex
Lateral parietal cortex
Lateral occipital cortex
Lateral temporal cortex
Subjacent white matter
21
Q

Lenticulostriate Territory

A

Caudate
Putamen
Upper internal capsule

22
Q

PICA Territory

A

Medulla

Lower cerebellum

23
Q

AICA Territory

A

Lower pons
Middle pons
Anterior cerebellum

24
Q

SuCeA Territory

A

Upper pons
Lower midbrain
Upper cerebellum

25
Q

PCA Territory

A 
Medial occipital cortex
Medial temporal cortex
Subjacent white matter
Posterior corpus callosum
Upper midbrain
26
Q

Thalamoperforate Territory

A

Thalamus

27
Q

Thalamogeniculate Territory

A

Thalamus

28
Q

Symptoms of posterior circulation strokes

A 
Brainstem dysfunction
Cerebellar dysfunction
Coma
Drop attacks
Vertigo
Nausea
Vomiting
Cranial nerve palsies
Ataxia
Crossed sensorimotor defects

Less specific:
Hemiparesis
Hemisensory disturbances
Visual field deficits

29
Q

Stereotypic TIAs

A

Recurrent TIAs with identical clinical features

Caused by thrombosis or embolism arising from the same site

30
Q

How many patients with TIAs go on to have a stroke within 5 years?

A

1/3

31
Q

How do you definitively diagnose the difference between ischemic and hemorrhagic strokes?

A

CT or MRI!

32
Q

What are the causes of ischemic stroke?

A

Cardiac embolism (50%)
Large artery occlusion (25%)
Small artery occlusion (10%)
Crpytogenic/Unknown (15%)

33
Q

Mild ischemia with rapid reperfusion (such as cardiac arrest)

A

Selective vulnerability of certain neuronal populations

34
Q

Severe ischemia

A

Selective neuronal necrosis
Mos or all neurons die
Glia and vascular cells are preserved

35
Q

Complete/permanent ischemia (such as stroke without reperfusion)

A

Pannecrosis
All cell types affected
Chronic cavitary lesions

36
Q

Thrombotic strokes are often preceded by

A

TIAs

37
Q

Embolic strokes

A

Produce neurologic deficits that are maximal at onset

38
Q

Intracerebral hemorrhage

A

Causes more severe headache and depression of consciousness than ischemic stroke
Deficits that don’t correspond to a single blood vessel

Clinical Neurology (3 decks)

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