CVA Flashcards
62 y/o M w/ DM is not making sense, saying “thar szing is phrumper zu stalking”. Normal
intonation but no one in the family can understand it. He verbally responds to Qs w similar
utterances but fails to successfully execute any instruction. (8x)
WERNICKE’S APHASIA
Chronic A-fib develops aphasia and R hemiparesis at noon. ER exam notes weakness of R
extremities and severe dysfluent aphasia, but CT at 1:30 PM has no acute lesion. Most
appropriate treatment: (4x)
tpa
Head CT w/ lens-shaped hyperdensity (x2)
EPIDURAL HEMATOMA
A life threatening complication of cerebellar hemorrhage is: (2x)
ACUTE HYDROCEPHALUS
A 72 yo patient had an embolic infarct in the middle cerebral artery territory. ECG shows no
structural abnormalities. Doppler studies of the neck arteries reveal less than 50% occlusion
on both carotid arteries. An EKG reveals AFib. Which of the following strategies has the best
likelihood of reducing recurrent strokes in this patient? (2x)
ANTICOAGULATION WITH WARFARIN
68 y/o pt w/ hypertension develops rapidly progressing right arm and leg weakness, with
deviation of the eyes to the left. Within 30 minutes of the onset of this deficit, pt became
increasingly sleepy. Two hours after the onset, the patient became unresponsive. On exam:
dense right hemiplegia, eyes deviated to the left, pupils: equal and reactive, a right facial
weakness to grimace elicited by noxious stimuli. Cough and gag reflexes: present. Which CT
finding is most likely? (2x)
LEFT PUTAMINAL HEMORRHAGE
A pt has multiple stroke like symptoms of short duration over several days. And has new
onset symptoms for the last 90 minutes. CT scan shows no evidence of stroke or
hemorrhage. What is the appropriate treatment? (2x)
INTRAVENOUS THROMBOLYTIC AGENTS
70 y/o pt was hospitalized because of a middle cerebral artery stroke. The psychiatrist was
asked to evaluate the pt. The pt has non-fluent aphasia. Which most likely characterized the
pt’s interaction with the psychiatrist? (2x)
THE PT WAS ABLE TO FOLLOW THE
VERBAL REQUEST, “CLOSE YOUR EYES.”
Most common psychiatric presentation following a stroke? (2x)
DEPRESSION
Chiropractic adjustments are a known precipitant for which of the following acute
conditions? (2x)
VERTEBRAL ARTERY DISSECTION
The most common complication of temporal arteritis is caused by occlusion of the: (2x)
OPHTHALMIC ARTERY
The most common possible cause of a posterior cerebral artery infarct in 36 y/o F with hx of
migraine: (2x)
ocp
45 y/o with R hemiparesis, CT shows L internal capsule ischemic changes extending to
adjacent basal ganglia + old lacunar injury of R caudate head. LP – 65 wbcs (mostly
lymphocytes), 78 protein, 63 glucose, + reagin antibodies. Tx?
pcn
CT Head Large hypodensity on R frontal and parietal lobes
MCA STROKE W/ RESIDUAL L SIDED
WEAKNESS
Contralateral leg weakness with personality changes is an injury where
ACA
61 y/o with left frontal lobe damage secondary to cerebrovascular accident may be
predisposed to which psychiatric syndrome?
MDD
72 y/o pt had a lacunar infarct in the middle cerebral artery territory. Echo is normal.
Doppler studies of neck arteries reveal less than 50% occlusion on both carotid arteries.
EKG is normal. The best strategies to reduce recurrent stroke:
ANTIPLATELET THERAPY WITH ASPIRIN
AND DIPYRIDAMOLE
50 y/o pt recently began having VH of children playing. VH are fully formed, colorful and
vivid, but with no sound. Pt is not scared or disturbed, but rather amused. On exam, normal
language, memory, cranial nerves, no weakness or involuntary movement, no sensory
deficits. DTR: symmetric. CSF/UDS nml.
PCA ischemia
Why would brains >65 years old or a history of alcoholism more susceptible to chronic
subdural hematoma?
CORTICAL ATROPHY (LONGER DISTANCE FOR BRIDGING VEINS TO BE DAMAGED)
What is the most common manifestation of acute neurosyphilis?
STROKE
65 y/o pt wakes up with right-sided hemiparesis and motor aphasia. Pt is immediately
brought to the emergency department and an evaluation is completed within 1 hour.
Neurological exam: no additional abnormalities. Head CT w/o contrast: no additional
abnormalities. Which is the appropriate next step in management?
asa
Abnormal elevated metabolic findings associated with increased risk of stroke in patients
under 50
PLASMA HOMOCYSTEINE
Acute onset of dense sensorimotor deficit in the contralateral face and arm, with milder
involvement of the lower extremity, associated with gaze deviation toward the opposite
side of the deficit, likely indicates occlusion of:
SUPERIOR DIVISION OF THE MCA
CT scan with occipital and intraventricular hyper-intensities:
PARENCHYMAL HEMORRHAGE
Which med has secondary prevention against embolic stroke in pts with A-fib?
ORAL WARFARIN
As opposed to strokes caused by arterial embolism or thrombosis, those caused by cerebral
vein or venous sinus thrombosis are:
ASSOCIATED WITH SEIZURES AT ONSET
Pt who 5 days ago experienced a ruptured aneurysm located in the left middle cerebral
artery develops a fluctuating aphasia and hemiparesis with no significant headaches.
Underlying event
vasospasm
63 y/o with new onset aphasia and R hemiparesis, 2 days ago had milder/similar symptoms
that resolved in 30 minutes, yesterday had similar episode x 45 minutes. Current Sx started
1.5 hrs ago. CT shows no stroke or hemorrhage. Tx?
INTRAVENOUS THROMBOLYTIC AGENTS
57 y/o diabetic pt =w/ HTN c/o several episodes of visual loss, “curtain falling” over his L
eye, transient speech and language disturbance, and mild R hemiparesis that lasted 2 hrs.
Suggests presence of what?
EXTRACRANIAL LEFT INTERNAL CAROTID
STENOSIS
Head injury, LOC -> lucid interval x hours -> rapid progressing coma. Hemorrhage?
epidural
Poststroke depression in 80 yo pt (R handed) is assoc w cognitive impairments that:
CORRELATE WITH LEFT HEMISPHERIC
INVOLVEMENT
66 y/o M in ED w/ sudden occipital HA, dizziness, vertigo, N/V, unable to stand, mild
lethargy, slurred speech. Exam: small reactive pupils, gaze deviated to the R, nystagmus, w/
occasional ocular bobbing, R facial weakness, decreased R corneal reflex, truncal ataxia, b/l
hyperreflexia, b/l Babinski. Dx?
CEREBELLAR HEMORRHAGE
50 y/o pt is in the ED for acute onset of neck pain radiating down the left arm, progressive
gait difficulty, and urinary incontinence. This test should be administered immediately:
MRI SCAN OF THE CERVICAL SPINE TO
EXCLUDE A DIAGNOSIS OF SPINAL CORD
COMPRESSION.
In managing acute ischemic stroke, administer this within 48 hrs of onset of stroke for
beneficial effect in reducing risk of recurrent stroke, disability and death:
ASA
70 y/o pt w/ attacks of “whirling sensations” w/n/v, diplopia, dysarthria, tingling of lips.
Occurs several times daily for 1 minute, severe that pt collapses and is immobilized when
symptoms start. No residual s/s, no tinnitus, hearing impairment, ALOC or association with
any particular activity. Dx?
VERTEBROBASILAR INSUFFICIENCY
Vascular lesion most characteristic of sudden severe headache, vomiting, collapse, relative
preservation of consciousness, few or no lateralizing neurological signs, and neck stiffness:
SUBARACHNOID HEMORRHAGE
Head CT demonstrates which dx (grainy picture with diffuse speckling in posterior region,
unilateral)
SUBARACHNOID HEMORRHAGE
Mental status changes after CABG, fluent speech and excellent comprehension, inability to
name fingers and body parts, right and left orientation errors inability to write down
thoughts and calculation, but with good reading comprehension:
AN EMBOLIC STROKE AFFECTING LEFT
ANGULAR GYRUS
70 y/o F sudden onset paralysis R foot and leg. R arm and hand slightly affected. No aphasia
or visual field deficit. Over weeks found with loss of bladder control, abulia and lack of
spontaneity. Which vascular area:
L ACA
Pts in a locked in state following basilar artery occlusion typically retain what movement?
? EYELIDS AND VERTICAL GAZE
83 yo pt with mild HTN comes in with new onset headache and left hemiparesis. MRI shows
right parietal lobe hemorrhage, small occipital hemorrhage and evidence of previous
hemorrhage in right temporal and left parietal regions. What is likely etiology for these
findings?
AMYLOID ANGIOPATHY
39 y/o pt with hx of multiple miscarriages develops an acute left sided hemiparesis. Work
up reveals elevated anticardiolipin titers and no other risk factors for stroke. Appropriate
intervention at this point is?
PLASMAPHERESIS
In which arterial area would a stroke resolve in inability to read but preserved ability to
write?
pca
71yo pt w/ Parkinson’s x3yrs p/w difficulties getting up, is not motivated to do anything,
has no interest in social events, and has “slowness” in thinking; although motor sx well
controlled on Sinemet, sx stable throughout day and no sadness, worthlessness, or SI.
Cognitive eval shows slow processing. What is most likely explanation?
APATHY
