CVAs Flashcards
62 y/o M with DM is not making sense, saying “that swing is phrumper zu stalking”. Normal intonation but no one in the family can understand it. He verbally responds to Qs with similar utterances but fails to successfully execute any instruction
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 1:30PM has no acute lesion. Most appropriate tx
TPA
Head CT w/ lens-shaped hyperdensity
Epidural hematoma
A life threatening complication of cerebellar hemorrhage is
Acute hydrocephalus
A 72 yo patient had an embolic infarct in the MCA territory. ECG shows no structural abnormalities. Doppler studies of the neck arteries reveal less than 50% occlusion on both carotid arteries. An EKG reveals fib. Which of the following strategies has the best likelihood of reducing recurrent strokes in this patient?
Anticoagulation with warfarin
68 y/o patient w/ HTN develops rapidly progressing R arm and leg weakness, with deviation of the eyes to the L. Within 30 min pt became increasingly sleepy. 2 hrs after the onset, the pt becomes unresponsive. On exam: dense R hemiplegia, eyes deviated to the L, pupils equal and reactive, a R facial weakness to grimace elicited by noxious stimuli. Cough and gag reflexes present. Which CT finding is most likely?
Left putaminal hemorrhage
A pt has multiple stroke like sx of short duration over several days. And has new onset symptoms for the last 90 minutes. CT shows no evidence of stroke or hemorrhage. What is the appropriate treatment?
IV thrombolytic agents
70 y/o pt was hospitalized bc of a MCA stroke. The psychiatrist evaluates the pt. He has non-fluent aphasia. Which most likely characterized the pt’s interaction with the psychiatrist?
The pt was able to follow the verbal request close your eyes.
MC psychiatric ppt following stroke?
Depression
Chiropractic adjustments are known precipitant for which of the following acute conditions?
Vertebral a. dissection
The MC complication of temporal arteritis is caused by occlusion of the
Ophthalmic artery
The MC possible cause of a posterior cerebral a. infarct in a 36 y/o F with hx of migraine
OCP
L MCA stroke gait abnormality
Circumduction
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, 78 protein, 63 glucose, + reagin abs. Tx?
PCN
CT head large hypo density on R frontal and parietal lobes
MCA stroke with residual L sided weakness.
Contralateral leg weakness with personality changes is an injury where
Anterior cerebral
61 y/o with L 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 MCA territory. Echo is normal. Doppler studies of neck arteries reveal less than 50% occlusion on both carotid arteries. EKG normal. The best strategies to reduced recurrent stroke
Antiplatelet therapy with ASA and dipyridamole
50 y/o pt recently began having visual hallucinations of children playing. Hallucinations are fully formed, colorful, vivid, without sound. Pt is not scared or disturbed, but rather amused. Exam and labs wnl
Posterior cerebral a. ischemia
Why would brains > 65 y/o or a history of alcoholism more susceptible to chronic subdural hematoma?
Cortical atrophy (longer distance for bridging veins to be damaged)
What is the MC manifestation of acute neurosyphilis?
Stroke
65 y/o pt wake sup with R sided hemiparesis and motor aphasia. Pt is taken to ED and evaluation is completed within 1 hr. No additional abnormalities on exam. CT normal. Which is the appropriate next step in management?
ASA
Abnormal elevated metabolic findings associated with increased risk of stroke in patients <50 y/o
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 an occlusion of
Superior division of the MCA
CT 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 MCA develops a fluctuating aphasia and hemiparesis with no significant headaches. Underlying event
Vasospasm
Thrombosis of which a. results in acute headache, inability to read, inability to write fluently, although verbal fluency intact?
Left post cerebral
63 yo with new onset aphasia and R hemiparesis, 2 days ago had milder/ similar sx that resolved in 30 minutes, yesterday had similar episode x 45 minutes. Current sx started 1.5hrs ago. CT shows no stroke or hemorrhage. Tx?
IV thrombolytic agents
57 y/o diabetic pt with 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 L internal carotid stenosis
Head injury, LOC–>lucid interval x hours–> rapid progressing coma. Hemorrhage?
Epidural
Poststroke depression in 80 y/o pt (R handed) is ass. with cognitive impairments that
Correlate with L hemispheric involvement
66 y/o M in ED with sudden aciipital HA, dizziness, vertigo, N/V, unable to stand, mild lethargy, slurred speech. Exam: small reactive pupils, gaze deviated to the R, nystagmus, w/o 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 dx 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 yo pt with attacks of “whirling sensations” w/n/v, diplopia, dysrthria, tingling of lips. Occurs several times daily for 1 minutes, severe that pt collapses and is immobilized when symptoms starts. No residual s/s, no tinnitus, hearing impairment, ALOC or ass 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 yo 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
Left Anterior cerebral artery
Pt 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 a new onset headache and left hemiparesis. MRI shows R parietal love hemorrhage, small occipital hemorrhage and evidence of previous hemorrhage in R temporal and Left parietal regions. What is likely etiology for these findings?
Amyloid antipathy
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?
Plasmapheresis
In which arterial area would a stroke result in inability to read but preserved ability to write?
Posterior cerebral
71 yo pt with Parkinson’s for 3 yrs, with difficulty getting up, is not motivated to do anything, anhedonia, slowness in thinking. Motor sx well controlled with Sinemet, sx stable throughout day and no sadness, worthlessness, or SI. Cognitive eval shows slow processing. What is most likely explanation?
Apathy
62 yo with bilateral posterior cerebral artery strokes reports trouble seeing bc “lights were dim” or “glasses were not on”. What describes his visual issue?
Anosognosia
