CVAs

Question 1

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

Answer 1

Wernicke’s aphasia

Question 2

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

Answer 2

TPA

Question 3

Head CT w/ lens-shaped hyperdensity

Answer 3

Epidural hematoma

Question 4

A life threatening complication of cerebellar hemorrhage is

Answer 4

Acute hydrocephalus

Question 5

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?

Answer 5

Anticoagulation with warfarin

Question 6

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?

Answer 6

Left putaminal hemorrhage

Question 7

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?

Answer 7

IV thrombolytic agents

Question 8

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?

Answer 8

The pt was able to follow the verbal request close your eyes.

Question 9

MC psychiatric ppt following stroke?

Answer 9

Depression

Question 10

Chiropractic adjustments are known precipitant for which of the following acute conditions?

Answer 10

Vertebral a. dissection

Question 11

The MC complication of temporal arteritis is caused by occlusion of the

Answer 11

Ophthalmic artery

Question 12

The MC possible cause of a posterior cerebral a. infarct in a 36 y/o F with hx of migraine

Answer 12

OCP

Question 13

L MCA stroke gait abnormality

Answer 13

Circumduction

Question 14

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?

Answer 14

PCN

Question 15

CT head large hypo density on R frontal and parietal lobes

Answer 15

MCA stroke with residual L sided weakness.

Question 16

Contralateral leg weakness with personality changes is an injury where

Answer 16

Anterior cerebral

Question 17

61 y/o with L frontal lobe damage secondary to cerebrovascular accident may be predisposed to which psychiatric syndrome?

Answer 17

MDD

Question 18

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

Answer 18

Antiplatelet therapy with ASA and dipyridamole

Question 19

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

Answer 19

Posterior cerebral a. ischemia

Question 20

Why would brains > 65 y/o or a history of alcoholism more susceptible to chronic subdural hematoma?

Answer 20

Cortical atrophy (longer distance for bridging veins to be damaged)

Question 21

What is the MC manifestation of acute neurosyphilis?

Answer 21

Stroke

Question 22

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?

Answer 22

ASA

Question 23

Abnormal elevated metabolic findings associated with increased risk of stroke in patients <50 y/o

Answer 23

Plasma homocysteine

Question 24

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

Answer 24

Superior division of the MCA

Question 25

CT with occipital and intraventricular hyper-intensities

Answer 25

Parenchymal hemorrhage

Question 26

Which med has secondary prevention against embolic stroke in pts with A-fib

Answer 26

Oral warfarin

Question 27

As opposed to strokes caused by arterial embolism or thrombosis, those caused by cerebral vein or venous sinus thrombosis are

Answer 27

Associated with seizures at onset

Question 28

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

Answer 28

Vasospasm

Question 29

Thrombosis of which a. results in acute headache, inability to read, inability to write fluently, although verbal fluency intact?

Answer 29

Left post cerebral

Question 30

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?

Answer 30

IV thrombolytic agents

Question 31

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?

Answer 31

Extracranial L internal carotid stenosis

Question 32

Head injury, LOC–>lucid interval x hours–> rapid progressing coma. Hemorrhage?

Answer 32

Epidural

Question 33

Poststroke depression in 80 y/o pt (R handed) is ass. with cognitive impairments that

Answer 33

Correlate with L hemispheric involvement

Question 34

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?

Answer 34

Cerebellar hemorrhage

Question 35

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:

Answer 35

MRI scan of the cervical spine to exclude a dx of spinal cord compression

Question 36

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.

Answer 36

ASA

Question 37

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?

Answer 37

Vertebrobasilar insufficiency

Question 38

Vascular lesion most characteristic of sudden severe headache, vomiting, collapse, relative preservation of consciousness, few or no lateralizing neurological signs, and neck stiffness.

Answer 38

Subarachnoid hemorrhage

Question 39

Head CT demonstrates which dx (grainy picture with diffuse speckling in posterior region, unilateral).

Answer 39

Subarachnoid hemorrhage

Question 40

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

Answer 40

An embolic stroke affecting left angular gyrus

Question 41

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

Answer 41

Left Anterior cerebral artery

Question 42

Pt in a locked in state following basilar artery occlusion typically retain what movement

Answer 42

Eyelids and vertical gaze

Question 43

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?

Answer 43

Amyloid antipathy

Question 44

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?

Answer 44

Plasmapheresis

Question 45

In which arterial area would a stroke result in inability to read but preserved ability to write?

Answer 45

Posterior cerebral

Question 46

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?

Answer 46

Apathy

Question 47

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?

Answer 47

Anosognosia