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🧠📖💯 > CVD > Flashcards

CVD Flashcards

1
Q

Oculomotor palsy + c/l hemiplegia

A

Weber syndrome

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2
Q

Oculomotor palsy + c/l ataxia & tremor

A

Claude syndrome

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3
Q

Oculomotor palsy + c/l ataxia, tremor + c/l weakness

A

Benedikt syndrome

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4
Q

CN IV palsy + gaze paralysis + nystagmus + ataxia = ?

Usual cause?

A

Nothnagel syndrome

Tumor

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5
Q

CN VII and VI palsy, c/l hemiplegia, gaze palsy

A

Millard Gubler, Raymond Foville Syndrome

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6
Q

Paralysis of soft palate and vocal cord + c/l hemianesthesia

A

Avellis syndrome

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7
Q

Paralysis of soft palate, vocal cord + c/l hemianesthesia + ipsilateral tongue paralysis

A

Jackson syndrome

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8
Q

I/L V IX X XI palsy
Horner
Cerebellar ataxia
C/l loss of pain and temperature sense

A

Wallenberg syndrome

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9
Q

Alexia w/o agraphia. Localize:

A

Left PCA occlusion in a r-handed pt

Posterior corpus callosum + left occipital

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10
Q

What is the balint syndrome?

A

Simultagnosia
Oculomotor apraxia
Optic ataxia

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11
Q

Most common locations of lacunes:

A
  1. Putamen, caudate
  2. Thalamus
  3. Basis pontis
  4. Internal capsule
  5. Deep central WM
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12
Q

Most frequent symptomatic forms of lacunar stroke

A

Pure motor hemiplegia
Pure sensory stroke
Clumsy-hand dysarthria
Ipsilateral hemiparesis-ataxia

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13
Q

Side effect of rtpa for pts taking ACE inhibitors

A

Angioneurotic edema

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14
Q

Drug that inhibits plt cyclooxygenase, prevents production of thromboxane a2, prostacyclin

A

Aspirin

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15
Q

“Warfarin was non-superior to ASA in stroke prevention
ASA w fewer GI bleeds and stroke prevention. “

Wc trial?

A) WARSS
B) WASID
C) IST
D) CAST

A

B. WASID

WARSS - administer ASA in all cases of stroke
IST, CAST- ASA goven w/in 48h of stroke, modest reduction in mortality and stroke recurrence

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16
Q

Antiplatelet with a side effect of TTP

A

Clopidogrel

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17
Q

Antiplatelet w/ a side effect of Neutropenia

A

Ticlopidine

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18
Q

Trial recommending the use of HMG CoA Reductase Inhibitors:

A) WASID
B) CHANCE
C) POINT
D) SPARCL

A

D. SPARCL

WASID - ASA
CHANCE & POINT - dual antiplatelet

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19
Q

Wc patient population stands to benefit from PFO closure?

A

Younger pts
Mod-large shunts
Atrial septal aneurysms

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20
Q

Segment that most often lends itself to endarterectomy or stenting:

A) Common carotid
B) Carotid sinus
C) Innominate
D) Proximal subclavian

A

B) Carotid sinus

The rest are also alternative sites

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21
Q

Carotid endarterectomy recommended for lesions w/ stenosis of _%?

A

> 70-80%

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22
Q

Optimal timing of carotid endarterectomy after stroke

A

Within 2 weeks of TIA or minor stroke

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23
Q

Most common symptom of hyperperfusion syndrome (Post endarterectomy)

A

Unilateral severe headache

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24
Q

(Per adams)

Long-term morbidity sx of Left frontal lobe lesions

A

Fatigability

Depression

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25
Q

Posture assumed by the arm and leg post-stroke

A

Arm: flexed adducted

Leg: extended

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26
Q

Percentage of patients post-stroke who experience seizures

A

10%

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27
Q

Most frequently involved in FMD

A

ICA, extracranial part

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28
Q

String of beads is found in?

A

Fibromuscular dysplasia

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29
Q

Double lumen sign is found in?

A

ICA dissection

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30
Q

String sign

A

ICA dissection

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31
Q

Most common site affected in vertebral artery dissection

A

C1-C2

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32
Q

Where is the pain a/w MCA dissection?

A) Retrorbital
B) Occipital
C) Occipital + supraorbital

A

A) Retrorbital

B) Occipital - BASILAR
C) Occipital + supraorbital - VERTEBRAL

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33
Q

Most common presentation of Moyamoya disease in

A) Children
B) Adults

A

A) Children: Hemiparesis

B) Adults:
SAH

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34
Q

Moyamoya disease is a/w segmental stenosis or occlusion of ___?

A

TERMINAL INTRAcranial parts of both ICAs

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35
Q

Moyamoya disease is a/w which syndrome?

A

Down

& certain HLA types

(Chromosome 17q)

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36
Q

What are the three main clinical features of Binswanger disease?

A

Dementia
Pseudobulbar state
Gait disorder

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37
Q

Genetic abnormality in CADASIL?

A

NOTCH 3 gene
Chromosome 19
(Missense mutation)

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38
Q

Genetic locus in CADASIL is also found in?

A

Familial hemiplegic migraine

Remember: hx of migraine w/ sx, TIAs attributed to migraines in CADASIL

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39
Q

Clinical presentation of CADASIL

A

Recurrent small strokes in early adulthood -> subcortical dementia

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40
Q

Clinical presentation of CARASIL

A

Early alopecia
Lumbar spondylosis
WM changes typical of CADASIL

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41
Q

Genetic abnormality in CARASIL

A

HTAR1 gene

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42
Q

Genetic abnormality in activated protein C RESISTANCE

A

Leiden factor V mutation

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43
Q

Genetic abnormality in Protein C DEFICIENCY

A

Protein C gene

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44
Q

Genetic abnormality in Marfan Syndrome

A

Fibrillin 1

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45
Q

Genetic abnormality in Sickle cell syndrome

A

Globin genes

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46
Q

Genetic abnormality in hyperhomocysteinemia

A

MTHFr

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47
Q

Genetic abnormality in Fabry disease

A

Alpha-galactosidase

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48
Q

Most common inherited deficiencies of naturally occurring anticoagulant factors as a cause of stroke

A

Factor V Leiden mutation

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49
Q

Which is not a likely cause of stroke?

A. Mitral valve prolapse
B. Inflammatory bowel disease
C. Migraine + OCPs

A

A. MVP

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50
Q

Risk of cerebral infarction and ICH post delivery is highest during which time?

A

6-week period post-delivery

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51
Q

What is the presentation of stroke associated with cardiac surgery?

A

Acute encephalopathy (2/2 multiple small emboli)

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52
Q

Most frequent cause of stroke

A) Embolic
B) Thrombotic
C) Hemorrhagic

A

A) Embolic

Thrombotic (2nd)
Hemorrhagic (3rd)

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53
Q

Most common location of intracerebral hemorrhage?

A

Putamen and adjacent internal capsule (50%)

  1. Lobar hemorrhages
  2. Thalamus
  3. Cerebellar hemisphere
  4. Pons
54
Q

When is hemosiderin observed around clot margins in ICH?

A

5-6 days

55
Q

What do you call the sign wherein there’s an appearance of contrast within the hemorrhage on CT angio? This is associated with what?

A

Spot sign.

Associated with a high rate of hematoma expansion.

56
Q

Eye signs in ICH.

Match:
A. Putaminal
B. Thalamic
C. Pontine
D. Cerebellar

A. Opposite the paralysis
B. Fixed, pupils tiny but reactive
C. Opposite the lesion, ocular bobbing
D. Downward, unreactive pupils

A

Putaminal - opposite the paralysis

Thalamic - downward, unreactive pupils

Pontine - fixed, tiny pupils but reactive

Cerebellar - opposite the lesion, ocular bobbing

57
Q

Eye pattern in skew deviation 2/2 thalamic hemorrhage

A

The eye ipsilateral to the lesion is higher!

Others:

Pseudoabducens palsies (inward and downward)

Palsies of gaze

Absence of convergence

58
Q

What are the components of the ICH score?

A 
GAS Location
GCS
Age
Size of hemorrhage
Location

GCS
3-4: 2
5-12: 1
13-15: 0

Age
80 and above: 1

Size
> 30: 1
< 30: 0

Location
Infratentorial 1
Intraventricular 1

59
Q

What is the estimated mortality rate for pt w/ an ICH score of 4?

A

97%

5 - 100%
4 - 97%
3 - 72%
2 - 26%
1 - 13%
0 - 0
60
Q

What is the estimated mortality rate for pt w/ an ICH score of 3?

A

72%

5 - 100%
4 - 97%
3 - 72%
2 - 26%
1 - 13%
0 - 0
61
Q

What is the cutoff size for cerebellar hematoma to merit surgical evacuation?

A

4cm or more

or vermian location

62
Q

Aneuryms can be secondary to developmental defects in which layer/s of the cerebral arteries?

A

Media, elastica

63
Q

Aneurysms, when secondary to hemodynamic destruction, will have which component of the arteries affected?

A

Internal elastic membrane

64
Q

Aneurysmal size that is considered prone to rupture?

A

10mm or more

65
Q

What are the 4 most common sites of aneurysms?

A
  1. Acomm, proximal
  2. Pcomm origin (from ICA)
  3. MCA, first major bifurcation
  4. ICA bifurcation (into MCA, ACA)
66
Q

Incidence of convulsive seizures in SAH

A

10-25%

67
Q

Clinical finding in a supraclinoid aneurysm?

A

Monocular visual field defect

68
Q

Hunt hess score for.a patient with no symptoms and stiff neck?

A

H&H 1

69
Q

Hunt and hess score for a patient with mild focal deficit?

A

H&H III

70
Q

Hunt and hess score for a confused patient?

A

H&H III

71
Q

Hunt and hess score for a pt with severe HA and nuchal rigidity?

A

H&H II

72
Q

Hunt & hess score for a pt in stupor & with decerebrate posturing?

A

H&H IV

73
Q

Hunt & hess score for a patient in deep coma?

A

H&H V

74
Q

H&H score for a drowsy patient?

A

H&H III

75
Q

Most sensitive means of demonstrating an aneurysm

A

Digital subtraction angiography

76
Q

How long after an SAH can you find blood on the CSF

A

within 30 minutes or sooner

77
Q

Peak incidence of rebleeding in aneurysmal SAH?

A

First 24 hours

78
Q

When does vasospasm occur after aneurysmal SAH?

A

3-10 days after rupture

79
Q

Suspected location of aneurysm if you see SAH within the anterior perimesencephalic cistern?

A

Pcomm or distal basilar artery

80
Q

Single best index of outcome in aSAH patients

A

State of consciousness at the time of arteriography.

81
Q

Advised intervention for Hunt & Hess IV patients

A

Counseled against early operation

82
Q

Advised intervention for Hunt & Hess II patients

A

Obliteration of aneurysm within 24 hours

83
Q

Syndrome of unilateral subhyaloid hemorrhage to aSAH

A

Terson Syndrome

84
Q

Definition of Giant Cerebral Aneurysms in terms of size?

A

> 2.5 cm in diameter

85
Q

Clinical presentation of convexity SAH

A

Younger - HA

Older - TIA

86
Q

Genetic abnormality in AV Malformations

A

KRAS in endothelial cells

87
Q

Most common clinical presentation of AVM

A

SAH (50%)

Others:

  1. Sz
  2. HA
  3. Focal deficits
88
Q

Spetzler Martin score for an AVM 5mm in size, in an eloquent site, w/o venous drainage to deep veins

A

2 + 1 + 0 = 3

Small (1-3mm): 1
Medium (3-6mm): 2
Large (>6mm): 3
Eloquent: 1
Venous drainage to deep veins: 1
89
Q

Ideal management for a patient with an AVM of 6mm, in an eloquent area, with venous drainage to deep veins

A

Not resected

SM III - surgical w/ preceding embolization
SM IV-V: not resected

90
Q

Most common cerebral vascular malformation?

A

Deep (developmental) venous anomaly

91
Q

In CAA, where is the amyloid deposited in the blood vessels?

A

Media and adventitia (small vessels)

92
Q

Is CAA more common anteriorly or posteriorly?

A

Posteriorly

93
Q

Pathologic findings within the arterial and capillary walls in pts w/ hypertensive encephalopathy

A

Fibrinoid necrosis

94
Q

Nonbacterial thrombotic endocarditis causing large strokes in SLE patients

A

Libman-Sacks Endocarditis

95
Q

Sensitive indicator for SLE

A

anti-dsDNA

96
Q

Microangiopathy affecting the brain & retina. Findings of multiple retinal artery branch occlusions. Central Corpus Callosum WM lesions.

A

Susac Syndrome

97
Q

Most common and most serious disorder of coagulation affecting the nervous system

A

Disseminated intravascular coagulation

98
Q

Major target of antibodies in APAS (Hughes Syndrome)

A

B2-glycoprotein 1

99
Q

Main laboratory feature of APAS

A

Prolonged PTT

100
Q

Most frequent neurologic abnormality in APAS

A

TIA

often amaurosis fugax

101
Q

Genetic abnormality in TTP

A

ADAMTS13

102
Q

Genetic abnormality in Polycythemia Vera

A

JAK2

103
Q

Independent predictors of pneumonia (post-stroke) except

A) Age > 65 years
B) Dysarthria
C) Expressive aphasia
D) MRS of 3 or more
E) Failed bedside swallow test
A

D) MRS of 4 or higher

Independent predictors of pneumonia (post-stroke):

  1. Age > 65 years
  2. Dysarthria
  3. Expressive aphasia
  4. MRS of 4 or more
  5. Failed bedside swallow test
104
Q

Main mechanism of neuronal injury in the ischemic core?

A) Necrosis
B) Apoptosis
C) Free radical injury
D) Metabolic Acidosis
E) Mitochondrial dysfunction
A

A) Necrosis - ischemic core

  • Apoptosis: main mechanism in the penumbra!
105
Q

CBF in ischemia

A

12-23 ml/100g/min

106
Q

CBF in infarction

A

12 ml/100g/min and below

107
Q

CBF where we find histologic signs of necrosis

A

6-8ml/100g/min

108
Q

Normal CBF

A

55ml/100g/min

109
Q

CBF where we find electrographic changes (electrophysiologic failure)

A

30ml/100g/min

110
Q

CBF where we have metabolic failure (ion pumps)

A

15ml/100g/min

111
Q

Most specific symptom of transient ischemia in the carotid circulation

A

Amaurosis fugax

112
Q

Fundoscopic finding in amaurosis fugax?

A

Fibrin platelet embolus in a branch of the retinal artery on fundoscopic examination

113
Q

Most common location of intracranial aneurysms

A

Anterior communicating artery (30%)

Pcomm (25%)
MCA (20%)
ICA Bifurcation (7.5%)

114
Q

Most frequently affected nerve in carotid dissection

A

Hypoglossal nerve

115
Q

Localization of dysarthria clumsy-hand syndrome?

A

Basis pontis (junction of upper 1/3 and inferior 2/3) 2/2 x paramedian basilar artery branch

116
Q

Localization of pure motor hemiparesis?

A

Posterior limb of internal capsule (MC)

Others: CR, Pons, Medullary pyramid

117
Q

Localization of ataxia hemiparesis?

A

Corona radiata, IC, or pons

118
Q

What is the sensitivity of modern CT scanners for detecting SAH in

A) the first 12 hours?
B) the first 24 hours?

A

First 12 hours: 100% sens

First 24 hours: 93% sens

119
Q

Most common clinical presentation of AVM

A

Intracranial hemorrhage

120
Q

Most common cause of all types of stroke

A

Cerebral Embolism

121
Q

Most frequently involved artery in cerebral embolism

A

MCA, superior division

122
Q

Characteristic occurrence of stroke during sleep

a. Thrombotic
b. Embolic

A

a. Thrombotic

123
Q

TIAs induced by hyperventilation can be seen in?

A

Moyamoya disease

124
Q

TIAs w/ exercise or assumption of upright posture can be seen in (multiple)?

A

Takayasu arteritis

Dissection: carotid, aortic arch

125
Q

What is the formula for CPP?

A

CPP = MAP - ICP

Goal: 50-70

126
Q

What is the formula for CBF?

A

CBF = CPP/CVR

127
Q

ICA dissection presenting as Unilateral HA + ipsilateral Horner?

_____ syndrome

A

Raeder Syndrome

128
Q

Gene implicated in cavernous malformations?

A

CCM1

129
Q

Gene implicated in cerebral amyloidosis?

A

Apo E4

130
Q

Which is associated with stroke:

Estrogen or Progresterone?

A

Estrogen

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