Exam 3 -- Cerebrovascular Disease

Question 1

Cerebrovascular disease is the fifth leading cause of death in the US, second worldwide. What percentage of these events are ischemic, and what percentage are hemorrhagic?

Answer 1

80% are ischemic; 20% are hemorrhagic

Question 2

An ischemic stroke that is caused by a thrombus can be atherosclerotic or an artery dissection. What are the symptoms of an artery dissection thrombus?

Answer 2

Headache, amaurosis fugax, Horner’s

Question 3

True or false: an embolytic stroke has symptoms that are more acute than thrombolytic.

Answer 3

True.

Question 4

What type of infarcts are common with emboli in arteries with acute right angles?

Answer 4

Lacunar

Question 5

In what area of the brain are embolytic strokes common?

Answer 5

Basal ganglia.

Question 6

Transient ischemic attacks involve no infarction (tissue death) and there is full recovery of function. How long does a TIA usually last?

Answer 6

About 1 minute, but possible up to under 24 hours.

Question 7

ABCDD is an acronym used to estimate the risk of a stroke in the first two days after a transient ischemic attack. What do these letters stand for?

Answer 7

Age (over 60)
Blood pressure after TIA (over 140 systolic OR over 90 diastolic)
Clinical features (unilateral weakness, speech disturbance)
Duration
Diabetes

Question 8

What sort of workup can be done for a patient who has had a transient ischemic attack?

Answer 8

MRI (with diffusion weighted imaging), CT, MRA, CTA, ECG, CBC, metabolic panel, coagulation screening, lipid profile, ESR, CRP, Doppler and carotid Doppler

Question 9

What drugs are antiplatelets that can be used for reducing risk of a stroke?

Answer 9

Aspirin, aggrenox, clopidogrel, ticlopidine

Question 10

Alteplase is a tissue plasminogen activator that is sometimes used to break down clots. It must be used within 4.5 hours of the onset of symptoms. What are two scenarios that would contraindicate the use of alteplase?

Answer 10

If there is evidence of hemorrhage, or if the patient is an anticoagulants (warfarin, coumadin, heparin).

Question 11

Carotid endarterectomy is surgical treatment that involves removal of the plaque. What two criteria must be met in order to consider this procedure for a patient?

Answer 11

70-99% lumen occlusion and 5+ year life expectancy

Question 12

What is the most common location for an intracerebral hemorrhage?

Answer 12

Basal ganglia.

Question 13

What are the cardinal signs of hemorrhagic stroke?

Answer 13

Headache, N&V, seizures.

Question 14

Comparing intracerebral hemorrhage with subarachnoid hemorrhage, which has the more sudden onset?

Answer 14

Subarachnoid hemorrhage

Question 15

What clinical feature is found in 97% of patients with a subarachnoid hemorrhage?

Answer 15

A sudden, severe headache.

Question 16

In terms of pharmacologic treatment for hemorrhagic stroke, you want the patient off any anticoagulants and antiplatelets. You would also initiate anti-HTN meds, and possible anti-epileptic drugs if the patient is having seizures. What specific drug can be used for subarachnoid hemorrhage?

Answer 16

Nimodipine.

Question 17

Bell’s Palsy is the most common cranial nerve palsy and is most common in what kind of patient?

Answer 17

Pregnant women.

Question 18

Bell’s Palsy is thought to be related to which viral organisms?

Answer 18

Herpes simplex or herpes zoster.

Question 19

Does Bell’s Palsy typically involve an acute or chronic onset?

Answer 19

Acute (within about 48 hours)

Question 20

If resolution of a Bell’s Palsy begins within 21 days, full recovery is likely. There is a poorer prognosis if the symptoms last more than 4 months.

Answer 20

Free card.

Question 21

How would you treat Bell’s Palsy?

Answer 21

Treat with 60-80mg of prednisone for 1 week (beginning within 3 days of start of symptoms). If the presentation is severe, you can add valacyclovir 1,000 mg TID.