Ischemic Stroke

Question 1

What is the most likely problem?:
major neuro deficit
clear rapidly

Answer 1

Cardiac embolus

Question 2

What is the most likely cause?

Pure motor stroke or pure sensory stroke, localized Sx?

Answer 2

Vasoocclusive event - small vessel

Question 3

What is the most common cause of cardiac embolic stroke? second most common?

Answer 3

Atrial fibrillation

2nd: valvular heart disease

Question 4

What are two factors that neuronal survival of the ischemic penumbra relies on?

Answer 4

1. Time to reperfusion
2. Presence of STRESS GRANULES and P BODIES
   - —-reduced in diabetes

Question 5

How do surrounding neurons protect themselves from local stress? (2)

Answer 5

1. factors activate Astrocytes - form glial scar

2. Closure of inter-astrocyte gap junctions - reduce diffusion of K+, Ca+, glutamate (toxic)

Question 6

What is Translational Arrest of Neurons?

Answer 6

1. intravascular fluids leak into interstitial space (AQP channels move to astrocyte cell body)
2. Neurons, Astrocytes absorb the fluid
3. Free radical formation,
4. reduced ADENOSINE, GLUTATHIONE (both are neuroprotective)
5. cell death

Question 7

What is Cytotoxic edema?

Answer 7

Astrocytic swelling from ischemia

upregulation of: NKCC1, AQP4, SUR1 NCCa-ATP

Question 8

How do astrocytes facilitate neuronal healing? (4)

Answer 8

1. wall off inflammtory/harmful cytokines
2. release glutathione (antioxidant)
3. remove glutamate (neurotoxic)
4. remove extracellular K+ (toxic)

Question 9

What are Stress Granules and P bodies, how are they produced?

Answer 9

contain mRNA (HSP 70), RNA/DNA binding proteins

produced in TRANSIENT:

1. Ischemia
2. Hypoglycemia

reduced in Diabetes (decreased glucosaminoglycan production)

Question 10

What are two components of Neurorestoration

Answer 10

1. Neuronal plasticity (rewiring) - glial trophic fx

2. Synaptogenesis - BNDF, EPO, CNTF

Question 11

disease?
stroke in young person
“string of beads” sign on arteriography
thromboembolism to distal circulation

Answer 11

Fibromuscular hyperplasia - carotid most commonly affected

Question 12

stroke in young person
from trauma
genetic causes increase risk

Answer 12

Spontaneous Dissection

–Ehlers Danlos, Marfan syndrome, osteognesis imperfecta, Loeys Dietz syndrome, alpha-antitrypsin deficiency

Question 13

Stroke in young person
vasoocclusive disease of the distal ICA (supraclinoid) at the carotid intracranial bifurcation disease of children
“Puff of smoke”/cloud like in imaging

Answer 13

Moyamoya disease

Question 14

What are two hereditary causes of small vessel disease?

Answer 14

1. CADASIL (cerebral autosomal dominant arteriopathy subcortical infarcts and leukoencephalopathy), presents 4th -5th decade –notch -3 mutation
2. MELAS - multiple endocrinopathy lactic acidosis stroke like events

Question 15

pt over 50 with temporal headache, transient monocular blindness:

what should you consider first?

Answer 15

Temporal Arteritis

Question 16

What cell types are responsible for Temporal Arteritis

Answer 16

T cell - granulomatous

Question 17

Vasculitis disease where the inflammation on imaging looks much worse that the presenting Sx?

Answer 17

Behcet disease

Question 18

What should you suspecti first if imaging shows bilateral strokes that look the same?

Answer 18

Cardiac Emboli

Question 19

What causes cortical venous hemorrhagic infarcts?

Answer 19

Dural venous sinus occlusion