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STEP > Neuro V > Flashcards

Neuro V Flashcards

1
Q

Most common site of berry aneurysm

A

Junction of anterior communicating and ACA.

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2
Q

berry aneurysm RF’s

A

1) advanced age
2) HTN
3) smoking
4) race (increased risk in blacks)

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3
Q

Locations of charcot-bouchard aneurysms

A

Micro aneurysms in basal ganglia + thalamus

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4
Q

Imaging and charcot-bouchard aneurysms

A

They’re too small to see on angiograms.

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5
Q

Etiology of charcot-bouchard aneurysms

A

HTN

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6
Q

Complications of ACA berry aneurysms?

A

1) compression of ACA can lead to bitemporal hemianopia; visual acuity deficits.
2) ACA rupture can lead to lower extremity hemiparesis, sensory deficits.

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7
Q

Complications of PCA berry aneurysms?

A

Compression may cause CN III palsy (blown pupil).

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8
Q

Complications of MCA berry aneurysms?

A

Rupture may cause ischemia in MCA distribution –> contralateral upper extremity and facial hemiparesis, sensory deficits.

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9
Q

What is central post-stroke pain syndrome? Presentation? Epidemiology?

A

1) Neuropathic pain due to thalamic lesions.
2) Initial paresthesias followed in weeks to months by allodynia (ordinarily painless stimuli cause pain) and dysesthesia.
3) happens to 10% of stroke patients.

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10
Q

Epidural hematomas due too.

A

middle meningeal artery rupture

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11
Q

middle meningeal branches from…

A

maxillary artery

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12
Q

Epidurals and suture lines?

A

DO NOT cross

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13
Q

epidural setting

A

often secondary to skull fracture

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14
Q

epidural complications

A

Rapid expansion under systemic arterial pressure can lead to transtentorial herniation + CN III palsy.

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15
Q

lucid interval…

A

epidural

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16
Q

Subdural hematoma etiology…

A

ruptured bridging veins

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17
Q

Chronic vs acute subdural on CT

A

1) acute (traumatic, high-energy impact) –> hyper dense on CT
2) Chronic –> hypodense on CT

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18
Q

Subdurals seen in..

A

1) mild trauma or high-energy trauma
2) cerebral atrophy
3) elderly
4) alcoholism
5) shaken babies

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19
Q

Subdurals and suture lines?

A

Cross suture lines.

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20
Q

Impt clinical finding for subarachnoid hemorrhage

A

bloody or yellow (xanthochromic) spinal tap.

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21
Q

When does vasospasm occur?

A

4-10 days after subarachnoid

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22
Q

Other impt subarachnoid sequela…

A

Communicating and/or obstructive hydrocephalus.

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23
Q

Intraparenchymal hemorrhage caused by…

A

1) most commonly systemic HTN
2) amyloid angiopathy
3) vasculitis
4) neoplasm
5) secondary to repercussion injury in ischemic stroke.

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24
Q

Location of intraparenchymal hemorrhage…

A

Typically basal ganglia + internal capsule but can be lobar.

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25
Q

Charcot-Bouchard and intraparenchymal hemorrhage

A

Rupture charcot-bouchard in lenticulostriate vessels in internal capsule can cause intraparenchymal hemorrhage.

26
Q

When does irreversible damage occur after a stroke?

A

5 minutes of hypoxia

27
Q

Most vulnerable brain regions to ischemic stroke

A

1) hippocampus
2) neocortex
3) cerebellum
4) watershed areas

28
Q

Stroke algorithm

A

1) get imaging: Noncontrast CT to exclude hemorrhage

2) tPA

29
Q

When can CT detect ischemic changes?

A

6-24 hrs

30
Q

When can diffusion-weighted MRI detect ischemia?

A

3-30 minutes

31
Q

Histologic features 12-48 hours after infarct in brain:

A

red neurons

32
Q

Histologic features 24-72 hours after infarct in brain:

A

necrosis + neutrophils

33
Q

Histologic features 3-5 days after infarct in brain:

A

macrophages (microglia)

34
Q

Histologic features 1-2 weeks after infarct in brain:

A

Reactive gliosis + vascular proliferation

35
Q

Histologic features >2 weeks after infarct in brain:

A

Glial scar

36
Q

Most common location of thrombotic stroke

A

MCA

37
Q

Where do thrombotic strokes usually occur?

A

on top of atherosclerotic plaques

38
Q

Common scenario for hypoxic stroke:

A

Common during cardiovascular surgery

39
Q

Window for tPA treatment

A

within 3-4.5 hours of onset, proved no hemorrhage risk

40
Q

How do you reduce stroke risk

A

1) aspirin + clopidogrel
2) control BP
3) get blood sugars under control
4) control lipids
5) treat conditions that increase risk (a fib)

41
Q

TIA prognosis

A

Most resolve in less than 15 minutes but you can get deficits due to focal ischemia.

42
Q

Venous sinus thrombosis presentation

A

signs/symptoms of increased ICP (eg. headache, seizures, focal neurologic deficits).

43
Q

Venous sinus thrombosis sequela

A

venous hemorrhage

44
Q

Venous sinus thrombosis associations

A

Hyper coagulable states (pregnancy, OCP use, factor V leaden)

45
Q

Identify all venous sinuses

A

470

46
Q

Where does internal jugular vein pass through?

A

jugular foramen

47
Q

cerebral aqueduct connects

A

3rd ventricle –> 4th ventricle

48
Q

foramen of monro connect

A

lateral ventricles with 3rd ventricle

49
Q

psuedotumor cerebri

A

idiopathic intracranial HTN. Increased ICP with no apparent cause on imaging.

50
Q

RFs for pseudotumor cerebri

A

1) being a woman of childbearing age
2) vitamin A excess
3) danazol
4) tetracycline

51
Q

pseudotumor cerebri presentation

A

1) headache
2) diplopia (usually from CN VI palsy)
3) *no change in mental status
4) papilledema
5) increased opening pressure on LP, which will also relieve headache.

52
Q

pseudotumor cerebri treatment

A

1) weight loss
2) acetazolamide
3) topiramate
4) invasive procedures for refractory cases (eg, repeat LP, CSF shunt placement, optic nerve fenestration surgery).

53
Q

hydrocephalus caveat

A

ICP not always increased

54
Q

Common cause of communicating hydrocephalus

A

arachnoid scarring post-meningitis

55
Q

communicating hydrocephalus presentation

A

1) increased ICP
2) papilledema
3) herniation

56
Q

NPH characteristics

A

1) *episodic CSF pressure elevation.

2) *No increase in subarachnoid space volume.

57
Q

pathophys of NPH

A

Expansion of ventricles distorts the fibers of the corona radiate.

58
Q

Characteristic finding in NPH other than triad?

A

Magnetic gait (feet appear stuck to floor)

59
Q

dysesthesia

A

abnormal sensation

60
Q

uncal/transtentorial herniation

A

uncal is a common type of transtentorial herniation.

STEP (85 decks)

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