Other Vascular Occlusive Conditions Flashcards
What are the patterns of stroke with total internal carotid artery occlusion?
● A. Whole hemispheric stroke
● B. Watershed infarct
● C. Carotid stump syndrome in which there are continued cerebral or retinal symptoms due to inadequacy of collaterals or due to emboli formed in the turbulent flow
● D. Whole brain ischemic symptoms
● E. All of them except D
E. All of them except D
Intra-arterial thrombolysis within 6 hours of onset of symptoms may increase recanalization rate and clinical improvement without significant increase in hemorrhagic transformation as compared to intravenous thrombolytic therapy. Surgical
options for these cases include carotid endarterectomy. Which patient is the candidate for surgical intervention in case of total internal carotid artery occlusion?
● A. Patients with acute neuro deficit associated with total occlusion presenting after about 2 hours
● B. Patients with extremely poor neuro deficit
● C. Patients with acute neuro deficit associated with total occlusion of internal carotid artery within 2 hours of symptoms onset
● D. Patients without persistent neuro deficit with total ICA occlusion
● E. Both C and D
E. Both C and D
A patient presents with symptoms of dizziness, vertigo, nausea, vomiting, loss of balance, and headache. This patient also has signs of truncal and appendicular ataxia, nystagmus, and dysarthria. This patient’s scan showed compression and obliteration of basal cisterns and 4th ventricle, hydrocephalus, and tight posterior fossa. In 1 hour, this patient develops deep coma and is found to have cerebellar infarct. What is the management option at this stage of the patient?
● A. Conservative and counselling of the attendants
● B. Surgical decompression with brain frontal lobectomy
● C. Suboccipital craniectomy
● D. Suboccipital craniectomy with enlargement of foramen magnum
● E. Only supportive therapy with ventilatory support
D. Suboccipital craniectomy with enlargement of foramen magnum
A patient presents with severe drowsiness, dense hemiplegia, early parenchymal hypodensity involving more than 50% of the MCA distribution on brain CT, midline shift of more than 8 to 10 mm, and hyperdense artery sign in MCA. What are the options of management in case of malignant middle cerebral artery infarction (which carries mortality of up to 80%)?
● A. Conventional measures to control ICP
● B. A + Hemicraniectomy
● C. Agents to lyse clot
● D. Hyperventilation, mannitol, or barbiturate coma
● E. Both C and D
B. A + Hemicraniectomy
Guidelines for hemicraniectomy in a patient with malignant MCA infarct include age less than 70 years, more strongly considered in nondominant hemisphere, and CT or clinical evidence of acute complete ICA or MCA infarcts with direct signs
of impending or complete severe hemispheric brain swelling. When should hemicraniectomy be performed to decrease the mortality and increase functional outcome?
● A. Within 24 hours
● B. Within 48 hours
● C. Within 6 hours
● D. Within 12 hours
● E. Within 72 hours
B. Within 48 hours
Causes of cardiogenic brain embolism include acute myocardial infarction, atrial fibrillation, prosthetic heart valves, paradoxical embolism, or endocarditis. Which of the following are the components of CHADS2 scoring system for risk of stroke with atrial fibrillation?
● A. CHF
● B. HTN
● C. Smoking
● D. Age more than 75 years
● E. Diabetes mellitus
C. Smoking
Following are the management steps for cardiogenic brain ischemic stroke except?
● A. CT should be obtained within 48 hours
● B. Anticoagulation should be used for large infarcts
● C. Heparin and warfarin are started simultaneously
● D. An INR of 2 to 3 appears satisfactory
● E. ASA is only about half as effective as warfarin but may be sufficient for those without associated risk factors
B. Anticoagulation should be used for large infarcts
Criteria for clinical diagnosis of vertebral basilar insufficiency include any two of the following: motor or sensory symptoms or both occurring bilaterally in the same event, diplopia which is due to upper brainstem involvement, dysarthria which is
due to lower brainstem involvement, or homonymous hemianopia which is due to ischemia of occipital cortex. What are the surgical treatment options for this condition?
● A. Vertebral endarterectomy
● B. Transposition of VA to ICA
● C. Bypass grafting
● D. C1 and C2 posterior arthrodesis in case of os odontoideum
● E. All of the above
E. All of the above
The most frequently involved sinus in cerebral venous thrombosis is superior sagittal sinus or left transverse sinus. Following are the signs on noncontrast that can help diagnose case of cerebral venous thrombosis except?
● A. Hyperdense sign or cortical vein of high density or clots in cortical veins
● B. Hemorrhage
● C. Small ventricles
● D. Venous infarct and white matter edema never occur with it
● E. Triangular shaped high density within the sinus posteriorly near the torcular herophili on axial CT images
D. Venous infarct and white matter edema never occur with it
For EC/ICA bypass graft, the type of graft depends on preoperative determination of amount of flow augmentation necessary, the size of recipient graft, and availability of donor vessel. What type of graft is used for high flow vessel with 70 to 140 mL/min flow rate?
● A. Superficial temporal artery
● B. Saphenous vein graft
● C. Radial artery graft
● D. Occipital artery
● E. All of the above
B. Saphenous vein graft
What is the overall rate of subsequent ischemic stroke ipsilateral to the occluded carotid artery?
● A. 2.9% per year
● B. 3.9% per year
● C. 4.9% per year
● D. 5.9% per year
● E. 6.9% per year
D. 5.9% per year
The emergency operations for acute neurological deficit associated with total occlusion of ICA should not be performed after how long?
● A. 2 hours
● B. 3 hours
● C. 4 hours
● D. 6 hours
● E. 12 hours
A. 2 hours
In case of cerebellar infarction, surgical decompression should not be attempted in presence of which of the following symptoms?
● A. Abducens (VI) nerve palsy, loss of ipsilateral gaze (compression of VI nucleus and lateral gaze center)
● B. Peripheral facial nerve paresis (compression of facial colliculus), confusion, and somnolence (may be partly due to developing hydrocephalus)
● C. Babinski sign, hemiparesis, lethargy
● D. Small but reactive pupils coma posturing→ flaccidity, ataxic respirations
● E. Dysphagia, dysarthria, Horner syndrome, ipsilateral facial numbness, crossed sensory loss
E. Dysphagia, dysarthria, Horner syndrome, ipsilateral facial numbness, crossed sensory loss
For malignant MCA infarct, mortality is reduced if hemicraniectomy is performed within what time?
● A. 48 hours
● B. 96 hours
● C. 3 days
● D. 5 days
● E. 7 days
A. 48 hours
Paradoxical cardiogenic embolism can occur with which of the following?
● A. Left ventricular hypertrophy
● B. Patent foramen ovale
● C. Subacute bacterial endocarditis
● D. Moyamoya disease
● E. Prosthetic heart valves
B. Patent foramen ovale
