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(2) MS: Neurological Conditions 🩺 > S2_L2: Stroke > Flashcards

S2_L2: Stroke Flashcards

1
Q

Known as the first stroke neurologist who analyzed the distribution of infarcts in various arterial territories and correlated brain lesions with clinical findings.

A

Charles Foix

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2
Q

Determine whether the finding is true for Weber, Benedikt, or both.

  1. Parasympathetic involvement; ptosis
  2. Ipsilateral CN III Palsy
  3. Tremors, involuntary movement of opposite limbs
  4. Contralateral hemiparesis
  5. Contralateral ataxia

A. Weber’s Syndrome
B. Benedikt’s Syndrome
C. both

A
  1. A
  2. C
  3. B
  4. C
  5. B
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3
Q

TRUE OR FALSE: Weber is caused by involvement of the fascicles of the 3rd nerve within the midbrain, while Benedikt’s is also caused by that along with the involvement of the cerebral peduncle & red nucleus.

A

True

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4
Q

TRUE OR FALSE: Affectation of the crus cerebri results in contralateral hemiparesis that is present in Weber Syndrome and Benedikt’s Syndrome.

A

True

Source: Snell, Ninja Nerd

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5
Q

In ipsilateral cranial nerve III palsy, the eyeball is deviated laterally because of the paralysis of what muscle?

A

Medial rectus

Source: Snell

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6
Q

Determine whether the structure affected is true for Wallenberg Syndrome, Medial Medullary Syndrome, or both.

  1. Nucleus ambiguus
  2. Cerebellum (inferior cerebellar penducle)
  3. Hypoglossal nerve (CN XII)
  4. Corticospinal / Pyramidal Tract
  5. Medial lemniscus

A. Wallenberg Syndrome
B. Medial Medullary Syndrome
C. both

A
  1. A
  2. A
  3. B
  4. B
  5. B
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7
Q

Determine whether the structure affected is true for Wallenberg Syndrome, Medial Medullary Syndrome, or both.

  1. Spinal trigeminal nucleus of CN V
  2. Vestibular nuclei
  3. Descending sympathetic fibers
  4. Vertebral Artery (Anterior Spinal Artery)
  5. Posterior Inferior Cerebellar Artery
  6. Spinal lemniscus (Spinothalamic tract)

A. Wallenberg Syndrome
B. Medial Medullary Syndrome
C. both

A
  1. A
  2. A
  3. A
  4. B
  5. A
  6. A
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8
Q

Determine whether the finding is true for Wallenberg Syndrome, Medial Medullary Syndrome, or both.

  1. Vertigo, nausea, nystagmus
  2. Contralateral hemiparesis
  3. Ipsilateral Horner’s Syndrome
  4. Contralateral body thermo-analgesia
  5. Contralateral decrease in vibration and position sense

A. Wallenberg Syndrome
B. Medial Medullary Syndrome
C. both

A
  1. A
  2. B
  3. A
  4. A
  5. B
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9
Q

Determine whether the finding is true for Wallenberg Syndrome, Medial Medullary Syndrome, or both.

  1. Ipsilateral bulbar palsy
  2. Ipsilateral ataxia
  3. Ipsilateral tongue weakness with deviation to paralyzed side when tongue is protruded
  4. Ipsilateral facial sensory loss & numbness
  5. Oscillopsia

A. Wallenberg Syndrome
B. Medial Medullary Syndrome
C. both

A
  1. A
  2. A
  3. B
  4. A
  5. A
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10
Q

What does FAST stand for?

A

Facial weakness
Arm weakness
Speech problems
Time

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11
Q

This infarct appears in the sinuses and one of its common causes is the intake of oral contraceptive medications in women

A

Venous infarct

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12
Q

C. Miller Fisher states, “Stroke is a neurological deficit of sudden onset accompanied by focal dysfunction and symptoms lasting more than ___ that are presumed to be of non-traumatic vascular origin.”

A

24 hours

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13
Q

The first most common cause of death in the world is (1)___, while the second is (2)___.

A
  1. Heart disease
  2. Stroke
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14
Q

It is the occlusion of the vessel by propagation of a thrombus. Over time, the occlusion depends on the size and location of the vessel and collateral flow.

A

Thrombotic infarct

Additional: Collaterals have more time to expand if the occlusion occurs over time.

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15
Q

This stroke’s predisposing factors are pregnancy and other hypercoagulable states. Patients present any combination of headache, seizures, cognitive difficulty, and focal weakness.

A

Venous infarct

Additional: Less common than arterial infarct

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16
Q

Determine if epidural or subdural hemorrhage is described.

  1. Due to trauma where the middle cerebral artery is ruptured
  2. Caused by tearing of the meningeal arteries
  3. Bleeding is most often slow and accumulates during days, weeks, and a few months
  4. Blood accumulates rapidly over minutes to hours between the skull and the dura mater
  5. Due to venous trauma located between the dura mater and arachnoid membranes

A. Epidural hemorrhage
B. Subdural hemorrhage

A
  1. A
  2. A
  3. B
  4. A
  5. B
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17
Q

A patient presents with signs and symptoms of acute CNS bleeding. A CT was performed and it showed (+) bleeding. What emergency management would be considered for the patient?

A

Surgery

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18
Q

A patient in the ED presents with a suspected infarction. They arrived at 5PM. The caregiver shared that the patient was last seen normal at 2PM. What emergency management would be considered for the patient?

A

tissue plasminogen activator (t-PA)

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19
Q

Enumerate the 5 stroke warning signs

A
  • Weakness (especially on one side of body)
  • Trouble speaking
  • Vision problems
  • Headache
  • Dizziness
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20
Q

After obtaining brain imaging, the patient presents with ischemic stroke / TIA. What management would be considered for the patient?

A

Thrombolysis / thrombectomy

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21
Q

After obtaining brain imaging, the patient presents with hemorrhage. What management would be considered for the patient?

A

Lowering the BP

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22
Q

A patient presents with a hemorrhage. Aneurysmal subarachnoid hemorrhage (SAH) is the established cause. What management would be considered for the patient?

A

Clip or coil

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23
Q

A patient presents with a hemorrhage. If the established cause is an intracerebral hemorrhage (ICH) or hypertension, what management would be considered for the patient?

A

Surgery

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24
Q

A patient has ischemic stroke/TIA. Atrial fibrillation is the established cause. What management would be considered for the patient?

A

Warfarin

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25
Q

A patient has ischemic stroke/TIA. Carotid disease is the established cause. What management would be considered for the patient?

A

Stent or Carcinoembryonic antigen (CEA)

26
Q

Determine whether the manifestation is ocular or from the cerebral hemisphere.

  1. Homonymous visual field defects
  2. Transient blindness in one eye
  3. Language defect
  4. Contralateral hemiparesis with/without sensory deficits
  5. Occasional headache (supraorbital or temporal)

A. Ocular
B. Cerebral hemisphere

27
Q

Ischemia in the internal carotid artery is also called?

A

Wake-up strokes

28
Q

Determine whether the left or right posterior cerebral artery is affected

  1. Left hemisensory loss and left hemiparesis
  2. Right homonymous hemianopia
  3. Aphasia, right hemisensory loss, and right hemiparesis
  4. Left homonymous hemianopia
  5. Alexia without agraphia

A. Left PCA
B. Right PCA

29
Q

Determine whether it is a manifestation of MCA, ACA, or PCA stroke syndrome.

  1. Abulia
  2. Transcortical motor aphasia or motor and sensory aphasia
  3. Wernicke’s aphasia
  4. Ipsilateral oculomotor deficits
  5. Contralateral hemiparesis affecting the LE

A. MCA
B. ACA
C. PCA

30
Q

Determine the likely etiology of these stroke syndromes

  1. Headache and Focal Deficit after Injury
  2. Awaken with focal deficit
  3. Acute Onset of Severe Headache w/o deficit
  4. Subacute Onset of Neurologic deficit
  5. Abrupt onset of focal deficit

A. Subarachnoid hemorrhage
B. Subdural, Epidural hemorrhage
C. Thrombotic or lacunar infarction
D. Embolic or thrombotic infarction
E. Intraparenchymal hemorrhage, ischemic stroke

31
Q

TRUE OR FALSE:
Epidural hemorrhage is a classic history of coma after head injury, with or without a lucid interval

32
Q

It is an ischemic stroke arising from the heart, aorta, carotid, or vertebral arteries. It may also be from valvular disease, akinetic myocardium with thrombus formation, or from the venous system via the right-to-left shunt from septal defect.

A

Embolic infarct

33
Q

It may be caused by breakage of the blood vessel due to hypertension or aneurysm, or trauma penetrating (shearing) injury of the brain.

A

Hemorrhage

34
Q

MCA stroke: Contralateral hemiparesis and hemisensory loss, affecting (1)___; ACA stroke: Contralateral hemiparesis mainly affecting (2)___.

A
  1. arms, face
  2. legs

*In ACA stroke, if the arm is affected, proximal arm is most prominent

35
Q

A focal deficit that is often with headache and/or seizures is suggestive of?

A

Veins & venous sinuses infarction / stroke

Additional: Occurs in postpartum women, or in young people generally at lower risk of arterial infarctions

36
Q

It is repeated episodes of painless transient monocular blindness related to ipsilateral carotid artery atherosclerosis. This
presents as blurring or darkening of vision in one eye, peaking within a few seconds and usually clearing within minutes.

A

Amaurosis fugax

Source: Merritt

37
Q

Vertigo, ataxia, diplopia, nystagmus, anisocoria, dysarthria, dysphagia, and hemiparesis or quadriparesis are clinical manifestations suggestive of what stroke?

A

Vertebrobasilar system stroke

38
Q

It is an abrupt onset & transient episode of neurologic impairment caused by focal cerebral or retinal ischemia without any permanent infarction. Imaging is normal, showing no abnormality or signs of previous strokes. Recovery usually lasting less than an hour.

A

Transient Ischemic Attack

Source: Merritt

39
Q

What is the most common cause of TIA?

A

Embolic disease from the heart or cerebral arteries

Additional: The emboli temporarily block the vessels resulting in loss of function

40
Q

A transient ischemic attack is often referred to as?

A

Mini-stroke

41
Q

It is usually due to rupture of an intracranial aneurysm and pts report this as the worst headache of their life. They also present with a stiff neck and (+) kernig’s sign.

A

Subarachnoid hemorrhage

Source: Merritt

42
Q

It is bleeding directly into the brain substance/parenchyma. Hemorrhagic infarction, hypertension, cerebral amyloid angiopathy, and trauma causes this type of bleeding.

A

Intraparenchymal hemorrhage

Source: Caplan

Additional from Merritt: It remains the most devastating and most untreatable form of stroke

43
Q

In seizures, the duration is (1)___ than TIA. In migraine, the neurologic deficit is (2)___, as compared to the abrupt onset of TIA.

A
  1. shorter
  2. gradual
44
Q

TRUE OR FALSE: An infarction affecting the internal carotid artery can be asymptomatic or cause any of the following: ipsilateral monocular blindness, transient limb shaking, or a combination of MCA and ACA syndromes.

A

True

Source: Merritt

45
Q

TRUE OR FALSE: PCA infarction can present with hemianopia or quadrantanopia, alexia, color anomia, simultanagnosia, prosopagnosia, amnesia, and agitated delirium, or cerebral blindness when the injury is bilateral.

A

True

Source: Merritt

46
Q

TRUE OR FALSE: ACA infarction can present with hemiparesis and sensory loss of the contralateral leg, transcortical motor aphasia (left), motor neglect (right), abulia (impaired responsiveness), gait apraxia, ideomotor apraxia or tactile anomia (right).

A

True

Source: Merritt

47
Q

TRUE OR FALSE: In a PCA infarction, the macula may be spared from the visual deficits.

48
Q

TRUE OR FALSE: TIA is a temporary neurologic deficit lasting < 24 hours. The deficit commonly lasts < 1 hour, with a typical time of 15 minutes. Migraine with classic sx and hemiplegia can also occur.

49
Q

Determine the blood supply of each artery

  1. Medial portion of frontal and parietal lobes
  2. Primary visual cortex and association cortex, occipital lobe
  3. Lateral side of frontal, parietal, and temporal lobes

A. ACA
B. MCA
C. PCA

50
Q

TRUE OR FALSE: Habitual snoring poses a higher risk for developing stroke in Filipinos

51
Q

TRUE OR FALSE: Pure motor or pure sensory symptoms suggest a penetrating vessel occlusion.

52
Q

Matching Type

  1. Contralateral hemiparesis
  2. Incoordination
  3. Ipsilateral appendicular ataxia
  4. Ocular signs, medial rectus palsy

A. Internal capsule or basal ganglia
B. Brainstem
C. Both A and B

53
Q

TRUE OR FALSE: Non-white racial groups are at a greater risk for having stroke

54
Q

Determine whether the risk factor is modifiable or non-modifiable.

  1. Hereditary factors
  2. Smoking
  3. Prior stroke, MI
  4. Heart disease or failure
  5. Hypertension

A. Modifiable RF
B. Non-modifiable RF

55
Q

Determine which division/area of the MCA is affected

  1. Constructional dyspraxia
  2. Contralateral weakness and sensory loss of face and hand
  3. Contralateral hemianopia
  4. Contralateral gaze palsy, hemiplegia, hemisensory loss, spatial neglect
  5. May lead to coma secondary to edema; neglect, anosognosia, disinterest or poor motivation, apathy

A. Superior branch
B. Inferior branch
C. Deep branch
D. Parasylvian branch
E. Entire territory
F. B and D
G. B and E
H. A and E

56
Q

Tetrad of Gerstmann Syndrome

A
  1. Left-right confusion
  2. Finger agnosia
  3. Agraphia
  4. Acalculia
57
Q

Determine which division/area of the MCA is affected

  1. Global aphasia
  2. Broca’s (Expressive) aphasia
  3. Conduction aphasia, apraxia, and Gerstmann syndrome
  4. Wernicke’s (Receptive) aphasia
  5. Transcortical motor and/or sensory aphasia

A. Superior branch
B. Inferior branch
C. Deep branch
D. Parasylvian branch
E. Entire territory

58
Q

Determine if the left or right hemisphere is affected in MCA stroke

  1. Neglect and instructional difficulty
  2. Severe constructional apraxia (dyspraxia)
  3. Global aphasia
  4. Transcortical motor and/or sensory aphasia
  5. Anosognosia, disinterest or poor motivation, apathy

A. Left side
B. Right side

59
Q

TRUE OR FALSE: Weber Syndrome is produced by occlusion of a branch of the posterior cerebral artery that supplies the midbrain, resulting in the necrosis of brain
tissue involving the oculomotor nerve and the crus cerebri.

A

True

Source: Snell

60
Q

Enumerate the 4 causes of ischemic stroke

A
  1. Thrombotic occlusion of arteries or veins
  2. Embolic disease from heart or great vessels
  3. Hypoperfusion
  4. Occlusion of small penetrating vessels
61
Q

It is the best validated tool for assessing the
short term risk of ischemic stroke after TIA

A

ABCD² Score

Source: Merritt

(2) MS: Neurological Conditions 🩺 (12 decks)

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