SECRETS Neurology - Cerebrovascular Accidents

Question 1

ischemic vs hemorrhagic stroke - more common?

Answer 1

ischemic

Question 2

tPA contraindications

Answer 2

recent surgery
recent GI bleeding
intracranial bleeding
severe hypertension

Question 3

epidural hemorrhage

Answer 3

middle meningeal artery
temporoparietal bone fracture
lucid interval
biconvex disk does not cross suture lines

Question 4

subdural hemorrage

Answer 4

bridging veins
blunt trauma or anticoagulation
elderly
shaken baby syndrome
crescent sign that can cross suture lines

Question 5

subarachnoid hemorrhage

Answer 5

AV malformation or ruptured aneurysm
CT disorders or Adult PCKD
star-shaped area of hemorrhage

Question 6

parenchymal hematoma

Answer 6

vessel rupture 2/2 hypertension or amyloid angiopathy

Question 7

major risk factors to cerebrovascular accidents

Answer 7

hypertension
smoking
hyperlipidemia
atherosclerosis

Question 8

predisposing conditions to stroke

Answer 8

a fib
MI

blood stasis –> clot formation –> embolus to brain

prophylaxis with warfarin

Question 9

stroke due to hypertension - what vessel?

Answer 9

lenticulostriate vessels - supply basal ganglia
Charcot-Bouchard microaneurysms

affect thalamus, basal ganglia

Question 10

anterior cerebral artery

Answer 10

motor and sensory cortex LE

weakness/loss of sensation in contralateral leg

Question 11

middle cerebral artery

Answer 11

motor and sensory cortex UE/head

dysphagia, dyslexia, dysgraphia, dyscalculia
weakness/loss of sensation in contralateral face/arm

Question 12

speech difficulty - what vessel occluded?

Answer 12

middle cerebral artery on L side usually (dominant side)

Question 13

Wernicke’s aphasia

Answer 13

difficulty understanding speech

temporal lobe

Question 14

Broca’s aphasia

Answer 14

difficulty articulating

frontal lobe

Question 15

global aphasia

Answer 15

both wernicke/broca

can’t understand or articulate

Question 16

conduction aphasia

Answer 16

difficulty with speech repetition

Question 17

posterior cerebral artery

Answer 17

visual cortex in occipital lobe
lateral geniculate nucleus

contralateral homonymous hemianopia (can’t see on one side)

Question 18

prox occlusion in anterior cerebral artery - stroke?

Answer 18

NO

collateral blood flow via anterior communicating artery

Question 19

ischemia from hypotension - susceptible areas

Answer 19

watershed areas = bordering zones supplied exclusively by 1 artery

Question 20

stroke gross pathology

Answer 20

wedge-shaped area of pale/hemorrhagic infarction

starts in periphery

Question 21

brain necrosis & progression

Answer 21

liquefactive with potentially dangerous swelling

myelin will break down –> loss of demarcation b/t grey & white matter
astrocytes proliferate near infarct
microglia will remove debris

days-weeks later = cystic areas may develop