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Peds neuro boards, V2 > Stroke > Flashcards

Stroke Flashcards

1
Q

CT finding for carotid cavernous fistula

A

Dilated superior ophthalmic vein

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2
Q

Affective motor aprosodia

lesion to ____

symptoms

A
  1. lesion to nondominant frontal lobe
  2. Symptoms
    1. inability to express nonaffective or affective intonations in speech
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3
Q

Portion of brain most likely to be affected with prospagnosia

A

Fusiform gyrus

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4
Q

How to differentiate Vertebral artery from carotid artery dissection:

Both have (2)
Vertebral (3)
Carotid (4 )

A

Both have:

  1. Horners
  2. headache (“painful horners”)

Vertebral

  1. Cerebellar signs
  2. Decreased sensation to IL face
  3. Decreased sensation to CL body

Carotid

  1. Amarosis Fugax
  2. pulsatile tinnitus
  3. decreased taste
  4. more localized weakness.
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5
Q

Compare Hunt / Hess score versus World federation of neurosurgical societies (WFNS) scale

A
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6
Q

Aneurysms of what artery are most likely to compress CN III

A

Posterior communicating artery

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7
Q

ABCD2 scoring system + 2- and 7-day risk for stroke at each risk level

A

Low risk (1-3)

  • 2-day: 1.0%
  • 7-day: 1.2%

Moderate risk (4-5)

  • 2-day: 4.1%
  • 7-day: 5.9%

High risk (6-7)

  • 2-day: 8.1%
  • 7-day: 11.7%
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8
Q

Mechanism of action:

Aspirin
Clopidogrel / Ticlopidine
Abciximab
Tirofiban
Eptifibatide

A
  • Aspirin:
    • Irreversible binding to cyclooxygenase
    • Leads to decreased synthesis of thromboxane A2
  • Clopidogrel / Ticlopidine
    • Irreversible inhibition of ADP
  • Abcimixab
    • monoclonal antibody which inhibits Glycoprotein IIb/IIIa complex formation
  • Tirofiban
    • Arginine-Glycine-Asperginine sequencs binds to glycoprotein IIb/IIIa complex
  • Eptifibatide
    • Analogue of carboxy-terminal of Delta chain of fibrinogen
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9
Q

CODE STROKE!

Inclusion criteria (3)

Absolute Contraindications regardless of time

Contraindications if within 3-4.5 hour window

A
  • Inclusion criteria
    • Symptoms consistent with ischemic stroke with measurable neurologic defecit
    • Last known Normal <4.5 hours ago
    • Age >18 years
  • Absolute contradindications: ABCDE
    • history of Aneurysms or AVM
    • Active Bleeding
    • intracranial Injuries or stroke within 3 months
    • bleeding Diathesis (such as anticoagulants / coagulopathies) with abnormal coag profile
    • Endocarditis
  • Contraindications at 3-4.5 hours: also ABCDE
    • Age >85 years
    • Bad stroke (NIHSS >25)
    • CT shows multilobar stroke
    • bleeding Diathesis (regardless of coagulations)
    • Ever had a stroke or Diabetes
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10
Q

Patient with left sided ptosis has this MRI

What other features would you suspect? (8)

A
  • Vomiting / vertigo / nystagmus
  • IL ataxia, dysmetria, dysdiadochokinesia
  • IL pain / temp loss to FACE
  • IL Horners
  • CL pain / temp sensation to BODY
  • Dysarthria, pharyngeal sx (hoarsenss)
  • Absent Gag
  • Palatal myoclonus
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11
Q

Breathing abnormalities and stroke

Apneustic
Ataxic
unilateral hemispheric
complete apnea

A

Apneustic: pontine lesion

Ataxic: Medullary (think “MAX”)

unilateral hemispheric: Cheyne-Stokes (though not specific)

complete apnea: high spinal cord lesion

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12
Q

Patient presents with cerebellar ataxia, Vertigo, hearing loss, and tinnitus

What vessel was injured?

What if he didn’t have deafness?

A

AICA

If no deafness can also be PICA (wallenberg syndrome)

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13
Q

Lesion responsible for dressing apraxia

A

Right parietal

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14
Q

Contralateral Face + Arm Weakness = Damage to…

A

Reurrent artery of Heubner (branch of ACA)

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15
Q

Why isn’t hydralazine used as first-line for lowering BP in the setting of stroke?

A

Selective arteriolar vasodilation > reflex tachycardia > can lead to myocardial injury

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16
Q

ASPECT scores

A
  1. start at 10, subtract 1 for each segment involved
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17
Q

Patient with dementia has this imaging finding. What is the most common presentation of this disorder?

A

Cerebral amyloid angiopathy, most common presentation = spontaneous lobar hemorrhage

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18
Q

Strokes presenting with confabulation, memory deficits, and confabulation

A

Mamillary body strokes

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19
Q
A
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20
Q

Causes of drug-induced necrotizing central nervous sstem vasculitis

A

Amphetamines

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21
Q

Blood pressure requirements for administrating IV tpa

Initial

within 24 hours

A

Initial

  1. 185/110

Within 24 hours

  1. 180/105
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22
Q

Patient presents with transient blindness for several minutes after being exposed to bright light. History of coronary artery bypass

What is this worrisome for?

A

Carotid occlusive disease

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23
Q

Mnemonic for Lateral Medullary syndrome

A

Aka Wallenberg syndrome

“Look at the Water to make sure it isn’t hot, Put In (PICA) your IL hand and rub it on your CL face (CL pain/temp to body, IL pain/temp to face); This is hard because of the IL ataxia. “you can’t cry out (hoarsness), and if you could it wouldn’t make sense (IL ataxia).

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24
Q

Someone comes in with because he burned his right hand and didn’t know he cut his left cheek while shaving

What was damaged?

What else would you look for?

A

PICA (Lateral medullary syndrome)

Hoarseness

Dysarthria

IL ataxia

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25
Q

Patient presents with stroke-like symptoms. MR angiography shows alternating dilation / vasoconstriction.

What is this and how do you treat?

What medicine should you avoid?

A

Cerebral vascular vasoconstriction. Treat with Nimodipine

steroids (can worsen)

26
Q

Best imaging modality for unruptured aneuryams

A

Digital subtraction angiography

27
Q

CHA2DS2-VASc score

A

Points for the following:

  • *C**ongestive heart failure (EF <35%)
  • *H**ypertension
  • *A**ge 66-74 (1 point)
  • *A**ge >75 (2 points)
  • *D**iabetes
  • *S**troke (2 points)
  • *V**ascular disease
  • *A**ge 65-74
  • *S**ex (female)
28
Q

Imaging signs and their meaning

Spot sign

Rail sign

perivascular lacunes

A
  • Spot sign: sign of active rebleeding
  • Rail sign: seen on MR venography, suggets cereral sinus thrombosis
  • Perivascular Lacunes: cerebral small vessel disease
29
Q

You suspect SAH but CT is normal. What test can you do to rule-in the diagnosis?

A

Lumbar puncture

(high opening pressure, xanthochromia, and persistently elevated RBCs in all 4 tubes)

Test is actually more sensitive for SAH > 6 hours after event

30
Q

Describe the modified rankin scale

A
  • 0 = no residual symptoms
  • 1 = no significant disability, but resitdual symptoms (not affecting daily life)
  • 2 = Slight impediment to daily life
  • 3 = moderate disability, but still able to do basic care
  • 4 = moderate-to-severe, unable to take care of themselves
  • 5 = severe disability, bed-bound, requires continuous care
31
Q

bilateral lesion to superior temporal gyrus causes what?

A

Cortical deafness

32
Q
A
33
Q

Patient presents with hemiparesis and draws this. Where is the lesion

A

Right parietal lobe

34
Q
A
35
Q

Regions of the brain that, when affected, cause alien Hand syndrome

A

Call a CAB with your alien hand

  • *C**orpus Callosum
  • *A**nterior cerebral Artery
  • *B**asal ganglia degeneration
36
Q

Ischemia to anteroir choroidal atery causes…

A

HOT CROSS GUCCI

  • *H**ippocampus
  • *O**ptic Tract
  • *T**Thalamus

Caudate
Red Nucleus
Optic radiations
Subthalamus
Substantia Nigra

  • *G**lobus Pallidus
  • *U**ncus
  • *C**erebral Peduncle
  • *C**horoid plexus
  • *I**nternal Capsul
37
Q

Symptoms of lesion to anterior choroidal Artery

A

All Contralateral:

Sensory loss
Hemiparesis
homonomous heminaopsia sparing horizontal median

38
Q

Midbrain syndromes

1) what is damaged?
2) Syndrome A
3) Syndrome B

A
  1. Damage to PCA perforators
  2. Syndrome A = Weber syndrome
    1. Contralateral Hemiparesis
    2. Ipsilateral CN III palsy (“down and out”)
  3. Syndrome B = Benedikt syndrome
    1. Weber +
    2. Contralateral hemiathetosis
    3. contralateral hemichorea
    4. contralateral tremor
39
Q

Pontine syndromes:

1) what vessel is damaged?
2) Syndrome A
3) Syndrome B

A
  1. Damage to basilar perforators
  2. Syndrome A = Millard-Gubler
    1. IL LMN-type facial palsy
    2. CL hemiparesis
  3. Syndrome B = Fovile syndrome
    1. MG +
    2. IL CN VI palsy
    3. INO
40
Q

Medullary syndromes

1) Syndrome A + damaged vessel
2) Syndrome B + damaged vessel

A
  1. Syndrome A = Wallenberg (aka lateral medullary syndrome)
    1. damaged PICA
    2. Loss of pain / temperature to IL Face
    3. Loss of pain / temperature to CL body
    4. Dysarthria / Hoarseness
    5. IL ataxia
  2. Syndrome B = Dejerine’s s (aka medial medullary syndrome)
    1. Damage to Vertebral artery + ASA perforators
    2. CL hemiparesis
    3. CL loss of vibration
    4. CL loss of proprioception
    5. IL XII Palsy (deviation away from lesion)
41
Q

What is damaged if patient presents with:
1) pure motor stroke to one side of body

2) Pure sensory symtoms to one side of body
3) Sensory and motor loss to one side of body
4) Ataxia and hemiparesis on one side
5) Clumsy hand dysarthria

A
  1. Pure motor: Internal capsule / corona radiata
  2. pure sensory: thalamus
  3. sensorimotor: thalamocapsular
  4. Ataxic hemiparesis: basis pontis, coronaratiata, thalmocapsular
  5. clumsy-hand-dysarthria: genu of internal capsule + basis pontis
42
Q

Symptoms of Anterior spinal cord syndrome

1) obvious (2)
2) not-so-obvious (3)
3) Normal (2)

A
  1. Big ones
    1. Motor loss belowlesion
    2. pain / temp at and below lesion
  2. less obvious
    1. Urinary retention
    2. intestinal obstruction
    3. falccid anal sphincter
  3. NORMAL
    1. proprioception
    2. vibration
43
Q

Left right discrimination + agraphia = what?

This is due to damage to what?

A

Gerstmann syndrome:

1) left-right disorientation
2) acaculia
3) agraphia
4) Finger agnosia

Damage to dominant angular gyrus

44
Q

Alzheimer’s Medications: Mechanism of action

Galantamine (2)
donepazil (1)
Rivastigmine (2)
Memantine (1)

A
  1. Galantamine
    1. Acetylcholinesterase inhibitor
    2. Allosteric modulator of Nicotinic ACTH receptors (increased 5HT and Glutamate)
  2. Donepazil
    1. Non-competitive central acetylcholinesterase inhibitor
  3. Rivastigmine
    1. Acetylcholinesterase inhibitor
    2. butrylcholinesterase inhibitor
  4. Memantine
    1. NMDA receptor antagonist
45
Q

Schizophrenia criteria

A

Need 2+ to CASH out

Catatonia - or- disorganized behavior
A’s (negative symptoms)

  • Affect flattening
  • Alogia (paucity of speech)
  • Avolition
  • Anhedonia
  • *S**peech = disorganized
  • *H**allucinatios / delusions
46
Q

Symptoms of Orbitofrontal syndrome

(3)

A

Innapropriate behavior
Utilization behavior
Innapropriate Jocularity

47
Q

Symptoms of Dorsolateral syndrome (5)

Symptoms of Anterior cingulate (medial) syndrome (4)

A

Dorsolateral syndrome

  1. Defect of executive function and working memory
  2. Inability to integrate information
  3. Inability to plan or anticipate
  4. Inability to sequence actions
  5. Problems with short term memory

Anterior cingulate (medial) syndrome

  1. Aka “apathy” or “abulic” syndrome
  2. decreased activity
  3. decreased spontaneous speech
  4. Akinetic mutism (most severe)
48
Q

Symptoms of Anterior Cingulate (medial) syndrome

(5)

A
49
Q

Indications for Carotid Endarterectomy

(2)

A

Symptomatic and 70% occlusion = for sure

symptomatic and 50% = “consider”

50
Q

How to differentiate between Vertebral arty dissection and carotid artery dissection

Both (2)
Carotid dissection (4)
Vertebral (3)

A

Both (“painful horners”)

  1. Headache
  2. Horners

Carotid dissection

  1. Amarosis Fugax
  2. pulsatile tinnitus
  3. hopguesia
  4. localized weakness

Vertebral Dissection

  1. Cerebellar signs
  2. Decreased sensation to IL face
  3. Decreased sensation to CL body
51
Q

Regulators of Cerebral blood flow

Intrinsic (5)
Extrinsic (4)

A

Intrinsic

  1. Regional/metabolic regulation with vasodilators
  2. PaCO2
  3. PaO2
  4. pH
  5. Hyperventilation

Extrinsic

  1. Cardiac output
  2. systemic blood pressure
  3. viscoscity
  4. stimulation of baroreceptors in carotid arch
52
Q

Frontal lobe symptoms

  1. Problems with Planning / executive function
  2. Akinetic mutism
  3. two other symptoms not related to particular region
A
  1. Problems with planning/executive function: dorsolateral frontal cortex
  2. Akinetic mutism: supplementary motor and anterior cingulate
  3. Nonspecific
    1. Frontal release signs
    2. abulia
53
Q

Parietal Lobe syndromes

  1. Sensory cortex
  2. Dominant lesion
  3. non-dominant lesion (4)
A
  1. Sensory cortex: tactile agnosia
  2. Dominant lesion: Gerstmann syndrome
  3. Non-Dominant:
    1. ​CL sensory neglect
    2. constructional apraxia
    3. dressing apraxia
    4. denial deficits
54
Q

Visual “what” versus Visual “where” regions

A

Visual “what” = parietal lobe

Visual “where” = temporal lobe

55
Q

Patient presents with ruptured aneurysm

Blood pressure medications OK to give (4)

blood pressure medicines to avoid (3)

A

BP meds OK to give

  1. Labetolol
  2. enalapril
  3. nicardipine
  4. nimodopine (oral only)

BP meds to avoid

  1. Nitroprusside
  2. nitroglycerine
  3. Nimodipine (IV)
56
Q

Internal Carotid vessels responsible for:

  1. Amarosis Fugax
  2. Contralateral Hemianopsia / hemiparesis
  3. Abulia + dysarthria + agitatoin + hemiparesis
  4. Contralateral Lower extremity weakness and sensory loss
  5. One more vessel that is on another card
A
  1. Amarosis Fugax = opthalmic artery
  2. Contralateral Hemianopsia / hemiparesis = anterior choroidal
  3. Abulia + dysarthria + agitatoin + hemiparesis = Anterior cerebral (perforating branches including recurrent artery of Huebner)
  4. Contralateral Lower extremity weakness and sensory loss = Anterior choroidal artery (cortical branches)
  5. Middle cerebral artery
57
Q

Middle cerebral artery branches responsible for:

    • CL hemiparesis
    • Face/arm motor/sensory loss
    • aphasia
    • Gerstmans
    • cortical seonsroy loss / neglect
A
  1. perforating branches
    • CL hemiparesis
  2. cortical branches
    • Face/arm motor/sensory loss
    • aphasia
    • Gerstmans
    • cortical seonsroy loss / neglect
58
Q

what transporter facilitates glucose transport across blood brain barrier?

A

Glut1

59
Q

Symptoms of Anterior ischemic optic neuropathy

(3)

A
  1. painless monocular vision loss (incomplete / “altitudinal”)
  2. swelling of optic disk
  3. 40% likely to involve other eye within 2-4 years
60
Q

Path of CSF flow through brain

A
  1. Lateral ventricles >(foramen of monroe)>third ventricle > (cerebral aqueduct) > fourth ventricle > (foramen of Magendie) (foramen of luschka)

Peds neuro boards, V2 (29 decks)

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