Stroke

Question 1

also known as brain attack or cerebrovascular accident/disease

Answer 1

Stroke

Question 2

2 types of strokes

Answer 2

1. Bleed
2. Infarctions

Question 3

Types of Infarction

Answer 3

1. Thrombotic
2. Embolic
3. Venous
4. Cryogenic
5. Lacunar

Question 4

Outcomes of Types of Ischemic

Answer 4

1. TIA
2. RIND
3. Completed Stroke

Question 5

Complete reversal of neurologic defects within 24 hours

Answer 5

TIA

Question 6

It is an outcome of thrombotic, embolic or lacunar strokes

Answer 6

TIA

Question 7

A brief episode of Neurologic dysfunction caused by focal brain or retinal ischemia with clinical symptoms typically lasting less than 1 hour and without evidence of Acute infarction

Answer 7

TIA

Question 8

-Complete reversal of all deficits within 7 days
- All deficits should last more than 24 hours

Answer 8

RIND

Question 9

• Deficits remain more than 7 day

Answer 9

Completed Stroke

Question 10

How do Infarction Occur?

Answer 10

1. Cerebral Metabolism
2. Neuronal Membrane
3. Cerebral Blood Flow
4. Acute Infarction

Question 11

Area with the lowest central blood flow is called the

Answer 11

Central core of the infarction

Question 12

Area with a little more blood in the periphery

Answer 12

Penumbra

Question 13

How much of cerebral blood flow required for normal brain function?

Answer 13

50-80 mL/ 100 mg per min

Question 14

Causes arterial blockage, stepladder presentation, seen upon waking up and more on the elderly age group

Answer 14

Thrombotic Infarction

Question 15

Leucocyte Adhesion

Answer 15

1. Endothelial Permeability
2. Leukocyte Migration
3. Endothelial Adhesion
4. Leukocyte Adhesion

Question 16

Plaque Formation

Answer 16

1. Smooth muscle contraction
2. Foam-cell formation
3. T-cell activation
4. Adherence and aggregation of platelets
5. Adherence and entry of leukocytes

Question 17

Consequences of Hypertension

Answer 17

Brain- stroke, dementia
Heart- MI, Heart failure, sudden death
Kidney- End-stage renal disease

Question 18

Increase relative risk of stroke by 2-2.5 times and accelerates atherosclerosis & has a hypercoagulable effect.

Answer 18

Smoking

Question 19

Treatment of Thrombotic Infarction

Answer 19

1. Control/Modify Risk Factors
2. Antiplatelets: Aspirin, Cilostazol . Ticlopidine, Clopidogrel, Triflusal

Question 20

Blockage of artery caused by an emboli. artery to artery, immediate onset, and seen in all ages.

Answer 20

Embolic Infarction

Question 21

Most common cause of Embolic Infarction

Answer 21

Cardiogenic

Question 22

This happens when abnormal electrical impulses suddenly start firing in the atria

Answer 22

Atrial Fibrillation

Question 23

CHADS2-VAS meaning

Answer 23

1. Congestive Heart Failure
2. Hypertension (>140/90_
3. Age> 75: any F age 65 scores 2
4. Diabetes Mellitus
5. Prior Stroke or TIA
6. Vascular Disease
7. Age: 65-74
8. Sex Category

Max Score: 9

Question 24

Tx of Embolic Stroke

Answer 24

1. Control RF
2. AntiCoagulation: Warfarin NOAC

Question 25

Affects small blood vessels. What type of infarct?

Answer 25

Lacunar

Question 26

Main RF of Lacunar Infarc

Answer 26

HTN leads to hypertrophy and hyalinization of artery

Question 27

Recovery for Lacunar Infarctions

Answer 27

6-8 wks.

Question 28

Also called the small vessel stroke or disease

Answer 28

Lacunar Infarcts

Question 29

Lacunar Syndromes

Answer 29

1. Pure motor 2. Pure Sensory 3. Dysarthria-Clumsy Hand 4. Hemichorea-Hemiballismus 5. Lateral Medullary (Wallenberg's Syndrome)

Question 30

Loss of motor functions

Answer 30

Pure motor

Question 31

Loss of sensory

Answer 31

Pure sensory

Question 32

Speech problems and weak grip

Answer 32

Dysarthria and Clumsy Hand

Question 33

Extra irregular movements, because basal ganglia is affected

Answer 33

Hemichorea-Hemiballismus

Question 34

presents with sudden onset of dysphagia and contralateral sensory loss

Answer 34

Lateral Medullary/ Wallenberg's Syndrome

Question 35

Most commonly involved arter which goes in the internal capsule, putamen, & globus pallidus which is located in diencephalon.

Answer 35

Lenticulostriate Artery

Question 36

Common location in lacunar infarctions

Answer 36

Diencephalon & Brainstem (pons, midbrain, & medulla)

Question 37

Medulla is supplied by your

Answer 37

PICA, AICA, ACA

Question 38

Bleeds that tend to occur in the basal ganglia, thalami, brainstem, and cerebellum

Answer 38

Hypertensive Vasculopathy Cerebral Microbleeds

Question 39

Bleeds that tend to occur in the cortical-subcortical and cerebellar regions

Answer 39

Cerebral Amyloid Angiopathy

Question 40

Washing Machine of the Brain

Answer 40

Perivascular Spaces

Question 41

Tx of Lacunar Strokes

Answer 41

1. Emphasis is to prevent another stroke 2. Control blood pressure (120/80) 3. Antiplatelets 4. Modify another risk factor

Question 42

Blockage of sagittal sinus and common w/ in 6 weeks postpartum. What type of infarct?

Answer 42

Venous Infarctions

Question 43

The most common sinus affected in venous infarction

Answer 43

Superior Sagittal Sinus

Question 44

Tx of Venous Infarctions

Answer 44

1. Verify 2. Anticoagulants 3. Decreased ICP 4. Anti convulsants

Question 45

Anterior Circulation Signs

Answer 45

1.Comes from two ICA that supply all of the cerebral hemisphere and diencephalon except for the occipital lobe and inferior temporal gyrus 2. Aphasia 3. Apraxia 4. Agnosia 5. Amaurosis Fugax 6. Chorea & Athetosis 7. Intact EOMS 8. Central Facial Palsy, but lowe part of face is paralyzed

Question 46

Posterior Circulation Signs

Answer 46

1. Vertigo 2. EOM Abnormalities 3. Diplopia/Nystagmus 4. Dysmetria 5. Dysdiadochokinesisa 6. Peripheral Facial Palsy 7. Ptosis 7. Dysphagia

Question 47

It supplies lateral side of the hemisphere where control of face and hands are located.

Answer 47

MCA Syndrome

Question 48

Lower Ex is more affected than Upper Ex and Face and may have behavioral changes. Contralateral Hemiplegia more of lower ex.

Answer 48

ACA Syndrome

Question 49

Affects occipital lobe and inferior temporal gyrus as well as hippocampus. Can present cortical blindness, transient global amnesia, or memory loss, visual agnosia.

Answer 49

PCA Syndrome

Question 50

1. PICA supplies Lateral Medulla, ASA supplies Medial Medulla 2. Spinothalamic tract is affected, 9th and 10th cranial nerve nuclei are affected- 3. Contralateral Hemisensory Loss-Dysphagia-Dysphonia-Ataxia

Answer 50

Lateral Medullary Syndrome

Question 51

Types of Bleeds

Answer 51

1. Intracerebral 2. Subarachnoid

Question 52

Hypertensive Intracerebral bleeds

Answer 52

1. Putaminal 2. Lobar 3. Thalamic 4. Pontine 5 .Cerebellar 6. Intraventricular

Question 53

Non-hypertensive bleeds

Answer 53

1. Alcoholic 2. Blood Dyscrasia 3. Methamphetamine 4. Leukemia 5. AV Malformation 6. High caffeine drinks such as energy drinks

Question 54

This condition presents severe headache, meningeal signs, and transient loss of consciousness

Answer 54

Subarachnoid Hemorrhage Syndrome

Question 55

Verification of SAH

Answer 55

1. CT Scan 2. Lumbar Puncture

Question 56

Subarachnoid Hemorrhage Etiology

Answer 56

1. Aneurysm 2. AV Malformation 3. Hypertensive

Question 57

Failure of Tunica Media (muscular layer of the blood vessels) to form

Answer 57

Aneurysm Malformation

Question 58

Common Aneurysms

Answer 58

1. PCOM 2. ACOM 3. MCA 4. Basilar 5. All Cx by failure of Tunica Media to develop

Question 59

Third Nerve Compression, dilated pupils, ptosis and medial rectus pals. Type of Aneurysm?

Answer 59

PCOM

Question 60

Behavioral Changes. Type of Aneurysm.

Answer 60

ACOM

Question 61

Brainstem Signs, diplopias, vertigo, dizziness. Type of Aneurysm

Answer 61

Basilar