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724: Medical Lectures > Stroke > Flashcards

Stroke Flashcards

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USMLE® Step 1 flashcards
1
Q

Stroke is the ___ leading cause of death in the US

A

3rd

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2
Q

What are the 2 kinds of strokes?

A
  • Infarcts (thrombotic or embolic)

- Hemorrhages

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3
Q

What are the 3 subtypes of ischemic stroke?

A
  • lacunar infarct
  • carotid circulation obstruction
  • vertebrobasilar occlusion
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4
Q

What are the 4 subtypes of hemorrhagic stroke?

A
  • spontaneous intracerebral hemorrhage
  • subarachnoid hemorrhage
  • intracranial aneurysm
  • arteriovenous malformations
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5
Q

Describe lacunar infarcts

A

They are small lesions (<5 mm in diameter) that occur in the distribution of short penetrating arterioles in the basal ganglia, pons, cerebellum, internal capsule, thalamus

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6
Q

What are lacunar infarcts associated with?

A

poorly controlled hypertension or diabetes

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7
Q

The prognosis for recovery from the deficit produced by a lacunar infarct is usually good, with partial or complete resolution occurring over the following - weeks in many instances.

A

4-6

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8
Q

What leads to a cerebral infarction?

A

A thrombotic or embolic occlusion of a major vessel

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9
Q

What causes a cerebral infarction?

A
  • TIA causes

- atherosclerosis of cerebral arteries

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10
Q

What does deficit following a cerebral infarction depend on?

A

the particular vessel involved and the extent of any collateral circulation

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11
Q

What leads to an increase in neurologic deficit following a cerebral infarction?

A

Cerebral ischemia leads to the release of neuropeptides that augment calcium flux into neurons, thereby leading to cell death and increasing the neurologic deficit.

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12
Q

Onset of stroke is usually _____.

A

abrupt

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13
Q

What does occlusion of the ophthalmic artery lead to?

A

Amaurosis fugax (sudden and brief loss of vision in one eye)

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14
Q

What does an occlusion of anterior cerebral artery distal to its junction with anterior communicating artery lead to?

A
  • weakness and cortical sensory loss in the contralateral leg
  • mild weakness of the arm (especially proximally)
  • contralateral grasp reflex
  • paratonic rigidity
  • abulia (lack of initiative)
  • frank confusion
  • urinary incontinence
  • marked behavioral changes
  • memory disturbances
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15
Q

What does an occlusion of middle cerebral artery lead to?

A
  • contralateral hemiplegia
  • hemisensory loss
  • homonymous hemianopia
  • global aphasia
  • drowsiness
  • stupor
  • coma in extreme cases
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16
Q

Involvement of the anterior main division of the middle cerebral artery leads to what?

A
  • expressive dysphasia

- contralateral paralysis and loss of sensations in the arm, the face and, to a lesser extent, the leg

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17
Q

Involvement of the posterior main division of the middle cerebral artery leads to what?

A
  • receptive (Wernicke) aphasia

- homonymous visual field defect

18
Q

Occlusion of posterior cerebral artery leads to what syndrome?

A

thalamic syndrome

19
Q

What are the signs of thalamic syndrome?

A

contralateral hemisensory disturbance, followed by the development of spontaneous pain and hyperpathia

20
Q

How is vision impaired following occlusion of the posterior cerebral artery?

A

macular-sparing homonymous hemianopia

21
Q

What happens when the small paramedian arteries arising from vertebral artery are occluded?

A
  • contralateral hemiplegia and sensory deficit

- ipsilateral cranial nerve palsy at the level of the lesion

22
Q

What happens when the posterior inferior cerebellar artery is occluded?

A
  • ipsilateral spinothalamic sensory loss involving the face
  • ninth and tenth cranial nerve lesions
  • limb ataxia and numbness
  • Horner syndrome
23
Q

What happens when the major cerebellar arteries are occluded?

A
  • vertigo
  • nausea
  • vomiting
  • nystagmus
  • ipsilateral limb ataxia
  • contralateral spinothalamic sensory loss in the limbs
24
Q

What may a massive cerebellar infarction lead to?

A

coma, tonsillar herniation, and death

25
Q

Infarction in what 2 areas my lead to LOC?

A
  • carotid territory

- vertebrobasilar territory

26
Q

Coma occurs when there is a bilateral brainstem infarction that involves which structure?

A

the reticular formation

27
Q

What is the preferred first imaging technique?

A

CT without contrast

28
Q

CT should occur before what?

A

The administration of aspirin or other antithrombotic agents

29
Q

What is effective in reducing the neurologic deficit in selected patients without CT evidence of intracranial hemorrhage?

A

Intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rtPA)

30
Q

What is the time window in which patients can receive tPA?

A

1 - 4.5 hours

31
Q

What are the contraindications to intravenous thrombolytic therapy?

A
  • recent hemorrhage
  • increased risk of hemorrhage (treatment with anticoagulants)
  • arterial puncture at a noncompressible site
  • systolic pressure > 185 mm Hg or diastolic pressure > 110 mm Hg
32
Q

What non-thrombolytic treatment is used to treat thrombotic stroke?

A

endovascular intra-arterial tPA or mechanical removal of an embolus/clot

33
Q

How is elevated intracranial pressure treated?

A
  • Head elevation
  • Mannitol
  • Decompressive hemicraniectomy
34
Q

Should BP be attempted to be lower in hypertensive patients following stroke?

A

No

35
Q

What is the immediate treatment recommendation for patients contraindicated for thrombolytic treatment?

A

aspirin daily

36
Q

The prognosis for survival after cerebral infarction is ____ than after cerebral or subarachnoid hemorrhage

A

better

37
Q

What does prognosis of acute stroke depend on?

A

the time that elapses before arrival at the hospital

38
Q

What implies a poorer prognosis after a cerebral infarct?

A

Loss of consciousness

39
Q

What reduces the risk for recurrent strokes of MIs?

A

statin therapy to lower serum lipid levels

40
Q

Antiplatelet therapy reduces the recurrence rate by __% among patients without a cardiac cause for the stroke who are not candidates for carotid endarterectomy

A

30

724: Medical Lectures (42 decks)

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