Stroke

Question 1

ACA stroke

Answer 1

Motor or sensory loss

Predominantly legs

Question 2

MCA stroke

Answer 2

Aphasia
Apraxia
Anosmia
Motor or sensory loss more in arm than leg

Question 3

PCA stroke

Answer 3

Motor: CN palsy, Hemiplegia
Sensory: hemi loss
Vision: homonymous hemianopia, issues with conjugate gaze

Question 4

SCA stroke

Answer 4

Motor: ataxia

Question 5

Basilar artery stroke

Answer 5

Coma

Motor: quadriparesis

Question 6

PICA stroke

Answer 6

Wallenberg syndrome
Horners
CN 9, 10 palsy
Sensory loss

Question 7

Lacunar stroke

Answer 7

Pure motor stroke from infarct of internal capsule

Question 8

5 main types of stroke

Answer 8

Cardio embolic 
Large Artery
Small vessel
Other
Unknown

Question 9

Cardio embolic stroke

Answer 9

History: atrial fibrillation, cardiomyopathy, ,I, endocarditis, mechanical heart valve
IX: multiple territory lesions from huge clots
Tx: warfarin, NOACs

Question 10

Large artery stroke

Answer 10

IX: scattered single territory lesions,
CTA: stenosis
Tx:
Carotids can have stent or end arterectomy if symptomatic and greater than 50% stenosis
Intracranial: statins and dual anti platelet agent

Question 11

Small vessel stroke

Answer 11

Hx: non white
IX: lesion in territory of small perforating arteries
To: BP lowering prevents hemorrhage later
Single anti platelet agent
Statins are controversial

Question 12

Other kinds of stroke

Answer 12

Causes:
Moyà Moyà disease
Cervical dissection
Arteriopathy

Question 13

Transient ischemic attack

Answer 13

Transient episode of neurological dysfunction resulting from ischemia but without acute infarction

SX: high risk: unilateral motor weakness, speech deficit lasting more than 5 minutes, occurring in last 48h

IX: diffusion weighted MRI, CTA, carotid us, ECG, CBC
Rule out transient neurological attacks (migraine, seizure, vertigo)

Tax: if carotid stenosis: antiplatelets and revascularization, intracranial may use tpa

Question 14

Sub-arachnoid hemorrhage

Answer 14

Ex: trauma, aneurysm 
SX: thunderclap headache
Stiff neck
Nausea/vomit
CN palsy 
(Beware sentinel headache)
IX: CT head if 6h
Tx: clip/coil aneurysm, quit smoking, lower BP

Question 15

Cerebral venous thrombosis

Answer 15

Ex: OCP, genetic, infection, iron deficiency
SX: new seizure, headache progressive, focal neurological findings
IX: CT venogram
Tx: anticoagulate, treat cause, surgical intervention if fulminant

Question 16

Intercerebral hemorrhage

Answer 16

Ex: HTN”drugs, amyloid angiopathy, AVM
SX: seizure
IX: CTA, MRI- measure volume
Tx: blood pressure

Question 17

If a stroke is in the frontal eye fields, which way do the eyes deviate?

Answer 17

Towards the stroke (away from paralysis)

Question 18

Conduction aphasia localized to

Answer 18

Arcuate fasiculus

Question 19

How to treat cerebral edema in stroke?

Answer 19

Peaks at 24-96h
SX: drowsiness, pupillary asymmetry, periodic breathing patterns
Tx: hyperventilation, mannitol, furosemide

Question 20

Webers Syndrome

Answer 20

Ex: infarction in penetrating vessels of PCA
Path: damages cerebral peduncle, fasicle of CN 3, pyramidal fibers

Question 21

Difference between RAPD and blown pupil

Answer 21

RAPD is CN2 issue- decreased response when light shines on affected pupil
Blown pupil- cN3 issue- no response to stimulation