Stroke Flashcards
1
Q
stroke is the ____ most common cause of death in the US
A
3rd
after heart disease and cancer
2
Q
Most important modifiable risk factors for stroke (5)
A
hypertension AF DM cigarette smoking hyperlipidemia
3
Q
AF increases risk of stroke by
A
6x
4
Q
RHD increases risk of stroke by
A
18x
5
Q
Diabetes increases stroke compared to nondiabetics by
A
2x as much
6
Q
in the case of CAD, the level of ___ has the most impact on the incidence of stroke
A
LDL
7
Q
characteristic of atherothrombotic vs cardioembolic stroke is the occurrence during sleep
A
atherothrombotic
8
Q
preferential location of atheromatous plaques (IVMPA) (5)
A
(1) in the internal carotid artety; at its origin from the common carotid;
(2) in the cervical part of the vertebral arteries and at their junction to form the basilarartery;
(3) in the stem or at the main bifurcation of the middle
cerebral arteries;
(4) in the proximal posterior cerebral arteries as they wind around the midbrain; and
(5) in the proximalanterior cerebral arteries
9
Q
Most typical sign of CVD
A
hemiplegia
10
Q
For embolic strokes, the most important risk factors are (2)
A
structural cardiac disease and arrhythmias (AF)
11
Q
TIAs are generally cosidered as more closley aligned with
embolic or atherothrombotic stroke
A
atherothrombotic
12
Q
True or False
It is unusual for the cerebellar and ophthalmic arteries to show atheromatous involvement
A
True
13
Q
It is high degree of stenosis usually above ____ % of the original lumen compromised or a residual lumen of less than approximately __mm of the carotid artery that is most likely to be associated with strokes in the distal territory of the vessel
A
90% and less than 2mm
14
Q
CHADS2
A
Congestive Heart Failure Hypertension Age (<65,0; 65-74,1; >75,2) Vascular disease 1 Diabetes Female Stroke or TIA (2)
15
Q
CHA2DS2-VASC
A
Congestive Heart Failure - 1 Hypertension - 1 Age (<65=0; 65-74=1; >75=2) Diabetes - 1 Stroke or TIA - 2 Coronary or peripheral vascular disease - 1 Female - 1
16
Q
How many percent of infarcts that follow TIAs occur within a month? how many percent within a year?
A
20% of infarcts that follow TIAs occur within a month
50% within a year
17
Q
True of False
Blindness in amaurosis fugax or TMB is painless
A
True
p787
18
Q
Vascular factors in Ischemic infarcts
Anastomosis in occlusion of ICA (neck) via _____ (1)
Occlusion of vertebral artery
_____________(3)
A
ICA - from the ECA via ophthalmic artery
vertebral artery - anastomotic vessels via deep cervical, thyrocervical, or occipital arteries
19
Q
Over a range of mean
blood pressures of approximately ____ to ____ mm Hg, the small pial vessels are able to dilate and to constrict in order to maintain cerebral blood flow (CBF) in a relatively narrow range.
A
50 to 150 mm Hg
20
Q
CBF in which it causes infarction regardless of duration
A
10-12ml/100g/min
21
Q
critical level of hypoperfusion that abolishes function and leads to tissue damage
A
12-23ml/100g/min
22
Q
Changes at the previously mentioned critical level of hypoperfusion
A
EEG changes: slow and isoelectric
K - increases
ATP - depleted
reversible if circulation is quickly restored
23
Q
Temperature and reduction of metabolic requirements
reduction of 2 to 3C reduces metabolic requirements of neurons and increases tolerance to hypoxia by ____%
A
25 to 30%
24
Q
Stroke Trial ATC
A
Antiplatelet Trialists’ Collaboration
pts with symptomatic atherosclerosis on ASA 50-1500mg/day
23% odds reduction in the composite outcome of MI, vascular death, stroke
25
Stroke Trial CATS
Canadian American Ticlopidine Study
pts with thromboembolic strokes were randomized to ticlopidine 250mg BID vs placebo
ticlopidine reduces the risk of composite outcome of MI, stroke and vascular death by 30%
26
Stroke Trial TASS
Ticlopidine Aspirin Stroke Study
pts with recent TIA or ischemic stroke were randomized to ticlopidine 250mg BID vs ASA 1300mg/d
Ticlopidine reduced the risk of stroke or death at 3 years by 12% relative to ASA
27
Stroke Trial CAPRIE
Clopidogrel versus ASA at Risk of Ischemic Events
clopidogrel showed slightly reduced vascular complications rates compared to ASA, driven mostly by reductions in the rate of vascular complications in PAD pts
primary outcome: composite cluster of ischemic stroke MI vascular death
borderline clinical signiifcance RR 8.7% clopid vs ASA
with h/o PAD: RR 23.8%
28
Stroke Trial MATCH
Management of Atherothrombosis with Clopidogrel in High Risk Patients with TIA or Stroke
Aspirin and clopidogrel compared with clopidogrel alone after recent ischemic stroke or TIA in high risk patients
SA 75mg + clopid 75mg is no more effective than clopid 75 for secondary prevention of vascular complications with a siginificant higher risk of major and minor bleeding
29
Stroke Trial CHARISMA
Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization Management and Avoidance
(Clopidogrel and ASA vs ASA alone for the prevention of Atherothrombotic events
Clopidogrel +ASA is not superior to ASA for preventing vascular complications and death, but may be considered in pts with symptomatic atherothrombosis. that is offset by a nonsignificant absolute risk increase of 0.4% for sever bleeding especially in those multiple vascular risk factors
30
Stroke Trial SPS3
Secondary Prevention of Small Subcortical Strokes 3
pts with lacunar infarcts within 180 days were randomized to clopid 75+ASA 325mg vs ASA 325 mg
ffup of 3.4 yrs rate of recurrent stroke was not significantly different between groups
31
Stroke Trial CSPS
Cilostazol Stroke Prevention Study
pts with cerebral infarctions in the past 6 months were randomized to cilostazol 100mg BID vs placebo
reduction of recurrent ischemic stroke in cilostazol group by 41.7%
32
Stroke Trial TOSS 1
Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis
progression of symptomatic intracranial stenosis by MRA was significantly lower with cilostazol and ASA compared with ASA alone
33
Stroke Trial CSPS 2
Cilostazol Stroke Prevention Study 2
pts with cerebral infarctions were randomized to cilostazol 100mg BID vs ASA 81mg
primary outcome of non-inferiority
hemorrhagic events occurred less but headache, tachycardia and diarrhea were more frequent in cilostazol group
34
Stroke TOSS 2
Trial of Cilostazol in Symptomatic Intracranial Arterial Stenosis
pts with acute ischemic stroke within 2 weekssecondary to stenosis of MCA and basilar artery were randomized to cilostazol 100mg BID + asa vs Clopid + ASA
no significant difference in the rate of progression between groups
less hemorrhagic complications seen in cilostzol treated grp
35
Stroke Trial ESPS 1
European Stroke Prevention Study 1
pts with ischemic strokes were randomized to dipyridamole + ASA vs placebo
combination DP + ASA reduces the risk of stroke and detah by 33%
36
Stroke Trial ESPS 2
European Stroke Prevention Study 2
Dipyridamole and ASA in the secondary prevention of stroke
ASA 25 mg BID and dipyridamole 400mg in a modified realease form at a dose 200 mg twice daily have each been shown to be equally effective for the secondary prevention of ischemic stroke and TIA compared to placebo and the combination of the two is superior to either agent alone with no significant increase in death
37
Stroke Trial ESPRIT
European/Australasian Stroke Prevention in Reversible Ischemia Trial
Aspirin plus Dipyridamole versus Aspirin Alone after Cerebral Ischemic of Arterial Origin (ESPRIT)
Aspirin 30 -325 mg plus dipyridamole220 mg bid compared to ASpirin monotherapy significantly lowers the incidence of stroke, MI, death, from vascular causes and major bleeds and is equally safe in pts with h/o of ischemic stroke or TIA in the last 6 months
38
Stroke Trial PROFESS
Prevention Regimen for Effectively Avoiding Second Stroke
Although telmisartan reduces mena BP in recurrent stroke pts, it does not affect disability or cognitive dysfunction at 30 months compared to placebo
ASA + dipyridamole vs clopidogrel cofers no similar benefits, but significantly increases major hemorrhagic complications
39
Stroke Trial TACIP
Triflusal Aspirin Cerebral Infarction Prevention
pts with tia or ischemic strokes
triflusal 600mg/day vs ASA 325
similar efficacy between groups in in combined endpoint of stroke,MI and vascular death
40
Stroke Trial TAPIRSS
Triflusal versus Aspirin in the Prevention of Infarction: A Randomized Stroke Study
pts with recent TIA or ischemic strokes were randomized to triiflusal 600mg/day vs ASA 325 mg/day
no significant difference in combined endpoint of stroke, MI, vascular death
41
Stroke Trial WARSS
Warfarin Aspirin Recurrent Stroke Study
there was no benefit from warfarin INR 1.4 -2.8 compared to ASA 325mg daily for secondary prevention of ischemic, non cardioembolic stroke or death
42
Stroke Trial WASID
Warfarin Aspirin in Symptomatic Intracranial Disease
for symptomatic intracranial stenosis 50-99% warfarin increased the risk of adverse events without any vascular cause other than stroke compared to Asa 1300mg
43
T/F
| Migraine headaches are not a component of Binswanger Disease
True
44
recurrent small strokes beginning in early adulthood culminate in a subcortical dementia
imaging: large confluent cerebral white matter changes
mutation: missense change on chromosome 19 of the NOTCH 3 gene
CADASIL
| Cerebral Autosomal Dominant Arteriopathy with Subcortical infarcts and leukoencephalopathy
45
different vasculopathy, migraine not part of the syndrome
NOTCH gene is normal
inheritance is a recessive trait from a mutation in HTAR1 gene
resulting in fragmentation and duplication of the internal elastic lamina of cerebral vessels with narrowing of their lumens
CARASIL
46
T/F
| Levels of protein C and S and of antithrombin are temporarily depressed after stroke
True
Adams p833
so that any detected abnormalities must be confirmed months later and in the absence of anticoagulation
47
Genetic disorder which cause arterial or venous infarction with maternal type of inheritance
MELAS (mitochondrial)
48
most common sites of ICH
1. putamen and int capsule 50%
2. central white matter of temporal parietal frontal lobes
3. thalamus
4. cerebellar hem
5. pons
49
the _____ sign the appearance of contrast within the hemorrhage during CT angiography is associated with a high rate of hematoma expansion
spot sign
50
how many weeks before the surrounding edema in ICH begins to recede and the density of hematoma decreases
2-3 weeks
51
hypertensive vascular lesions that lead to arteriolar rupture
changes in arterial wall referred to as segmental lipohyalinosis and the formation of false aneurysm (microaneurysm) named as
Charcot Bouchard aneurysms
52
aspirin can prevent stroke due to AF by how many percent
24
53
warfarin reduces stroke in AF by how many percent
64
54
warfarin compared with aspirin reduced stroke by
38
55
identify trial
among patients intolerant with warfarin, dual antiplatelet therapy using clopidogrel and aspirin is better than aspirin alone but there was increased bleeding with DAPT
ACTIVE-A
56
Mortality rate in patients with clots of 60mL or larger and an initial Glasgow Coma Scale score of 8 or less
Mortality is 90%
57
Mortality rate for ICH score of 4
97%
58
```
ICH score for the following
GCS 5-12
>30ml
age <80
with intravetricular hemorrhage
```
ICH score 3, mortality rate of 72%
59
T/F
In patient with ICH who survive, there can be as surprising degree of restoration of function because in contrast to infarction, the hemorrhage has to some extent pushed brain tissue aside rather than destroy it
True
60
goals in management of patients with large ICH
PCO2
osmolality
Na
PCO2 25-30mmHg
Osmolality 295 to 305 mOsm/L
Na 145 to 150 mEq
61
STICH
Surgical Trial in ICH
1033 patients with supratentorial hemorrhage
failed to show benefit from early surgery on survival or neurologic functioning at 6 months
62
site of rupture in saccular or berry aneurysm
dome of the aneurysm
63
increased incidence of "conditions" with saccular aneurysms and vice versa
(5)
```
congenital polycystic kidneys
fibromuscular dysplasia of the extracranial arteries
moyamoya
arteriovenous malformations of the brain
coarctation of the aorta
```
64
Percentage of saccular aneurysms that lie on the anterior part of the circle of Willis
90 to 95 percent
65
Most Common Sites of Aneurysm formation
(1) proximal portion of Acomm
(2) origin of Pcomm at the stem of ICA
(3) first major bifurcation of MCA
(4) bifurcation of ICA into middle and anterior CAs
66
in patients who survive the initial aneurysmal rupture, the most feared complication
rerupture
67
Radiation of pain of ruptured aneurysms in the ffg
cavernous or anterolaterally situated
posteroinferior or Anteroinferior cerebellar artery
cavernous or anterolaterally situated - projected to the orbit
posteroinferior or Anteroinferior cerebellar artery - unilateral occipital or cervical pain
68
where is the aneurysm located?
(1) monocular visual field defect
(2) partial CN III palsy, dilated pupil
1 supralcinoid aneurysm near the anterior and middle cerebral bifurcation or the ophthalmic-caroitd bifurcation
2 PComm-IC junction or at the PComm-PC junction
69
in Both traumatic puncture and early AH the proportion of WBCs to RBCs in the CSF is usually the same as the circulating blood
ration of WBC to RBC
1:700
70
How many percent of patients with with aneurysmal rupture will not have an aneurysm evident after 4v angio
5-10%
71
Vasospasm usually appears when
3-10 days after rupture
72
morphologic changes seen in arteries in chronic spasm
smooth muscle cells of media become necrotic
| adventitia infiltrated with neutrophilic leukocytes, mast cells, and red blood corpuscles
73
Delayed and subacute HCP as a result of blockage of the CSF pathways by blood may appear after how many weeks
2 to 4 weeks
74
subhyaloid hemorrhages, or preretinal hges
| outlined collections of blood that cover the retinal vessels, associated with SAH
Terson Syndrome
75
systemic changes associated with SAH
```
1 ECG changes, large peaked T waves, cerebral T waves
2 minor elevation of troponin and myocardial band of creatine phosphokinase
3 decreasing EF
4 hyponatremia
5 albuminuria and glycosuria
6 DI
7 leukocytosis 15 to 18k
8 ESR and CRP Normal
```
76
International Subarachnoid Aneurysm Trial Group
2000 patients
surgery vs coiling
Endovascular: 24% overall rate of death or dependence at 1 year
Surgery: 31%
77
in SAH risk of infection in shunt tubing is high if it is left in place for more than
3 days
78
for unruptured aneurysms, what is the significant feature in relation to rupture
aneurysmal size
79
rate of rupture for aneurysms smaller than 7mm diameter
size between 7mm and 10mm
size 13mm to 24mm
>25mm
smaller than 7mm diameter 0.1%
size between 7mm and 10mm 0.5%
size 13mm to 24mm
0.6 to 3.5%
depending on location
>25mm 10%
80
in AVM rate of rebleeding in most series
2-4% per year over decades or
| 6-9% per year in the year after hemorrhage
81
Spetzler Martin Scale
gives guidance to surgical difficulty and risk
82
prognosis of 20 - 40 % of AVMs amenable to block dissection
Mortality rate 2-5% and morbidity of 5-10%
83
size of AVMs amenable to radiosurgery
smaller than 3 cm
84
drawback of radiosurgery in obliteration of AVM
latency of at least 18 to 24 months
| patient is unprotected from rebleeding
85
success rate after 2 years in AVMs less than 2.5cm which underwent radiotherapy
75-80% have been obliterated
86
Complications of radiotherapy
delayed radiation necrosis and venous congestion
87
Endovascular techniques prognosis
25% of small and medium size AVM have been completely obliterated
Mortality rate 3 %
Morbidity 5-7%
88
Dural AV fistulas at high risk of bleeding are those located in (2)
anterior cranial fossa
| tentorial incisura
89
risk of intracranial hemorrhage with use of thrombolytic drugs in the treatment of stroke and MI
%?
6-20%
90
top 3 MC tumors than can cause tumoral bleed
choriocarcinoma
melanoma
renal cell and bronchogenic ca
```
others
pituitary adenoma
thryroid Ca
GBM
intravascular lymphoma
carcinoid
medulloblastoma
```
91
Mortality rate in CVT with large hemorrhagic venous infarctions
20%
92
Stroke Trial ARISTOTLE
Apixaban Versus Warfarin in Patients with AF
apixaban 5mg BID is superior to warfarin INR 2-3 for the prevention of stroke and systemic embolism in patients with Afib and causes significantly less ICh, major bleeding and death
93
ACTIVE-A
Effect of Clopridogrel
added to Aspirin in Patients with AF
In patients with AF not suitable to warfarin, ASA + clopid significantly decreases ischemic stroke risk and significantly increases minor + major bleeding risks compared to ASA monotheraoy
94
AVERROES
Apixaban in Patients with AF
Apixaban 5mg BID is superior to ASA 81-324mg for prevention of stroke or systemic embolism in pts with AF who are unsuitable for warfarin and apixaban appeared to have similar bleeding rates to ASA in this cohort
95
CHANCE
Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack
Among patients with TIA or minor stroke who can initiate antiplatelets within 24 hrs after symptom onset, the combination of clopidogrel and aspirin for the first 21 days after stroke is superior to aspirin alone for reducing the rist of stroke in the first 90 days and does not increase the risk of moderate-sever hemorrhage
96
CREST
Stenting versus Endarterectomy for Treatment of Carotid-artery Stenosis
Pts undergoing CAS are more likely to have periprocedural stroke whereas CEA patients are more likely to have periprocedural MI, Patients <70 years who underwent CAs had less periprocedural stroke than those >70; patients >70 who underwent CEA had better outcomes than CAS. There is no significant difference in composite stroke, MI, death between CEA and CAS in suymptomatic or asymptomatic extracranial ICA stenosis
97
ECASS
Thrombolysis with ALTEPLASE 3-4.5 hrs after Acute Ischemic Stroke
treatment with IV tPA at 3-4.5 hrs from stroke onset is associated with more favorable outcomes (mRS 0-1) and more symptomatic ICH compared to placebo
european
new exclusion criteria: age > 80, NIHSS > 25, prior stroke with diabetes
98
FASTER
Fast Assessment of Stroke and TIA to prevent early recurrence
ASA clopidogrel load 300mg + daily maintenance 75 mg or simvastatin 40mg to ASA 81 mg may when given <24 hrs from stroke onset showed no difference in stroke risk at 90 days, but study was underpowered to detect a statistically significant difference
99
INTERACT 2
Rapid Blood pressure lowering in patients with Acute ICH
In patients with mild to moderate spontaneous IC, intensive SBP control to goal <140 within 1 hour compared to conservative treatment of <180 within 6 hrs shows no difference in major disability or death at 3 months, but is equally safe
100
IST -3
The Benefits and Harms of IV thrombolysis with rTPA within 6 hrs of Acute ischemic stroke
tPA given within 6 hours after onset leads to more ICH and death in the first 7 days but there was an increase in favorable outcomes at 6 months Pts aged >80 and pts <80 showed no difference in independence at 6 months
101
NINDS
TPA in acute ISchemic Stroke
Acute Ischemic Stroke treated with IV TPA in the first 3 hrs is associated with a better 3 month global outcome measure compared to placebo as well as an increased rate of symptomatic ICH at 36 hours
symptomatic ICH rate at 36 hrs was 6.4% in tPA vs 0.6% in placebo
minor external bleeding in tPA vs placebo 23 vs 3%
102
T/F
| The occurrence of carotid TIAs is a predictor of myocardial infarction.
True
| p786
103
After TMB/amaurosis fugax
The risk of stroke over 3 yrs following an attack is _____ if there are no other issues such as diabetes
but the risk of stroke is _____ in patients with atherosclerosis
2%
24%
104
anticoagulant factors
heparin cofactor 2
antithrombin III
protein C and S
105
Right common carotid artery arises at
level of sternoclavicular notch from the innominate (braciocephalic) artery
106
Left common carotid artery comes form
aortic arch
107
bifurcation of the common carotid artery is at the level of
C4
108
atherosclerosis or stenotic occlusion of MIDPORTION of CCA occurs after
radiation therapy for laryngeal, thyroids, or any head and neck cancer
109
T/F
The internal carotid is an end vessel.
FALSE
NOT AND END VESSEL
p795
110
T/F
Studies over the years have affirmed that most carotid occlusions are thrombotic whereas most middle cerebral occlusions are embolic.
True
p797
111
T/F
Occlusion of the anterior cerebral arteries is usually embolic.
True
| p800
112
With a left sided occlusion of _____ there may be a sympathetic apraxia of the left arm and leg or involuntary misdirected movements of the left arm (alien arm or hand)
ACA
113
Language disturbance that may occur with anterior cerebral artery stroke
transcortical motor aphasia
114
with occlusion of the penetrating branches of the ACA, which structures are usually involved
caudate
| anterior limb of internal capsule
115
origin of the anterior choroidal artery
internal carotid
116
what structures are being supplied by the anterior choroidal artery
internal segment of globus pallidus
posterior limb of Internal capsule
optic tract
choroid plexus and anastomoses with posterior choroidal artery
117
thalamoperforate branches arise from
junction of the posterior cerebral branch and posterior communicating arteries
118
thalamoperforate branches supply what structures
inferior
| medial and anterior parts of the thalamus
119
thalamogeniculate branches supply
geniculate body and central and posterior parts of thalamus
120
artery of Percheron
anatomic variant
| azygos paramedian artery supplies both sides of the posterior medial thalamus
121
occlusion of which part of the thalamus causes amnesic (Korsakoff) syndrome
paramedian thalamic branches to the mediodorsal nucleus
122
Cortical Syndromes of the Posterior Cerebral Artery
occipital infarcts of the dominant hemisphere may cause alexia without agraphia, anomia, a variety of visual agnosias, rarely some degree of impaired memory
123
effect of bilateral occipito-parietal border-zone lesions
Balint syndrome
124
Branches of basilar artery
1. paramedian 7-10 pairs supplying wedge of pons on either side of midline
2. short circumferential 5-7 pairs - lateral 2/3 of pons and the middle and SCP
3. long circumferential - 2 on each side
SCA and AICA
4. several paramedian (interpeduncular) branches
125
3 mechanisms for lacunar infarction
1. local type of fibrohyalinoid arteriolar sclerosis that involves the orifice or proximal part of a small penetrating blood vessel
2. atherosclerosis of a large trunk vessel that occludes the origin of these small vessels
3. entry of small embolic material into one of the vessels
126
MOA tPA
| tissue plasminogen activator
convert plasminogen to plasmin
127
T/F
For tPA the dose used in acute stroke is higher than that of myocardial infarction.
False
Lower dose
p813
128
risk of symptomatic ICH after rtPA treatment
6%
p813
129
T/F
Ticlopidine and clopidogrel are considered on the basis of clinical trials to be equivalent or marginally more effective than aspirin for the prevention of stroke but they are more expensive.
True
p819
130
toxicity of clopidogrel and ticlopidine
ticlopdiine - neutropenia
clopidogrel - TTP
*dipyridamole in high doses not tolerated because of dizziness induced by peripheral vasodilation
131
Mortality rate in extensive brainstem infarction caused by basilar artery occlusion
40%
132
segmental, nonatheromatous, noninflammatory arterial disease of unknown etiology
fibromuscular dysplasia
133
most common origin of vertebral artery dissection
C1 and C2 segment of vessel where it is mobile but tethered as it leaves the foramen of the axis and turns sharply to enter the cranium
134
T/F
in vertebral artery dissection, pseudoaneurysms in the cervical portions of the vessels generally do not require specific treatment..
True
| p829
135
treatment of cervical artery dissection
primarily anticoagulation for several weeks or months and followed up with some form of arteriography
choice between aspirin and warfarin has not been clarified
136
formation of a network of small anastomotic vessels at the base of the brain around and distal to the circle of Willis
seen in carotid arteriograms, associated with segmental stenosis or occlusion of the terminal intracranial parts of both internal carotid arteries
Moyamoya Disease
137
abnormality in Moyamoya disease
carotid lesion:
thickened intima by fibrous tissue
normal adventitia, media and internal elastic laminae
rete mirabile:
microaneurysm formation because of weakness of the IEL and thinness of vessel wall
138
widespread degeneration of cerebral white matter having a vascular causation and observed in the context of hypertension, atherosclerosis of the small blood vessels and multiple strokes
dementia, pseudobulbar state, and a gait disorder alone or in combination are the main features
Binswanger Disease
139
large confluent cerebral white matter changes
hereditary multiinfarct dementia
autosomal dominant
migraine headaches precede the strokes
CADASIL
| cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
140
syndrome of early alopecia and lumbar spondylosis with the white matter changes typical of CADASIL
CARASIL
| cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy
141
mutation in CADASIL
missense change in Chrom 19 NOTCH3 gene
142
gene implicated in CARASIL
HTAR1
143
vascular lesion underlying cerebral thrombosis in women taking oral contraceptives
nodular intimal hyperplasia of eccentric distribution with increased acid mucopolysaccharides and replication of the internal elastic lamina
144
T/F
The use of progestin-only pills or of subcutaneously implanted capsules of progestin has been associated with stroke.
False
has NOT been associated
p836
145
In thalamic hemorrhage presenting with skewed eyes, which of the ffg is CORRECT?
a. contralateral eye assumes a higher position
b. ipsilateral eye assumes a higher position
c. both eyes assume a high position
d. can be any of the above
b. ipsilateral eye assumes a higher position
146
ICH score components
GCS 3-4 = 2
5-12 = 1
13-15 = 0
ICH volume more than 30cc = 1, less than 30cc = 0
Age 80 and above = 1, less than 80 = 0
infratentorial = 1
IVH = 1
147
ICH score and mortality rate
```
score 5 above, 100%
4, 97%
3, 72%
2, 26%
1, 13%
```
148
Hunt and Hess grading in SAH
Grade I. Asymptomatic or with slight headache and stiff neck
Grade II. Moderate to severe headache and nuchal rigidity but no focal or lateralizing neurologic signs
Grade III. Drowsiness, confusion, and mild focal deficit
Grade IV. Persistent stupor or semicoma, early decerebrate rigidity and vegetative disturbances
Grade V. Deep coma and decerebrate rigidity
149
marker that is overrepresented in Alzheimer disease is associated with amyloid angiopathy
Apo E4
150
Stroke in hypercoagulable state
criteria for diagnosis of antiphospholipid antibody (Hughes) syndrome
an ischemic event be accompanied by the detection of auto antibodies on two occasions at least 6 weeks apart
151
caused by anacquired circulating IgG inhibitor of the von Willebrand Factor-cleaving protease
disease of the small blood vessels combined with microangiopathic hemolysis
characterized by widespread occlusions of arterioles and capillaries
Thrombotic Thrombocytopenic Purpura
fever, anemia, symptoms of renal and hepatic disease and thrombocytopenia
neurologic: confusion, delirium, seizures, hemiparesis
152
abnormal hemoglobin S in red corpuscles
Sickle cell disease
