Stroke Flashcards
1
Q
Stands as the most typical sign of cerebrovascular diseases
A
Hemiplegia
2
Q
Miscellaneous conditions taken to be as stroke
A
Migraine, Bell’s palsy, Stokes-Adams syncopal attacks, labyrinthine vertigo, diabetic ophthalmoplegia, temporal arteritis
3
Q
It is the most recognised factor in the genesis of primary intracerebral hemorrhage
A
Hypertension
4
Q
Atrial fibrillation increases the incidence of stroke by how may folds?
A
6x
5
Q
The top three most frequent sites of atheromatous plaques
A
1) in the ICA at its origin from the carotid artery
2) in the cervical part of the VA and at their junction to form the BA
3) in the stem or at the main bifurcation of the MCA
6
Q
This is the most common cause of ischemic strokes and of all types of stroke
A
Cerebral embolism
7
Q
Approximately how many percent of infarcts that follow TIA occur within a year?
A
50%
8
Q
TIA consisting of homonymous hemianopia should suspect stenosis of which vessel?
A
PCA
9
Q
Hemodynamic changes in the cerebral circulation when the lumen of the ICA is reduced to how many mm?
A
2.0 mm
10
Q
Why does the necrotic tissue at the centre of an ischemic stroke swells rapidly?
A
because of excessive intracellular water content
11
Q
The critical level of hypoperfusion that abolishes function and leads to tissue damage?
A
12-23 mL/100g/min
12
Q
After how many minutes can cells withstand complete absence of O2?
A
20 minutes
13
Q
A reduction of 2-3 degrees celsius reduces metabolic requirements of neurons and increases their tolerance to hypoxia by how many %?
A
25-30%
14
Q
Origin of the left common carotid artery
A
Aortic arch
15
Q
Which artery supplies the lower internal capsule, globes pallidus, uncus, amygdala and hippocampus?
A
Anterior choroidal artery
16
Q
Which artery supplies the putamen, upper internal capsule, lower corona radiate and body of caudate?
A
Penetrating branches of MCA
17
Q
Occlusion of this segment of the ACA results in a sensorimotor deficit of the opposite foot and leg, and to a lesser degree, of the shoulder and arm, with sparing of the hand and face
A
A2 segment
18
Q
The anterior choroidal artery springs from what artery?
A
ICA
19
Q
Syndrome characterized with paralysis of soft palate and vocal cord and contralateral hemianesthesia
A
Avellis Syndrome
20
Q
Characterised by transient loss of consciousness, oculomotor disturbances, hemianopia, bilateral ptosis and pupillary enlargement with preserved reaction to light
A
Top of the basilar artery occlusion
21
Q
Lacunes are usually caused by occlusion of small arteries measuring?
A
50-200 microns in diameter
22
Q
81% of lacunar stroke are caused by?
A
hypertension
23
Q
Most common location of lacunes?
A
putamen and caudate nuclei
24
Q
The relative improvement in neurologic state after TPA infusion came at the expense of how many percent risk of symptomatic cerebral haemorrhage?
A
6%
25
Two situations in which the immediate administration of heparin is indicated
Basilar Artery Thrombosis with fluctuating deficits
| Impending Carotid Artery Occlusion from thrombosis
26
Bleeding into any organ after heparin infusion may occur when the PTT is how many times greater than the pretreatment level?
3x
27
Drugs that may alter the anticoagulant effects of warfarin
Aspirin, Cholestyramine, Alcohol, Carbamazepine, Cephalosporin, Quinolones, Sulfa drugs, Penicillin
28
This develops several days to a week after carotid endarterectomy presenting with headache, focal deficits, seizures, brain edema or cerebral haemorrhage.
Hyperperfusion Syndrome
29
A bruit generally corresponds to the reduction in luminal diameter of the artery to how many mm?
2mm
30
Artery most frequently involved in fibromuscular dysplasia
Internal carotid artery
31
Treatment for cervical dissection
Anticoagulation
32
Refer to an extensive basal cerebral rete mirabile
Moyamoya disease
33
Disease characterised by dementia, pseudobulbar state and gait disorder?
Binswanger disease
34
Mutation associated with CADASIL?
missense change on chromosome 19 of the NOTCH 3 gene
35
small brainstem hemorrhages secondary to temporal lobe herniation and brainstem compression
Duret hemorrhages
36
Approximately 50% of the cerebral haemorrhages occur in what area?
putamen and adjacent internal capsule
37
Appearance of contrast within the hemorrhage during CTA which is associated with a high rate of hematoma expansion
spot sign
38
Why is arteriography necessary in establishing the diagnosis of AVM?
1) to define the feeding arteries
2) to look for the presence of an aneurysm
3) to determine the channels of venous drainage
39
Dural Arteriovenous Fistula is usually fed by which vessels?
Dural arterial vessels of the internal cranial circulation
40
Vascular malformations composed mainly of clusters of thin-walled veins without important arterial feeders
Cavernoma
41
Second most common cause of cerebral haemorrhage next to hypertension
Anticoagulant therapy
42
Tumors most commonly associated with cerebral haemorrhage?
Choriocarcinoma, melanoma, renal cell and bronchogenic carcinoma
43
T/F: The brain edema in hypertensive encephalopathy is caused by active exocytosis of water rather than simply a passive leak from vessels subjected to high pressures.
True
44
Patient presenting with bilateral headache, stiffness in the proximal muscles of the limbs associated with the markedly elevated sedimentation rate
Temporal arteritis
45
This is a nonspecific chronic arteritis involving mainly the aorta and the large arteries arising from its arch
Takayasu Disease
46
The disease was originally distinguished by the triad of relapsing iridocyclitis and recurrent genital and oral ulcers
Behcet disease
47
Least common of the venous syndromes
Occlusion of the vein of Galen
48
Most common and most serious disorder of coagulation affecting the nervous system
Disseminated Intravascular Coagulation
49
The formal criteria for the diagnosis require that an ischemic event be accompanied by the detection of autoantibodies on two occasions at least 6 weeks apart
Antiphospholipid Antibody Syndrome
50
The most frequent neurologic abnormality of APAS
Amaurosis fugax
51
Arteriopathy producing deep blue-red skin lesions of livedo reticularis and livedo racemosa in association with multiple ischemic strokes
Sneddon Syndrome
52
T/F: Seizures are quite infrequent as the initial manifestation on an ischemic stroke and when they do occur in this fashion, an embolus is usually the causative mechanism
True
53
Percent increase in the number of patients with little of no neurologic deficit with the use of IV RTPA
30%
54
T/F: Administration of IV heparin prevents early recurrence of stroke
True
55
Infarction is caused by a reduction of CBF below this level
10-12 ml/100g/min
56
A reduction of 2-3 degrees celsius reduces the metabolic requirement of neurons and increases the tolerance to hypoxia by how many %?
25-30%
57
These neurotransmitters, released by ischemic cells, excite neurons and produce an intracellular influx of Na and Ca.
Glutamate and aspartate
58
It is a Vitamin K-dependent protease, that in combination with its cofactors protein S and antithrombin III, inhibits coagulation.
Protein C
59
A dangerous complication of anticoagulation which is a result of paradoxical microthrombosis of skin vessels and is liable to occur in patients with unsuspected deficiencies of endogenous clotting proteins.
Hemorrhagic skin necrosis
60
T/F: the value of surgical decompression has not been limited to patients with right-hemispheric strokes.
True
61
It is a segmental nonatheromatous, noninflammatory arterial disease of unkonwn etiology almost exclusively in women characterized by a series of transverse constriction of the arteries.
Fibromuscular dysplasia
62
T/F: a unilateral Horner syndrome is often present in internal carotid artery dissection.
True
63
Where does vertebral artery dissection commonly originates?
C1-C2 segment of the vessel
64
Characterized by a combination of dementia, pseudobulbar state and gait disorder
Binswanger disease
65
T/F: the risk of both cerebral infarction and intracerebral hemorrhage appears to be mainly in the 6-week period after delivery rather than during the pregnancy itself.
True
66
T/F: As a rule, a cerebellar hematoma less than 2cm in diameter leaves most patients awake and infrequently leads to deterioration, therefore generally not requiring surgery.
True
67
The four most common sites of aneurysm
1) proximal portion of the ACA 2) origin of the PCA 3) first major bifurcation of the MCA 4) bifurcation of the ICA into MCA and ACA
68
An entity which has been used in an imprecise way to refer to both a headache that precedes SAH and to a small leakage prior to rupture.
Sentinel headache
69
T/F: The patient usually does well and a second arteriogram is probably not required in perimesencephalic hemorrhage.
True
70
T/F: In almost half of the patients with AVMs, the first clinical manifestation is a cerebral SAH.
True
71
Second most common cause of intracerebral hemorrhage next to hypertension
Anticoagulant therapy
72
This is perhaps the most common and most serious disorder of coagulation affecting the nervous system.
Disseminated intravascular coagulation
73
The most frequent neurologic abnormality of APAS
TIA
74
The occurrence of carotid TIA is a predictor not only of cerebral infarction but also of myocardial infarction.
True
75
T/F: The frequency of seizures after each type of hemorrhage is lower than for ischemic strokes.
True
76
The "hematocrit effect" is particularly prone to occur in cases of what type of hemorrhage.
Anticoagulant-induced
77
What is the normal CBF?
55 ml/100mg/min
78
The cardinal clinical sign of ICA stenosis near its origin from the common carotid artery
Transient ischemic attacks
79
What is the most common stroke subtype in Asians utilizing the oxfordshire classification?
Partial Anterior Circulation Infarct (PACI)
80
What is the gold standard for the definitive diagnosis of AVM?
Digital subtraction angiography
81
A 63-year old male, hypertensive, diabetic presented with right-sided weakness lasting for 30 minutes. BP 150/100. What is his ABCD2 score?
6
82
Cerebral Ischemia accounts for what percentage of stroke cases?
80%
83
Most important factor in hematoma expansion during the acute phase of ICH
Blood pressure
84
Usual location of hypertensive intracerebral hemorrhage
1) basal ganglia
2) lobar
3) thalamus
4) pons
5) cerebellar
85
Most common cause of drug-related strokes
Cocaine
86
Most common cause of intracerebral bleed in preadolescent children
Vascular malformation
87
T/F: Hydrophilic statin (Atorvastatin) when used in high doses are associated with elevated transaminases but not CPK.
True
88
Most common adverse effect related to dipyridamole
Headache
89
T/F: in bilateral lesions confined to the occipital poles, there may be a loss of central vision only.
True
90
T/F: a solely left-sided infarction of the inferomedial temporal lobe impairs retentive memory.
True
91
T/F: doing decompressive hemicraniectomy for malignant MCA infarcts involving the dominant hemisphere will lead to a worse functional outcome.
False
92
Size of the bone flap for adequate external decompression
```
12 cm (anterior-posterior)
9 cm (superior-inferior)
```
93
NOAC that cannot be given per NGT
Dabigatran
94
Cardinal clinical sign of ICA stenosis near its origin from the common carotid
Transient ischemic attacks
95
Most important cause of drug-related strokes
Cocaine
96
Location of more than 90% of unruptured aneurysms
Acomm and Pcomm
97
Most common organism associated with infectious aneurysms
Streptococcus
98
False aneurysms resulting from intimal tear and intramural hemorrhage
Dissecting aneurysms
99
Trauma causing tearing of bridging veins
Subdural hematoma
100
A focal neurologic deficit that lasts longer than 24 hours but resolves by 3 weeks.
Reversible Ischemic neurologic deficit (RIND)
101
Refers to nonbacterial thrombotic endocarditis (NBTE) in patients with malignancy
Marantic endocarditis
102
Autosomal dominant condition characterized by numerous telangiectasias in multiple organs.
Osler-Weber-Rendu disease
103
In the Northern American Symptomatic Carotid Endarterectomy Trial (NASCET) among patients with symptomatic internal carotid artery stenosis, the 2-year ipsilateral stroke rate was __ in medically treated vs. __ in carotid endarterectomy group.
26% vs. 9%
104
Considered "gold standard" for assessment of degree of internal carotid artery stenosis
Arteriography
105
Risk of angioplasty and stenting is highest in this blood vessel because of many perforating vessels
Basilar artery
106
Recommended for patients with ischemic stroke related to antiphospholipid antibody syndrome
Anticoagulation with warfarin
107
Vascular malformation composed mainly of clusters of thin-walled veins without important arterial feeders and with little or no intervening nervous tissue
Cavernoma
108
Earliest histopathological finding in cerebral infarction
Shrunken eosinophilic neurons
109
T/F: Patients with SAH and negative angiograms have a good prognosis.
True
110
Most common syndrome in lacunar stroke
Pure motor hemiplegia
111
The most common cause of subarachnoid hemorrhage
Post-traumatic
112
Most common cause of TIA
Artery to artery platelet embolism
113
Risk factor for stroke reaches the level of a nonsmoker after how many years?
5 years
114
The single best index of outcome of SAH
Patient's state of consciousness at the time of arteriography
115
Mechanism of stroke among alcoholics
Head trauma
116
CADASIL is associated with what genetic abnormality?
Chromosome 19 Notch 3 gene
117
Most common symptom of hyperperfusion syndrome after carotid endarterectomy
Unilateral severe headache
