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Brain Power: First Aid Neurology > Stroke and Neurocritical Care > Flashcards

Stroke and Neurocritical Care Flashcards

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1
Q

Embolic strokes most commonly affect which artery.

A

MCA

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2
Q

Headaches associated with MCA strokes are usually localized to ___; while they occur in the ___ in PCA strokes.

A

MCA: temporal
PCA: retro-ocular

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3
Q

Lesions to NONDOMINANT parietal lobe cause:

A

Isolated agitated delirium

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4
Q

This direct branch of the ICA supplies the internal segment of the globus pallidus and posterior limb of the internal capsule and optic tract. Occlusion leads to which symptoms.

A

Anterior choroidal artery

Hemiplegia, hemisensory loss, homonymous hemianopia, sparing cognition and language

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5
Q

Components of Gerstmann syndrome.

Where is the lesion?

A

Finger agnosia
Acalculia
Right/left confusion
Agraphia

Dominant inferior parietal lobule / angular gyrus

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6
Q

APRAXIA QUIZ

Choose which term is described:
(A) Ideomotor, (B) ideational, (C) dressing, (D) constructional, (E) dressing apraxia or (F) limb-kinetic apraxia

Where is the lesion?

Inability to perform complex learned movements with preserved understanding of intended movement

A

Ideomotor

Dominant parietal lobe

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7
Q

APRAXIA QUIZ

Choose which term is described:
(A) Ideomotor, (B) ideational, (C) dressing, (D) constructional, (E) dressing apraxia or (F) limb-kinetic apraxia

Where is the lesion?

Inability to perform complex learned movements with impaited understanding of intended movement

A

Ideational

Dominant parietal lobe

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8
Q

APRAXIA QUIZ

Choose which term is described:
(A) Ideomotor, (B) ideational, (C) dressing, (D) constructional, (E) dressing apraxia or (F) limb-kinetic apraxia

Where is the lesion?

Inability to construct a whole from its parts

A

Constructional apraxia.

Nondominant parietal lobe

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9
Q

APRAXIA QUIZ

Choose which term is described:
(A) Ideomotor, (B) ideational, (C) dressing, (D) constructional, (E) dressing apraxia or (F) limb-kinetic apraxia

Clumsiness of skilled acts with preserved understanding of intended movement

A

Limb-kinetic

Premotor or dominant parietal lobe

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10
Q

APRAXIA QUIZ

Choose which term is described:
(A) Ideomotor, (B) ideational, (C) dressing, (D) constructional, (E) dressing apraxia or (F) limb-kinetic apraxia

Loss of topographical orientation resulting in inability to dress in an organized manner

A

Dressing apraxia

Nondominant parietal lobe

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11
Q

NAME THAT SYNDROME

Bilateral cortical blindness with normal-appearing optic disks and preserved pupillary light reflexes, with denial of blindness and visual hallucinations

A

Anton’s syndrome

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12
Q

NAME THAT SYNDROME

Simultagnosia (Inability to synthesize disparate images within the visual field into a coherent whole)

Optic ataxia (Inability to reach targets under visual guidance)

Gaze apraxia (Inability to direct gaze at a target)

Where is the lesion?

A

Balint’s syndrome

Bilateral occipitoparietal border zone strokes

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13
Q

Patient presents with purely visual hallucinations that are well formed, complex, and appear cartoonish and nonthreatening, and are perceived as unreal by the patient. If due to a stroke, where is the lesion?

A

Peduncular hallucinosis

Stroke of the MIDBRAIN in the vicinity of the cerebral peduncles related to PCA occlusion

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14
Q

Inability to recognize and identify familiar faces, interpret facial expressions or judge age or gender based on facial features. If due to a stroke, where is the lesion?

A

Prosopagnosia

Bilateral ventromesial occipitotemporal stroke

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15
Q

Name that syndrome.

Ipsilateral CN III lesion +
Contralateral hemiparesis

A

Weber’s syndrome

Midbrain stroke due to PCA thrombus

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16
Q

Name that syndrome.

Ipsilateral CN III lesion +
Contralateral ataxia / tremor

A

Claude’s syndrome

Midbrain stroke due to PCA thrombus

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17
Q

Name that syndrome.

Ipsilateral CN III lesion +
Contralateral hemiparesis +
Contralateral ataxia / tremor

A

Benedikt’s syndrome

Midbrain stroke due to PCA thrombus

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18
Q

Name that syndrome.

Ipsilateral CN V, IX, X and XI palsy +
Horner syndrome +
Cerebellar ataxia +
Contralateral pain and temperature loss +
Vertigo, nausea, hiccups
A

Wallenberg’s syndrome

Lateral medullary stroke due to vertebral or PICA thrombus

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19
Q

Palatal tremor that persists during sleep and is audible to the patient. If due to stroke, where is the lesion?

A

Palatal myoclonus

Stroke in the dentato-rubro-olivary triangle of Guillan-Molere (usually pontine tegmentum)

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20
Q

Name that syndrome.

Hemisensory loss +
Painful paresthesias

Where is the lesion?

A

Thalamic syndrome of Dejerine and Roussy

VPL/VPM stroke

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21
Q

All CN nuclei are ipsilateral to the nerve except ____ and the ____ subnucleus of ____, which cross contralaterally.

A
  1. CN IV

2. Superior rectus subnucleus of CN III

22
Q

As a rule of thumb, sensory nuclei are located laterally/medially within the brainstem; while motor nuclei are located laterally/medially.

A

Sensory nuclei are lateral while motor nuclei are medial.

23
Q

Normal cerebral blood flow (in mL/100g/min).

What is the critical threshold for functional impairment? Infarction?

A

Normal: 55
Functional impairment: 23
Infarction: 12

24
Q

Autoregulation occurs within this range of mean arterial pressures.

A

50 - 150 mmHg

25
Q

CT signs of stroke

A

Cortical effacement
Loss of grey-white distinction
Spontaneous HYPERdensity along an occluded proximal MCA (hyperdense MCA sign) or MCA branches within the Sylvian fissure (MCA dot sign)

26
Q

What is the gold standard for imaging stroke?

A

MRI

Hyperintensity on DWI and hypointensity on apparent diffusion coefficient maps present within 30 minutes

27
Q

Trials have demonstrated the superiority of this anticoagulant for primary and secondary prevention of stroke in patients with AF (SPAF II trial)

A

Warfarin

28
Q

Indication for elective carotid endarterectomy for low-risk patients

A

> 70% SYMPTOMATIC carotid stenosis (stroke or TIA) (NA-SCET Trial)

> 60% ASYMPTOMATIC (ACAS trial)

29
Q

For patients with dilated cardiomyopathy, warfarin is recommended as prophylaxis if EF is < ___.

A

20%

30
Q

Syndrome of episodic migraine-like headache and cyclic vomiting with focal neurologic deficits and seizure. May have sensorineural hearing loss, pigmentary retinopathy and myopathy.

A

Mitochondrial myopathy, encephalopathy, lactic acidosis and strokes (MELAS)

31
Q

Renovascular hypertension, renal artery stenosis, and internal carotid stenosis associated with aneurysm formation and dissection. Angiogram shows “chain-of-lakes” pattern

A

Fibromuscular dysplasia

32
Q

Indications for use of tPA in ischemic stroke

A
  1. Ischemic stroke within 3 hours of onset
  2. NIHSS > 3
  3. No hemorrhage on head CT
  4. Clear time of onset
33
Q

Contraindications for use of tPA

A
  1. Rapidly resolving deficits
  2. Seizure at onset
  3. Prior stroke or head trauma 14 days
  4. Prior ICH
  5. SBP >185
  6. DBP > 110
  7. GI or GU tract hemorrhage 400
34
Q

Most common site of an ICH

A

Putamen

35
Q

Indications for neurosurgical consultation re: ICH

A

Posterior fossa hemorrhage >3cm in maximal diameter; or significant mass effect on the 4th ventricle or rapidly expanding superficial supratentorial ICH in a young patient with a rapidly declining neuro exam

36
Q

Recommendations for clipping or coiling unruptured aneurysm

A

Anterior circulation aneurysms >7mm
Posterior circulation aneurysms >3mm
Remote aneurysm in a patient with prior rupture
Rapidly enlarging aneurysm

37
Q

CSF Physiology

  1. Normal volume
  2. Rate of CSF production
  3. Normal ICP
A
  1. 150 mL
  2. 20mL/h (450 - 500 mL)
  3. <15 mmHg
38
Q

In hyperosmolar therapy for patients with increased ICP, what is the target serum osmolarity? What is the risk of higher serum osmolarity?

A

Target: 300 - 310 mOsm/L

Acute tubular necrosis if serum osmolarity is higher

39
Q

Target PCO2 range in patients with increased ICP

A

28 - 32 mmHg

40
Q

Goal ICP in patients with increased ICP

A

<20 mmHg

41
Q

Describe grading of concussions.

A

Grade 1: No LOC, sx (ex. confusion) 15 mins

Grade 3: (+) LOC

42
Q

Patient with severe brain injury is comatose; CT is normal. Diagnosis?

A

Diffuse axonal injury

43
Q

Most common locations of punctate hemorrhages in diffuse axonal injury

A

Gray-white junction
Corpus callosum
Middle cerebral peduncles

44
Q

How many percent of TBI patients have C-spine injuries?

A

5 - 10%

45
Q

In DAI, what is the goal CPP and goal ICP?

A

CPP > 60

ICP < 20

46
Q

Is seizure prophylaxis recommended for brain trauma patients?

A

YES. For 1 week in setting of moderate to severe

47
Q

Total caloric needs of patients with severe TBI

A

140%

48
Q

Criteria for intubation in GBS

A
  1. VC < 15 mL/kg
  2. Negative inspiratory force < -25 mL/kg
  3. 30% decrement in forced vital capacity or NIF over 24h
  4. Severe uncompensated respiratory acidosis
  5. Severe bulbar involvement with inability to control secretions
49
Q

Tetrad of neuroleptic malignant syndrome

A

Fever
Rigidity
Autonomic instability
Mental status changes

50
Q

Serotonin syndrome antidote

A

Cyproheptadine

51
Q

Name that syndrome.

Action myoclonus occurring in chronic survivors of cardiac arrest

A

Lance-Adams syndrome

Postanoxic myoclonus

Brain Power: First Aid Neurology (10 decks)

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