Stroke - Cerebral Circulation

Question 1

Pt 45 M with Vertigo, right Horner, right sensorineural hearing loss, blurred vision, numbness of RHS of face and LHS of body. Whats the most likely cause? 176/95 bp

Answer 1

Right Vertebral Artery Thrombosis Wallenberg syndrome

Question 2

Posterior cerebral Arteries (PCAs) are terminal branch associated with narrower range of symptoms. TRUE OR FALSE

Answer 2

TRUE. Acute vision loss, confusion, headache, paresthesia, limb weakness, dizziness, nausea, memory loss, language dysfunction.

Question 3

Wallenberg syndrome (lateral medullary syndrome) and Pica occlusion. Whats the most common CONTRALATERAL symptom?

Answer 3

Loss of pain and temperature sense in the body and extremities. (Spinothalamic tract)

Question 4

Whats the most common artery affected in circle of Willis aneurysms?

Answer 4

Anterior communicating artery.
(stokes are not common, they present with personality changes, motor weakness and sensory disturbances more prominent in lower limbs).

Question 5

With internal carotid occlusion, presentation is like anterior and middle cerebral arteries plus ………..

Answer 5

vision loss (amaurosis fugax)

Question 6

3rd nerve palsy. Sympt and most common cause.

Answer 6

Ptosis (drooping of the eyelid) due to paralysis of the levator palpebrae superioris muscle.
Eye position (“down and out”): The unopposed action of the lateral rectus (abducts the eye) and superior oblique (depresses and abducts) muscles causes the eye to be positioned inferiorly and laterally.
Inability to move the eye medially or vertically, due to paralysis of the medial rectus, superior rectus, inferior rectus, and inferior oblique muscles.
Sluggish pupillary light reflex: This indicates involvement of the parasympathetic fibers of the oculomotor nerve, which control pupillary constriction.

Posterior Communicating Artery (PCom) Aneurysm
Explanation: A PCom aneurysm is a common cause of isolated oculomotor nerve palsy. The oculomotor nerve (cranial nerve III) lies close to the PCom, and aneurysmal dilation can compress the nerve, particularly the parasympathetic fibers responsible for pupillary constriction, leading to a sluggish pupillary reflex.
Key Clue: The sluggish pupillary reflex in this patient points to a compressive etiology, as parasympathetic fibers are superficial and more susceptible to compression.
Other causes to consider but less likely in this case include:

Ischemic neuropathy: Often spares the pupil.
Trauma: No history of head injury provided.
Tumor: Typically associated with progressive symptoms or additional neurological findings.

Question 8

What is Bell’s palsy?

Answer 8

Bell’s palsy is a sudden, temporary weakness or paralysis of the muscles on one side of the face.

Question 9

True or False: Bell’s palsy can affect both sides of the face equally.

Answer 9

False

Question 10

Fill in the blank: The exact cause of Bell’s palsy is ________.

Answer 10

unknown

Question 11

Which nerve is primarily affected in Bell’s palsy?

Answer 11

The facial nerve (cranial nerve VII)

Question 12

What are common symptoms of Bell’s palsy?

Answer 12

Symptoms include facial drooping, difficulty closing one eye, loss of the sense of taste, and increased sensitivity to sound.

Question 13

UPM SYMPT + LMN SYMPT+ SAME AREA+ INTACT SENSATION. Likely d(x) and study

Answer 13

Amyotrophic lateral sclerosis (ALS). Electromyography.

Question 14

UMN SYMPT

Answer 14

Stiffness (spasticity)
Hyperreflexia
Abnormal Reflexes (Babinski, Chaddock or Hoffman)
Loss of dexterity with NORMAL STRENGTH Muscles spasms

Question 15

LMN SYMPT

Answer 15

Fasciculation
Reduction of muscle bulk (atrophy)
Decreased muscle strength
Depressed deep tendon reflexes.

Question 16

Most common neurodegenerative disease of adult onset.

Answer 16

ALS AMYOTROPHIC LATERAL SCLEROSIS.

Question 17

What is the primary cause of subarachnoid hemorrhage?

Answer 17

The primary cause of subarachnoid hemorrhage is the rupture of a cerebral aneurysm.

Question 18

True or False: Subarachnoid hemorrhage can be diagnosed using a CT scan.

Answer 18

True.

Question 19

Fill in the blank: The classic symptom of subarachnoid hemorrhage is a sudden onset of ________ headache.

Answer 19

thunderclap.

Question 20

Which of the following is a risk factor for subarachnoid hemorrhage? (a) Hypertension (b) Diabetes (c) Asthma

Answer 20

(a) Hypertension.

Question 21

What is the typical management approach for a patient diagnosed with subarachnoid hemorrhage?

Answer 21

Management typically includes monitoring in an intensive care unit, controlling blood pressure, and possibly surgical intervention to repair any aneurysms.

Question 22

SAH symptoms include headache plus ……

Answer 22

n, v, seizures, brief loss of consciousness. Meningeal (hours after bleed, aseptic meningitis)

Question 24

What is an epidural hematoma?

Answer 24

An epidural hematoma is a collection of blood between the outer membrane covering the brain (dura mater) and the skull.

Question 25

True or False: Subdural hematomas occur between the dura mater and the brain.

Answer 25

True

Question 26

Fill in the blank: An epidural hematoma is often caused by __________ injury.

Answer 26

traumatic

Question 27

Which type of hematoma typically has a ‘lens-shaped’ appearance on imaging?

Answer 27

Epidural hematoma

Question 28

What is the primary treatment approach for a large subdural hematoma?

Answer 28

Surgical intervention, such as craniotomy or burr hole drainage.