Stroke—General Information and Physiology Flashcards
Following statements are correct except?
● A. Transient ischemic attack (TIA) is transient neuronal dysfunction secondary to focal ischemia of brain, spinal cord, or retina without (permanent) acute infarction (10–15% of patients with TIA have stroke within 3 months)
● B. Stroke is permanent (irreversible) death of neurons caused by hyperperfusion of a region of the brain or brainstem
● C. Watershed infarct is ischemic infarction in a territory located at the periphery of two bordering arterial distributions due to a disturbance in flow in one or both of the arteries
● D. Normal cerebral blood flow is 45 to 60 mL/100-g tissue/min
● E. Normal cerebral metabolic rate of oxygen consumption averages about 3.0 to 3.8 mL/100-g tissue/min
B. Stroke is permanent (irreversible) death of neurons caused by hyperperfusion of a region of the brain or brainstem
The effects of ICA stenosis/occlusion may be ameliorated by collateral blood flow. Potential alternate routes for blood to reach brain tissue include the following except?
● A. Flow through circle of Willis from contralateral ICA through anterior communicating artery and from forward flow through the ipsilateral posterior communicating artery
● B. Retrograde flow through ophthalmic artery parasitizing blood from both ECAs via facial artery, maxillary artery, transverse facial artery, and superficial temporal artery
● C. Proximal maxillary artery
● D. Cortical–cortical anastomoses
● E. Dural–dural anastomosis
E. Dural–dural anastomosis
A patient presents with expressive aphasia + mild hemiparesis (upper extremity more than lower extremity, proximal muscle weaker than distal) in neurosurgical emergency. What is the most likely blood vessel involved in this case?
● A. Anterior choroidal artery
● B. Recurrent medial striate artery (of Heubner)
● C. Posterior cerebral artery
● D. Anterior cerebral artery
● E. Anterior inferior cerebral artery
B. Recurrent medial striate artery (of Heubner)
A patient presents with vertigo, nausea and vomiting, diplopia, oscillopsia, hiccups with ipsilateral facial pain, paresthesias, impaired sensation, ataxia of limbs, Horner syndrome
dysphagia, and hoarseness of voice. This patient is diagnosed with lateral medullary syndrome (also known as Wallenberg’s syndrome). What is the most likely artery occluded in this syndrome?
● A. AICA
● B. Posterior cerebral artery
● C. Anterior cerebral artery
● D. Posterior inferior cerebral artery
● E. Anterior choroidal artery
D. Posterior inferior cerebral artery
Small infarcts in deep noncortical cerebrum or brainstem result from occlusion of penetrating branches of cerebral arteries. Size of infarcts ranges from 3 to 20 mm. Which of the following is the typical location for lacunar infarcts?
● A. Putamen and caudate
● B. Thalamus
● C. Pons and internal capsule
● D. Convolutional white matter
● E. All of the above
E. All of the above
Trauma is the most common cause of stroke in young adults making 22% of total stroke causes in young adults. What is the second most common cause of stroke in young adults (comprising about 20% of stroke cases)?
● A. Atherosclerosis
● B. Embolisms with source from cardiac origin or fat embolism syndrome or paradoxical embolism
● C. Vasculopathy or coagulopathy
● D. Peripartum
● E. Both A and B
E. Both A and B
Carotid artery lesions are considered symptomatic if there are one or more lateralizing ischemic episodes appropriate to the distribution of the lesion. What is the acceptable initial screening test for carotid artery stenosis?
● A. Catheter angiogram
● B. Doppler
● C. CTA
● D. MRA
● E. All of the above except A
E. All of the above except A
What are the medical management options for carotid artery stenosis?
● A. Antiplatelet therapy including aspirin, P2Y12 receptor blockers, combination of dipyridamole and ASA
● B. Antihypertensive therapy
● C. Good control of diabetes
● D. Antilipid therapy
● E. Patients with asymptomatic atrial fibrillation should be treated with anticoagulation
● F. Intervention to help patients to quit smoking
● G. All of the above
G. All of the above
Which of the following statements is incorrect regarding practice guidelines of asymptomatic carotid stenosis?
● A. Carotid endarterectomy is reasonable in asymptomatic patients with more than 70% stenosis if risk of perioperative stroke, MI, and death is low
● B. Prophylactic carotid artery stenting may be considered in highly selected patients with asymptomatic ICA stenosis (more than 60% by angiography, more than 70% by validated
Doppler ultrasound)
● C. In patients with age more than 80 years, the effectiveness of revascularization over medical therapy alone is not well recognized
● D. It is reasonable to choose carotid artery stenting over carotid endarterectomy when revascularization is not indicated in patients with anatomy favorable for surgery
● E. None of the above
D. It is reasonable to choose carotid artery stenting over carotid endarterectomy when revascularization is not indicated in patients with anatomy favorable for surgery
What is the gold standard test for carotid artery stenosis?
● A. Catheter angiogram
● B. Doppler ultrasound
● C. CT angiography brain
● D. Magnetic resonance imaging
● E. All of the above
A. Catheter angiogram
What is the cerebral blood flow (mL/100-g tissue/min) for normal brain at rest?
● A. 15 to 30
● B. 30 to 45
● C. 45 to 60
● D. 55 to 80
● E. > 70
C. 45 to 60
What is the typical EEG change for ischemic brain?
● A. Flat line
● B. Tall alpha waves
● C. Increased amplitude
● D. Frequency > 50 Hz
● E. Bizarre pattern
A. Flat line
Marie-Fox syndrome/lateral pontine syndrome is associated with the occlusion of which of the following?
● A. Posterior inferior cerebellar artery
● B. Anterior inferior cerebellar artery
● C. Anterior choroidal artery
● D. Superior cerebellar artery
● E. Inferior petrosal vein
B. Anterior inferior cerebellar artery
Lacunar infarct most commonly involves which of the following locations?
● A. Putamen
● B. Thalamus
● C. Pons
● D. Internal capsule
● E. Convulational white matter
A. Putamen
Pure motor hemiparesis sparing face indicates a lacune in which of the following?
● A. Medullary pyramid
● B. Posteroventral thalamus
● C. Lower basis pontis
● D. Posterior limb of internal capsule
● E. Mesencephalothalamus
A. Medullary pyramid
