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Step 2 > Stroke/Neuro HY > Flashcards

Stroke/Neuro HY Flashcards

1
Q

Biggest risk factor for strokes?

A

HTN

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2
Q

Elderly with asymmetric motor and/or sensory deficits
Stroke is suspected, NBSIM?

A

NC-CT Head

(differentiates between ischemic & hemorrhagic)

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3
Q

Pt has Transient ischemic attack (TIA) a temporary, focal cerebral ischemic event that results in neurological symptoms which self resolve

It is not associated with a ____ on neuroimaging.

List the 2 mcc of TIA

A

visible acute infarct

Cardioembolic (atrial fibrillation, recent MI)
Atherosclerosis (carotid artery stenosis)

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4
Q

Pt with hx of Atrial Fibrillation (or recent MI) presents after a TIA/Stroke.
NCCT → pharmacotherapy?

A

Anticoagulation
Warfarin

(not antiplatelet drug like the other pts if the cause of stroke was cardioembolic use anti coagulant)

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5
Q

60M smoker with a history of HTN and DM
presents after transient, painless vision loss (or a recent TIA)
NBSID?

A

Carotid duplex U/S

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6
Q

Recent TIA
carotid duplex u/s shows >50% stenosis
NBSIM?

A

Carotid Endarterectomy

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7
Q

Asymptomatic with carotid bruit
found to have less than 80% carotid stenosis of duplex u/s
NBSIM?

A

Wait for pt to become symptomatic or have ≥ 80% stenosis
then do Carotid Endarterectomy
Until then, statin, smoking cessation, Aspirin
━━
Symptomatic means pt has:
contralateral motor/sensory deficits (TIA/Stroke)
ipsilateral transient blindness (Amaurosis fugax)

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8
Q

Patient found to have ischemic stroke on head CT.
What is the next best step in diagnosis?

A

Carotid duplex Ultrasound

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9
Q

Pt found to have carotid stenosis.
What medication do you start (1st-3rd line)?

A

Aspirin (1st line) antiplatelet
Clopidogrel (2nd line) antiplatelet
Dipyridamole (3rd line)

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10
Q

Pt found to have 100% stenosis on carotid duplex u/s
NBSIM?

A

No carotid endarterectomy
━
Start Aspirin (2nd line Clopidogrel), Statin (high intensity), Manage risk factors (smoking cessation, HTN, DM)
━
pt’s body has developed collateral circulation → no surgery

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11
Q

Pt is elderly/smoker/ and/or hx of HTN
presents with sudden and severe headache, nausea & vomiting
FMH (+) renal dz, brain bleeds (AVMs/Aneurysms)
± nuchal rigidity or AMS
NCCT Head negative
Suspected Dx/NBSIM?

A

Lumbar Puncture (xanthochromia: RBCs in CSF)
Subarachnoid Hemorrhage (still suspected despite negative imaging)

NCCTH (+) hyperdensities in the subarachnoid space

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12
Q

Once SAH is confirmed, ____ is always necessary in order to identify the source of bleeding (aneurysms or AVMs) and plan definitive treatment.

A

angiography

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13
Q

Recent DVT now has a stroke.
Dx/Dxt?

A

PFO (Patent Foramen Ovale)
Cryptogenic Stroke
TEE with a Bubble Study
(bubbles travel to left side heart)

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14
Q

Management of hemorrhagic stroke focuses on

A

1st: Secure ABCs (posturing = herniation = intubate)
───
Then preventing further bleeding
1st: BP control (Nicardipine, Labetalol)
2nd: AC Reversal (Warfarin: PCC or Heparin: Protamine)
3rd: Lowering ICP (HOB, Sedation, Mannitol)

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15
Q

Pure motor (Upper & Lower Extremity) stroke
Dx/location/artery/Patho

A

Lacunar Stroke
Internal Capsule
microatheroma–lipohyalinosis
thrombotic small-vessel occlusion of lenticular striate a

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16
Q

Left side FACE sensory sxs
Right Side BODY sensory sxs
Tongue deviates left
Localize Lesion. List arteries involved.

A

Lateral set up (Face and Body Opposite)
Left face sxs = ipsilateral to lesion
CN12 (medulla)
Lateral Left Medulla
PICA
(Vertebral artery if s/t next extension)

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17
Q

Pure sensory (Upper & Lower Extremity) stroke
Contralateral numbness & paresthesia of the face & L/UE
dx/location

A

Lacunar stroke
Thalamus VPL (ventral posterolateral )

18
Q

Pt with Ischemic stroke develops worsening stroke sxs and AMS the next day? NBSIM?

A

Repeat CT Head
(hemorrhagic transformation)

FYI: Putaminal hemorrhage always involves the internal capsule (Hemiparesis)

19
Q

Elderly woman
R sided Headache + ↑ ESR
NBSIM (2)?

A

Start Prednisone
& get Temporal Artery Biopsy

Giant cell arteritis

20
Q

Negative CT Head
LP: elevated opening pressure, and elevated red blood cell count that does not decline with successive samples.
Dx?

A

Subarachnoid Hemorrhage

21
Q

Depending on the time of presentation (<__ hr for thrombolysis, <__ hr for mechanical thrombectomy) tx considered independently
Mind Contraindications before tx

A

<4.5hr → TpA
<24hr → Embolectomy

22
Q

Pt with mechanical valves and suspected TIA NBSIM (aside from NCCT Head)

A

Echocardiography

23
Q

Brain Stem Blood supply (Medial to lateral)
Midbrain →
Pons →
Medulla →

A

Midbrain → PCA/SCA
Pons → Basilar/AICA
Medulla → Vertebral/ PICA

24
Q

Brainstem CN locations
Midbrain →
Pons →
Medulla →

A

Midbrain → CN 3,4
Pons → CN 5,6
Pontine medullary Jxn → CN 7, 8
Medulla → CN 9, 10 & 12

25
Q

CT scan of the head: biconvex (lens-shaped) hyperdensity that does not cross suture lines

A

Epidural Hematoma

26
Q

CT scan of the head: Concave (Crescent-shaped) hyperdensity that crosses suture lines
(Banana-shaped)

A

Subdural Hematoma

27
Q

Rupture of Bridging veins

A

Subdural Hematoma

28
Q

Trauma to sphenoid bone with tearing of middle meningeal artery

A

Epidural Hematoma

29
Q

BRF for Subdural Hematoma (3)

A

Age (Old)
Alcoholism (Chronic)
AntiCoagulant use

30
Q

Elderly with
*Fluctuating Cognition
*Visual hallucinations (before motor sxs)
*Parkinsonism
± REM sleep behavior disorder
dx?

A

dementia with Lewy bodies

31
Q

Medication C/I in lewy body dementia?

A

Severe sensitivity to antipsychotics

32
Q

50+ y.o. Patient with
Executive dysfunction + Behavior changes:

Disinhibition (sexual/ Rude comments)
Apathy (unconcerned/uninterested)
Compulsions or ritualistic behaviors
Hyperorality (chewing, sucking)
Executive dysfunction (low MOCA score)

A

frontotemporal dementia

(Frontal lobe atrophy)

33
Q

Pt with h/o HTN
Sudden or stepwise decline in executive function + memory
± FND
Imaging: multiple small cortical and subcortical infarctions.

A

Vascular dementia

BRF: HTN

34
Q

Presents with
shuffling gait with quick, short steps
Bradykinesia
Muscle Rigidity
Resting Tremor (improves w/ voluntary movement)

A

Parkinson’s

Dopaminergic neurons degeneration in the substantia nigra pars compacta

35
Q

rapidly progressive dementia + Executive dysfunction
startle myoclonus/hyperreflexia/babinski
mood symptoms
sleep disturbances
Dx?

A

CJD

Enhancement of putamen & caudate head (hockey stick sign)
not atrophy like HD

36
Q

Executive dysfunction
Mood symptoms (rude)
Repeated abrupt, involuntary movements in the upper extremities, Head, or Neck.
Dx?
Disorder?
Patho:
Neuro imaging:

A

Huntington disease (AD)
CAG trinucleotide repeat expansion disorder
Loss of GABA-ergic neurons
Caudate & putamen atrophy

37
Q

Presents with progressive cognitive decline that impairs activities of daily living (bathing, dressing, preparing meals) and eventually leads to mood sxs (apathy, withdrawal)
Dx/Mcc?

A

Dementia
MCC: Alzheimer’s

Cognitive decline precedes mood sxs

38
Q

Early on presents with isolated impairments in memory.

Then progresses to apathy, social withdrawal, and
± Hallucinations

Can mimic depression.

Dx/Tx?

A

Alzheimer’s Dementia

Donepezil, Rivastigmine, and galantamine
Cholinesterase inhibitors

(Donna & Riva going to the Gala)

39
Q

Subacute (>1 week) back pain + radiating down leg +
impaired motor/sensory/reflex activity in the BLE (LMN sxs)
bowel/bladder/sexual dysfunction
and/or saddle anesthesia.

A

Cauda equina syndrome

40
Q

Classic triad
Fever + Focal/severe back pain +
Neurologic findings (motor/sensory change, bowel/bladder dysfunction)
↑ ESR
Dx? Dxt (2)?
Mcc?

A

Spinal Epidural Abscess

MRI Spine + Blood cx
mcc: Staph a.

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