Stroke - Neuro medi

Question 1

To dx a TIA, what is the criteria?

Answer 1

must last less than 1 hour and not greater than 24 hours

MRI must be negative

Question 2

What should you initially be looking at on CT if there is a possible CVA?

Answer 2

grey-white disctinction decrease

Question 3

What is the MCA dot sign?

Answer 3

on CT, a white dot in the M1 positon, thrombus sitting there

Question 4

How does a stroke look on DWI v ADC?

Answer 4

DWI will have protons light up - edema/fluid area

ADC will be dark area

Question 5

What are the differences in presentation of ischemic stroke v hemorrhagic stroke?

Answer 5

• ischemic
  
  • moderate or no HA
  • consciousness relatively preserved (variable)
  • herniation is rare
  • clear vascular territory
• hemorrhagic
  
  • hyperacute
  • severe HA
  • consciousness usually impaired if large
  • early signs of herniation
  • no obvious territory

Question 6

What increases stroke risk 5x?

Answer 6

atrial fibrillation

Question 7

An ischemic stroke in a pt with long standing HTN and DM will likely be what kind of CVA?

Answer 7

small-vessel lacunar stroke in anterior basal ganglia

Question 8

What am I looking at?

Answer 8

string of pearls sign

watershed MCA-ACA

more proximal occlusion

carotid stenosis or hypotension

Question 9

What am I looking at? Most likely…

Answer 9

bihemispheric punctate

cardioembolic MC in anterior circulation but can be posterior

Question 10

What am I looking at ?

What are RF?

Answer 10

large vessel dz

RF: atherosclerotic disease affecting MCA or ACA

Question 11

What am I looking at? What are RF?

Answer 11

lacunar infarct

RF: HTN, DM, HLD, smoking

Question 12

What four things could predispose a person to have a carotid dissection?

Answer 12

Ehlers Danlos type IV

Marfans

polycystic kidney disease

osteogenesis imperfecta type I

Question 13

How long will tpa be effective after an ischemic stroke?

For large vessel occlusion, how long is endovascular thrombectomy effective?

Answer 13

4.5 hours

24 hours

Question 14

A stroke to the PICA area of the lateral medulla would be considered

Answer 14

Wallenberg Syndrome

Question 15

Stroke of the vertebral artery perforators and the anterior spinal artery in the medial medulla would be what syndrome?

Answer 15

Dejerines syndrome

Question 16

Locked in syndrome and stroke of basilar artery causes a disconnect where?

Answer 16

between supratentorium/midbrain from pons and medulla

Question 17

What are some modifiable RF of CVA?

Answer 17

HTN, HLD, DM, smoking, metabolic syndrome, Afib, carotid stenosis, etoh abuse, obesity, physical inactivity, OSA

Question 18

Carotid endarterectomy should be done as secondary stroke prevention when…

Answer 18

70-99% stenosis

Question 19

What is the neurologist’s goal for LDL?

Answer 19

<70

Question 20

What will stopping smoking for 5 years do for your risk for stroke?

Answer 20

after 5 years cessation, will have same risk as non-smoker

Question 21

venous sinus thrombosis MC involves..

what is the classic presentation?

Answer 21

superior sagittal sinus

female with HA and hypercoaguable state