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-Neuro > Strokes > Flashcards

Strokes Flashcards

1
Q

What are the most vulnerable areas of the brain to ischemic stroke

A

Hippocampus (MOST)
Neocortex (layers 3, 5, 6)
Cerebellum (purkinje cells)
Watershed areas

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2
Q

When will an ischmic change be detected on MRI and CT

A

CT: in 6-24 hours (will exclude hemmorage though)
MRI: within 3-30 minutes

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3
Q

What is seen Histologically post stroke?

12-24 hours

A

Eosinophilic cytoplasm + pyknotic nuclei (red neurons)

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4
Q

What is seen Histologically post stroke?

24-72 hours

A

Necrosis + neutrophils

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5
Q

What is seen Histologically post stroke?

3-5 days

A

Macrophages (microglia)

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6
Q

What is seen Histologically post stroke?

1-2 weeks

A

Reactive gliosis (astrocytes) + vascular proliferation

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7
Q

What is seen Histologically post stroke?

>2 weeks

A

Glial scar

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8
Q

What are the 3 types of ischemic stroke and how do they tend to differ

A

Thrombotic: clot formation directly at site of infaction (usually atherosclerotic) (commonly MCA)

Embolic: embolus from another part of body; can affect MULT vascular territories (afib, DVT w/ patent foramen, carotid stenosis)

Hypoxic: due to hypoperfusion or hypoxia; common during cv surgeries tends to affect watershed areas

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9
Q

Presentation of altered level of consciousness, bulging fontanelle, hypotension, seizures, and coma in a preme infant

A

intraventricular hemorrhage into ventricles/perivent white matter; commonly due to rupture in germinal matrix due to reduced glial fiber support and impaired BP autoreg in premature infants

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10
Q

What intracranial hemorrhage does not cross suture lines

A

Epidural hematoma (mm artery damage)

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11
Q

What intracranial hemorrhage does cross suture lines

A

Subdural hematoma (bridging veins tear)

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12
Q

What is one possible associated risk with an Epidural Hematoma

A

Transtentorial herniation –> CN III palssy

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13
Q

What causes a hypodense vs a hyperdense subdural hematoma

A

Hyperdense: acute (trauma or high impact)

HypOdense: chronic (mild trauma, cerebral atrophy, elderly, alcoholism)

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14
Q

Which type of brain bleed would you see in a shaken baby

A

Subdural hematoma (also may see broken ribs)

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15
Q

If a spinal tap is bloody or xanthochromic what would the associated hemorrhage be

A 
Subarachnoid hemorrhage ( can be due to trauma, rupture of aneurysm or arteriovenous malformation
(worst headache of my life, rapid time course)
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16
Q

What is the relationship of vasospasm to stroke pathology

A

After a stroke (usually subarachnoid) 3-10 days after due to blood breakdown or rebleed –> vasospasm occurs
This leads to an ischemic infarct
(pts given nimodipine to prevent/reduce)

17
Q

A subarachnoid hemorrhage puts you at greater risk for what in the future

A

developing communicating and/or obstructive hydrocephalus

18
Q

What are the most common causes of intraparenchymal hemorrhage?

A 
Systemic hypertension (most common)
Amyloid angiopathy (recurrent lobar hemorrhagic stroke in elderly) 
Vasculitis
Neoplasm
Secondary to reperfusion from ischemic
19
Q

Where are hypertensive hemorrhages most commonly seen?

A 
(charcot bouchard microaneurysms- not visible on CT)
Basal ganglia (lenticulostriate) (MC)
Thalamus
Pons
Cerebellum
20
Q

A stroke in this artery covers what areas:

Middle Cerebral Artery (3)

A 
Motor/Sensory Cortices (upper limb/face)
Temporal lobe (wernicke area)
Frontal lobe (brocas area)
21
Q

A stroke in this artery presents with what symptoms:

Middle Cerebral Artery

A

Contralateral paralysis and sensory loss (face and upper limb)

Aphasia if in dominant hemisphere
Hemineglect if on nondominant

Wernicke aphasia is associated with a right superior quadrant visual field defect due to temporal lobe involvement

22
Q

A stroke in this artery covers what areas:

Anterior Cerebral Artery (1)

A

Motor/Sensory Cortices (lower limb)

23
Q

A stroke in this artery presents with what symptoms:

Anterior Cerebral Artery

A

Contralateral paralysis and sensory loss lower limb- URINARY INCONTINENCE

24
Q 
A stroke in this artery covers what areas:
Lenticulostriate Artery (2)
A

Striatum

Internal Capsule

25
Q

A stroke in this artery presents with what symptoms:

Lenticulostriate Artery

A

Contralateral paralysis ABSENCE OF CORTICAL SIGN (common location of lacunar infarcts due to hyaline arteriosclerosis due to hypertension)

26
Q

A stroke in this artery covers what areas:

Anterior Spinal Artery (3)

A

Lateral Corticospinal Tract
Medial lemniscus
Caudal medulla-hypoglossal nerve

27
Q

A stroke in this artery presents with what symptoms:

Anterior Spinal Artery

A

Contralateral paralysis (upper and lower limb) (lateral corticospinal)

Dec Contralateral proprioception (med lem)

Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally (lick your lesion)

28
Q

A stroke in this artery covers what areas:

Posterior Inferior Cerebellar Artery (6)

A 
Lateral Medulla:
Nucleus ambiguus (CN IX, X, XI)
Vestibular nuclei
Lateral spinothalamic tract
Spinal Trigem nucleus
Sympathetic fibers
Inferior Cerebellar peduncle
29
Q

A stroke in this artery presents with what symptoms:

Posterior Inferior Cerebellar Artery

A

Dysphagia, hoarseness, dec gag reflex, hiccups (nuc ambiguus)

Vomiting, vertigo, nystagmus

Dec pain/temp from CONTRA body IPSI face (spino thal, spinal trigem nuc)

Ipsilateral horner (symp fibers)

Ipsilateral ataxia, dysmetria (inf ped)

30
Q

A stroke in this artery covers what areas:

Anterior Inferior Cerebellar Artery (8)

A 
Lateral Pons:
Facial Nucleus
Vestibular Nuclei
Spinothalamic tract
Spinal trigeminal nucleus
Sympathetic fibers
Middle Cerebellar peduncles
Inferior Cerebellar peduncles
Labyrinthine Artery
31
Q

A stroke in this artery presents with what symptoms:

Anterior Inferior Cerebellar Artery

A

Paralysis of face (LMN vs UMN in cortical stroke) (dec lac, sal, taste from ant 2/3 tongue) (CNVII)

Vomiting Vertigo Nystagmus (VN)

Dec pain/tem from CONTRA body IPSI Face (spinothal, spinal trigem nuc)

Ipsilateral horners (symp fibers)

Ataxia, dymetria (mid/inf ped)

Ipsilateral sensorineural defness/vertigo (lab)

32
Q 
A stroke in this artery covers what areas:
Basilar Artery (5)
A 
Pons, Medulla, Lower midbrain
Corticospinal tract
Corticobulbar tract
Ocular cranial nerve nuclei
Paramedian pontine reticular formation
33
Q

A stroke in this artery presents with what symptoms:

Basilar Artery

A

RAS spared- So preserved consciousness
Quadriplegia (CS/CB)

loss of voluntary face, mouth, tongue movements (CS/CB)

Loss of horizontal but not vertical eye movements (Ocular/PPRF)

34
Q

A stroke in this artery covers what areas:

Posterior Cerebral Artery (1)

A

Occipital lobe

35
Q

A stroke in this artery presents with what symptoms:

Posterior Cerebral Artery

A

Contralateral hemianopia with macular sparing

alexia without agraphia (dominant hemisphere/ PT CAN WRITE BUT NOT READ)

36
Q

What would be seen with a:

Cingulate (subfalcine) herniation under falx cerebri

A

Can compress anterior cerebral artery

37
Q

What would be seen with a:

Transtentorial (central downward herniation)

A

caudal displacement of brain stem

can rpture paramedian basilar artery branches –> duret hemorrhages

38
Q

What would be seen with a:

uncal herniation

A

Uncus=medial temporal lobe
Compresses ipsilateral CNIII and contralateral crus cerrebri against kernohan notch
see CNIII palsy and or ipsilateral hemiparesis (false localizing sign)

39
Q

What would be seen with a:

Cerebellar tonsillar herniation into foramen magnum

A

Coma and death when they compress the brainstem

-Neuro (16 decks)

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