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neurology FA + STEP 2 > strokes > Flashcards

strokes Flashcards

1
Q

strokes - anterior circulation - arteries

A
  1. middle cerebral artery
  2. anterior cerebral artery
  3. lenticulo-striate artery
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2
Q

stroke on middle cerebral artery - area of lesion

A 
motor cortex - upper limb and face 
sensory cortex - upper limb and face 
termpal lobe - wernicke area 
frontal lobe - broca area 
if in dominant --> aphasia 
if non dominant --> hemineglect
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3
Q

stroke on anterior cerebral artery - area of lesion

A

motor cortex - lower limb

sensory cortex - lower limb

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4
Q

stroke on lenticulo-striate artery - area of lesion

A
  1. striatum

2. internal capsule

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5
Q

stroke on lenticulo-striate artery - symptoms

A

Contralateral hemiparesis/hemiplegia (face + body)

absence of cortical signs. eg. neglect, aphasia, visual field loss

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6
Q

a common cause of stroke on lenticulo-striate artery - and why

A

2ry to unmanaged hypertension because is a common location of lacunar infarcts

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7
Q

strokes - posterior circulation - arteries

A
  1. anterior spinal artery
  2. posterior inferior cerebellar artery
  3. anterior inferior cerebellar artery
  4. posterior cerebral artery
  5. basilar artery
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8
Q

stroke of basilar artery - area of lesion (areas and structures)

A
  1. pons, medulla, lower midbrain,
  2. corticospinal and corticobulbar (UMN)
  3. ocular cranial nerve nuclei
  4. paramedian pontine reticular formation
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9
Q

stroke of basilar artery - symptoms

A

locked-in syndrome :

  1. preserved consciousness, blinking + vertical eye movement
  2. quadriplegia
  3. loss of voluntary facial, mounth and tongue
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10
Q

stroke of anterior spinal artery - area of lesion and symptoms

A
  1. lateral corticospinal tract - contralateral hemiparesis (upper and lower limbs)
  2. medial lemniscus - decreased contralateral proprioception
  3. Caudal medulla/hypoglossal nerve - ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)
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11
Q

medial medullary syndrome is caused by

A

infarct of paramedian branches of anterior spinal artery and vertebral arteries

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12
Q

stroke of posterior inferior cerebellar artery - area of lesion

A 
lateral medulla (Lateral medullary (wallenberg) syndrome): 1. vestibular nuclei 2. lateral spinothalamic tract  3. spinal trigeminal nucleus  4.  nucleus ambiguus (vagus) (μεικτός), 5. sympathetic fibers 
 6. inferior cerebellar peduncle
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13
Q

stroke of posterior inferior cerebellar artery - symptoms

A

vomiting, vertigo, nystagmus, decreased pain and Q sensation from ipsilateral face and contralateral body, dysphagia, hoarness, decreased gag reflex, ipsilateral Horner, ataxia, dysmetria

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14
Q

Lateral medullary (wallenberg) syndrome (specific involvement)

A

POSTERIOR INFERIOR CEREBELLAR ARTERY SYNDROME (STROKE)

nucleus ambiguus effects are specific

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15
Q

stroke of posterior cerebral artery - area of lesion / symptoms

A

occipital cortex
visual cortex
- contralateral hemianopia with macular sparing

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16
Q

stroke of anterior inferior cerebellar artery - area of lesion

A

lateral pons: (LATERAL PONTINE SYNDROME)

  • cranial nerve nuclei (vestibular, facal, spinal trigeminal, cochlear,)
  • sympthathetic fibers
  • middle and inferior cerebellar peduncles
  • lateral spinothalamic tract
  • corticospinal tract
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17
Q

stroke of anterior inferior cerebellar artery - symptoms

A

LATERAL PONTINE SYNDROME

  • vomiting, vertigo, nystagmus
  • face paralysis, decreased lacrimation and salivation, decreased taste of the anterior 2/3 of the tongue
  • ipsilateral decreased pain and Q of the face and contralateral of the body
  • ataxia dysmetria
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18
Q

lateral pontine syndrome - specific lesion

A

facial nucleus

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19
Q

anterior communicating arteries - lesion

A

most commonly saccular aneurysm (berry) that can impinge cranial nerves. It can lead to stroke

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20
Q

anterior communicating arteries - symptoms

A
  • visual field defects (bitemporal hemianopia)
  • visual acuity defecits
  • Rupture –> ischemia in ACA distribution –> contralateral lower extremity hemiparesis, sensory deficits
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21
Q

central post-stroke pain syndrome - definition / course / occurs in

A
  • Neuropathic pain due to thalamic lesions
  • initial paresthesias followed in weeks to months by allodynia and dysesthesia
  • 10% of stroke patient
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22
Q

common locations of lacunar infarcts

A
  1. basal ganglia
  2. internal capsule
  3. thalamus
  4. pons
    (Oxford handbook)
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23
Q

stoke - dysphagia and hoarseness - artery?

A

posterior inferior cerebellar artery

24
Q

stroke - paralysis of face and loss of lacrimation - artery

A

Anterior inferior cerebellar artery

25
intracranial hemorrhage - types
1. epidural hematoma 2. subdural hematoma 3. subarachnoid hemorrhage 4. intraparenchymal (hypertensive) hemorrhage
26
epidural hemorrhage - mechanism
rupture of middle meningeal artery (branch of maxillary) often often 2ry to fracture of temporal bone --> rapid expansion (artery)
27
epidural hemorrhage - course
- Lucid interval (a temporary improvement in a patient's condition after a traumatic brain injury) - rapid expansion under systemic arterial pressure
28
epidural hemorrhage - complications
1. transtentorial herniation | 2. CN III
29
epidural hematoma - CT
- biconvex (lentiform), hyperdense blood collection - not crossing suture lines - can cross falx, tentorium
30
subdural hematoma - mechanism
rupture of bridging veins --> slow venous bleeding | (less pressure because of veins= hematoma develops over time). Can be acute or chronic
31
subdural hematoma - CT
- Crescent-shaped hemorrhage - crosses sature lines - Midline shift - Cannot cross falx, tentorium - findings of "acute on chronic" haemorrhage - if acute --> hyperdense, if chronic --> hypodense
32
causes of subarachnoid hemorrhage
1. rupture of an aneurysm (such as berry) | 2. arteriovenous malformations
33
Saccular (berry) aneurysm - associations and risk factors
1. ADPKD 2. Ehlers-Danlos syndrome 3. advanced age 4. hypertension 5. smoking 6. race (increased risk with black)
34
subarachnoid hemorrhage - complications after 4-10 days | visible on CT
1. vasospasm due to blood breakdown --> ischemic infract (not visible in CT) 2. rebleed (visible in CT) 3. high risk of developing communicating and/or obstructive hydrocephalus
35
intraparenchymal (hypertensive) hemorrhage - is caused by
1. hypertension (MCC) 2. amyloid angiopathy 3. vasculitis 4. neoplasm (can cause Charcot-Bouchard)
36
intraparenchymal (hypertensive) hemorrhage - area
typically occurs in basal ganglia and internal capsule (Charcot-Bouchard aneurysm of leniculostriate vessels) can be lobar
37
cns aneurysms - types
1. Saccular (berry) aneurysm | 2. Charcot-Bouchard microaneurysm
38
Charcot-Bouchard microaneurysm is associated with ... / area / important
chronic hypertension - it affects small vessels (eg. in basal ganglia, thalamus) - not seen in angiogram
39
Saccular (berry) aneurysm - area
bifurcations in the circle of Willis | MC site is junction of anterior communicating artery and anterior cerebral artery
40
Saccular (berry) aneurysm - complications
1. rupture (--> subarachnoid hemorrhage or hemorrhagic stroke) 2. bitetemporal hemianopia (via compression of optic chiasm) (anterior comm) 3. visual acuity deficits (anterior comm) 4. CN III palsy (posterior comm)
41
aneurysm associated with hypertension - saccular or Charcot Bouchard?
both
42
MCC and 2nd MCC of subarachnoid hemorrhage (and proportion)
1. rupture of an aneurysm (such as berry) (80%) | 2. arteriovenous malformations (15%)
43
most vulnerable areas of ischemic brain disease (which is the most)
1. hipocampus (MOST) 2. neocortex 3. cerebellum | 4. watershed areas
44
images can detect ischemic changes in (time)
1. CT--> 6-24h (but can show almost imminently hemorrhage) 2. diffusion-weighted MRI --> 3-30 min
45
Hemorrhagic stroke is often due to
1. hypertension 2. anticoagulation 3. cancer 4. 2ry to ischemic stroke
46
MC side of Hemorrhagic stroke
basal ganglia
47
transient ischemic attack - definition
Brief, reversible episode of focal neurologic dysfunction without acute infraction (-MRI), with the majority resolving in less than 15 mins
48
hypoxic ischemic stroke is due to / area / common during
hypoperfusion or hypoxemia / warershed areas | common during cardiovascular surgeries
49
thrombotic ischemic stroke is due to / MC area
a clot forming directly at site of infarction usually over an atherosclerotic plague. commonly the MCA
50
ischemic stroke - treatment
1. tPA (if within if 3-4,5 h of onset no hemmorrhage/risk of hemorrhage) 2. Reduce risk with medical therapy 3. optimum control of BP, blood sugar, lipids 4. treat conditions that increase risk (eg. aspirin, clopidogrel)
51
blood - cortical distribution - arteries and what the supply
1. anterior cerebral artery --> anteriomedial surface of the cortex 2. middle cerebral artery --> lateral surface of the cortex 3. posterior cerebral artery --> posterior and inferior surface
52
watershed zone are in danger to be damaged under / lesions
severe hypotension --> 1. upper leg/upper arm weakness 2. defects kn higher order visual processes
53
auto-regulation - Cerebral perfusion is primarily driven by
1. PCO2 (primarily) | 2. PO2 (in severe hypoxia)
54
autoregulation - relationship between PO2 and cerebral blood flow
P02 increases cerebral blood flow (until P02=50 mmHg) | PO2>50 --> plateau of cerebral blood flow
55
autoregulation - relationship between PCO2 and cerebral blood flow
cerebral perfusion pressure increases with PCO2 until PCO2=90 mmHg at PCO2>90 --> plateau of cerebral blood flow

neurology FA + STEP 2 (8 decks)

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