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vascular neurology Flashcards

1
Q

what is in the ABCD2 score for TIAs

A

Age >60 = 1 point BP > 140/90 = 1 point Clinical symptoms: 1 point for speech impariment alone, 2 points for focal weakness. Duration: 1 point 10-59 min, 2 points >60 min Diabetes: 1 point

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2
Q

What is the dose of tPA

A

0.9 mg/kg with a max dose of 90mg. 10% bolus with the rest over 1 hour.

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3
Q

what symptoms does bilateral infarcts of the basis pontis cause?

A

locked in syndrome- paralysis, mutism, impaired horizontal eye movements.

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4
Q

what are the 7 symptoms of Wallenberg syndrome, and what vessel is involved?

A

Lateral medullary syndrome: 1. nystagmus/nausea/vomiting 2. impaired sensation to ipsi hemi face 3. impaired pain and temp to contra body 4. ipsilateral horners 5. hoarsness, dysphagia and ipsi palate paralysis 6. ipsi ataxia 7. loss of taste PICA or Vertebral

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5
Q

What are the symptoms of AICA infarct?

A

similar to Wallenberg but with ipsilateral hearing loss.

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6
Q

What vascualr territory supplies the medial thalamus?

A

P1 segment of PCA

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7
Q

What vessel supplies the anterior limb if internal capsule?

A

Recurrent artery of heubner, which is a branch of the ACA.

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8
Q

what is the location of infarct in a Broca’s (expressive) aphasia?

A

superior branch of left MCA

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9
Q

what is the location of infarct in a Wernike’s (receptive) aphasia?

A

inferior branch of left MCA

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10
Q

what are symptoms of ACA infarct?

A

contralateral sensorimotor of leg, urinary incontinence, deviation of eyes towards lesion.

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11
Q

what structures does the recurrent artery of Heubner supply?

A

anterior limb of internal capsule, inferior part of caudate head, anterior globus pallidus.

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12
Q

what vessels supply the posterior limb of the internal capsule?

A

lenticulostriate branches of MCA.

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13
Q

what is the origin of the vessel that supplies the anterior thalamus?

A

PCOM

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14
Q

what is the origin of the vessel that supplies the lateral thalamus?

A

P2 branch of PCA

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15
Q

what is the vessel that supplies the posterior thalamus?

A

posterior choroidal artery, from P2 segment of PCA.

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16
Q

what vessel supplies the superior cerebellum?

A

SCA

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17
Q

What vessel supplies the ventral cerebellum?

A

AICA

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18
Q

what vessel supplies the inferior cerebellum?

A

PICA

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19
Q

what causes symptoms of “person in a barrel?”

A

bilateral watershed infarcts.

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20
Q

what are the symptoms of medial medullary syndrome? What vessel is involved.

A
  1. Contralateral arm and leg weakness sparing the face, 2. contralateral loss of sensation to position and vibration. 3. Ipsilateral tongue weakness. caused by vertebral artery occlusion.
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21
Q

What are the symptoms of Millard-Gublar syndrome? where is the lesion?

A
  1. Contralateral hemiplegia (face, arm leg) 2. complete Ipsilateral facial palsy. 3. ipsilateral abducens palsy.

Pontine lesion causing the cortical spinal tracts as well as CN VII nucleus and VI nerve injury.

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22
Q

What are the symptoms of Foville syndrome? Where is the lesion?

A
  1. Contralateral hemiplegia (face, arm, leg) 2. complete ipsilateral facial palsy 3. Ipsilateral gaze paralysis. Lesion is in the dorsal pons involving facial nucleus, corticospinal tracts and PPRF.
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23
Q

What syndromes can occipital strokes in the dominant hemisphere cause?

A

anomia achomatopsia (color anomia) visual agnosias

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24
Q

where is the lesion in alexia without agraphia?

A

left occipital infarct with splenium of the corpus callosum.

25
Q

what is Benedikt’s syndrome? Where is the lesion

A

ipsilateral 3rd nerve palsy, contralateral tremor and choreaoathetosis. Infarct in ventral midbrain tegmentum.

26
Q

what hemisphere is involved in neglect?

A

non-dominant.

27
Q

what is anosognosia, and what hemisphere is usually lesioned to produce it?

A

lack of awareness of one’s own disability. Non-dominant hemisphere.

28
Q

What is Parinaud’s syndrome and where is the lesion?

A
  1. defect in eye elevation 2. defect in convergence 3. convergence retraction nystagmus 4. light near dissociation 5. lid retraction 6. skew deviation. Lesion to dorsal midbrain-quadrigeminal plate.
29
Q

ICA stenosis criteria for doing CEA in SYMPTOMATIC patients.

A

>70% for sure >50% may benefit.

30
Q

what vessel does the anterior choroidal arise from and what structures does it supply?

A

ICA. 1. posterior limb of internal capsule 2. some other stuff.

31
Q

what is Claude’s syndrome? where is the lesion?

A
  1. ipsilateral 3rd palsy 2. contralateral ataxia and tremor. Lesion is in midbrain ventral tegmentum (more medial than Benedikt’s),
32
Q

what is the gene involved in CADASIL and what chromosome is it on?

A

NOTCH 3, Chr 19

33
Q

What is Weber’s syndrome and where is the lesion?

A

Ipsilateral 3rd nerve palsy and contralateral hemiplegia. Ventral midbrain.

34
Q

what vascular malformation consists of a cluster of thin walled vessels with no intervening brain parenchyma?

A

cavernous malformation

35
Q

what vascular malformations consist arteries communicating with veins without an intervening capillary bed?

A

AVM

36
Q

what vascular malformation consists of thin walled venous structures with normal intervening brain tissue?

A

venous angiomas- low risk of hemorrhage

37
Q

what vascular malformation consists of abnormally dilated capillaries separated by normal brain tissue?

A

capillary telangectasia- low risk of hemorrhage.

38
Q

what are the signal intensities 0-7 hours after ICH? What is the hemoglobin state?

A

T1- Iso T2- bright. Oxyhemoglobin

39
Q

what are the signal intensities 7hrs-3 days after ICH? what is the hemoglobin state?

A

T1- Iso T2- Dark. Deoxy Hb

40
Q

what are the signal intensities 3 -7 days after ICH? What is the hemoglobin state?

A

T1- bright T2- Dark. Extracellular met-Hbg

41
Q

what are the signal intensities 7days-3 weeks after ICH? What is the hemoglobin state?

A

T1- Bright T2- Bright. Intracellular MetHgb

42
Q

what are the signal intensities >3 weeks after ICH? What is the hemoglobin stat?

A

T1-Dark T2- Dark. Hemosiderin.

43
Q

What is Gertsmann’s syndrome and where is the lesion?

A

finger agnosia, right left disorientation, agraphia, acalculia. caused by lesion in the left angular gyrus.

44
Q

what type of infarct causes pure sensory loss? Where is the lesion.

A

Pure sensory lacunar syndrome, contralateral thalamus.

45
Q

What type of infarct causes pure motor deficits?

A

Pure motor lacunar syndrome, contralateral posterior internal capsule, or ventral pons.

46
Q

what type of infarct causes clumsy hand and dysarthria? where is the infarct?

A

clumsy hand dysarthria lacunar syndrome. Paramedian pons.

47
Q

What type of infarct causes weakness and ataxia out of proportion to the weakness?

A

ataxic hemiparesis lacunar syndrome. In pons, midbrain, or internal capsule.

48
Q

what type of aphasia does stroke involving the superior division of the Left MCA cause?

A

Broca’s (expressive/non-fluent) aphasia.

49
Q

what type of aphasia does a stroke involving the inferior (temporal) division of the Left MCA cause?

A

Wernike’s (receptive/fluent) aphasia.

50
Q

what type of stroke causes paraplegia, incontinence and abulic psychomotor slowing with depression?

A

BIlateral ACA territory. Can occur if both ACA’s arise from a single origin.

51
Q

What is limb-kinetic apraxia and in what location can a stroke cause this?

A

bilateral clumsiness of skilled acts with preserved understanding of the act. Dominant premotor cortex.

52
Q

in what location does a stroke cause dressing apraxia?

A

nondominant parietal lobe

53
Q

what is constructional apraxia, and in what location can a stroke cause this?

A

inability to construct a whole from its parts (eg puzzle). non-dominant parietal lobe.

54
Q

What is Anton’s syndrome, in what location can a stroke cause this?

A

Bilateral cortical blindness, with denial of blindness. Bilateral mesial occipital cortex.

55
Q

What is Balint’s syndrome and in what location can a stroke cause this?

A
  1. simultagnosia 2. gaze apraxia 3. optic ataxia. Bilateral occipito-parietal watershed infarcts.
56
Q

What is peduncular hallucinosis? In what location can a stroke cause this? What artery is occluded?

A

well formed visual hallucinations that are usually cartoonish and the patient knows they are not real. Stroek in medbrain near cerebral peduncles. Due to PCA occlusion.

57
Q

What is prosopagnosia, in what location can a stroke cause this?

A

inability to recognize familiar faces. due to bilateral ventromemesial occipito-temporal strokes.

58
Q

what is the main cause if cerebral infarction in patients with HHT?

A

thromboembolism from pulmonary AVMs

59
Q

What is the gene mutation in MELAS?

A

A2343G mitochondrial mutation

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