Stroke

Question 1

Cerebral blood flow

Answer 1

normal 50-55 ml/100mg/min

electric failure 18
cell death 8
8-18 penumbra

more than 60: CO2 retention

Question 2

ABCD2

Answer 2

age over 60
BP 140/90
weakness 2 speech 1
more than 60 min 2 more than 10 1
DM 1

Question 3

CHADS2

Answer 3

CHF
HTN
age 75
DM
prior CVA

Question 4

CHADS2 VASC

Answer 4

CHF
HTN
age above 75 - 2
age between 65-74 - 1
DM
Prior CVA -2
Vascular disease
SEX

Question 5

Anterior Choroidal Artery Stroke

Answer 5

Hemiparesis
Hemisensory (thalamus)
Hemianopsia LGN

Question 6

Posterior Choroidal Artery Stroke

Answer 6

lateral geniculate body, pulvinar, posterior thalamus, hippocampus, and parahippocampal gyros
homonymous quadrantanopsia, with or without hemisensory loss and neuropsychological dysfunction

Question 7

Artery of Heubner

Answer 7

anterior capsular interna
Face and Arm
no sensory

Question 8

Lacunar syndrome

Answer 8

1) pure motor hemiparesis (CI pons corona)
2) pure sensory (rventropostlateral thalamus)
3) Sensory motor stroke
4) homolateral ataxia and paresis
5) dysarthria clumsy hand syndrome

Question 9

Weber

Answer 9

Midbrain
PCA / Basilar

III fascicle - ipsilateral III
cerebral peduncle - contralateral Hemiplegia

Question 10

Claude

Answer 10

Midbrain
PCA / Basila

III Fascicle - ipsilateral III
Red Ncl / Peducnle - Contralateral Ataxia

Question 11

Benedikt

Answer 11

Midbrain
PCA/ Basilar

III Fascicle - ipsilateral III
Cerebral peduncle and Red Ncl - contralateral Hemi and ataxia

Question 12

Medial Superior Pontine Syndrome

Answer 12

Paramedian Branches of Basilar Artery

Sup/Med cerebellar Peduncle - ipsilat Ataxia
MLF - INO
Corticobulbar/spinal: contralateral plegia face hand leg
Medial Lemniscus: Hemisensory

Question 13

Lateral Superior pons

Answer 13

Superior Cerebellar Artery SCA

Ataxia ipsilateral
Dizziness Nausea
Horner
opposite: sensory loss all body

Question 14

Middle Medial Pons

Answer 14

Paramedian Basilar

Foville and Millard Gubler: both wrong way eyes syndrome

Foville:
ipsilateral face weakness VII
ipsilateral gaze palsy PPRF
contralateral: facial hand leg weakness

Millard Gubler:
ipsilateral face weakness VII
ipsilateral gaze palsy VI Ncl
contralateral face arm and leg

Question 15

Lateral Midpons

Answer 15

Short circumferential Arteries Basilar

all ipsilateral:
Ataxia
Facial Sensation
Chewing V

Question 16

Inferior medial pons

Answer 16

Paramedian Basilar

Ipsi:
PPRF and VI: wrong eye deviation nysagmus diplopia
Ataxia

Opposite:
Arm Face leg paralysis
Sensory

Question 17

Lateral Inferior Pons

Answer 17

AICA anterior inferior cerebellar artery

Vomiting nausea nystagmus
ipsilateral face and opposite body sensory loss
Ataxia ipsilat
ipsilateral horner
Deafness if labyrinthal artery

middle cerebral peduncle
VIII
V
sympathetic

Question 18

Medial Medullar

Answer 18

Dejerine
Vertebral Artery
Paramedian Branches Anterior spinal Artery

Ipsilateral Tongue XII
Oposite:
Hemiparesis Arms Leg
Hemisensory

Question 19

Lateral Medulla

Answer 19

Wallenberg
PICA Vertebral Artery

Ipsi:
Face pain and sensory loss
Ataxia
Vertigo Nausea VIII
Nystagmus
Hoarsness
Horner
Numbness

Contra: No Sensory in Hand Legs (spinithalamic)

Question 20

Post Hypoxic syndromes

Answer 20

Coma Stupor
Dementia w/wo extrapyramidal
Extrapyramidal (CO)
Choreoathetosis
Ataxia
Myoclonus
Korsakow

Question 21

Watershed

Answer 21

1) visual agnosia, Balint, cortical blindness

2) Man in the barrel prox arms MCA-ACA watershed

Question 22

Embolic risk MV AV Mechanical

Answer 22

1) MVS: 9-14%
2) Aortic valve calcification: no increased risk
3) Vegetation on valve 50%
mechanical valve and anticoagulant: MV 4%/year and AV 2%/Year
4) AF: 4-7.5% stroke per year;
5-6* stroke risk
if rheumatic AF: 17* stroke risk