Cerebral Vasculature

Question 1

What are the two main classifications of stroke and what is their relative incidence?

Answer 1

1. Ischemic: >85% of cases
2. Hemorrhagic: 15% of cases

Question 2

What are the most common causes of ischemic stroke?

Answer 2

1. Atherosclerotic complications
2. Atrial fibrillation (emboli from clot formation)
3. Endocarditis (septic emboli)
4. Sickle cell disease

Question 3

Describe the artery that has been occluded in each of the following stroke syndromes:

Paresis and sensory loss of contralateral lower extremity

Answer 3

Anterior cerebral artery (ACA)

Question 4

Describe the artery that has been occluded in each of the following stroke syndromes:

Hemiparesis, contralateral hemisensory loss, homonymous hemianopsia, aphasia

Answer 4

Middle cerebral artery (MCA) supplying the dominant hemisphere

Question 5

Describe the artery that has been occluded in each of the following stroke syndromes:

Altered mental status, memory deficits, hemisensory loss, homonymous hemianopsia with macular sparing

Answer 5

Posterior cerebral artery (PCA)

Question 6

Describe the artery that has been occluded in each of the following stroke syndromes:

Amaurosis fugax

Answer 6

Ophthalmic artery

Question 7

Describe the artery that has been occluded in each of the following stroke syndromes:

Vertigo, cranial nerve (CN) palsies, impaired level of consciousness, dysarthria

Answer 7

Basilar artery

Question 8

Describe the artery that has been occluded in each of the following stroke syndromes:

1. Ataxia
2. Nystagmus
3. Paresis of conjugate gaze
4. Horner syndrome
5. Contralateral decreased pain/temp in face and body
6. Decreased proprioception in LE>UE
7. Dizziness
8. N/V

Answer 8

Superior cerebellar artery (lateral medullary syndrome)

Question 9

Describe the artery that has been occluded in each of the following stroke syndromes:

Urinary incontinence, suck and grasp reflexes

Answer 9

MCA or ACA supplying the frontal lobe

Question 10

Describe the artery that has been occluded in each of the following stroke syndromes:

1. Ipsilateral nystagmus
2. Facial paralysis
3. Conjugate gaze paralysis
4. Deafness
5. Tinnitus
6. Ataxia
7. Decreased facial sensation
8. Contralateral decreased pain and temp
9. N/V, vertigo

Answer 10

Anterior inferior cerebellar artery

Question 11

Describe the artery that has been occluded in each of the following stroke syndromes:

1. Ipsilateral loss of pain and temp in face
2. Contralateral loss of pain and temp in body
3. Ipsilateral laryngeal/pharyngeal paralysis
4. Ipsilateral Horner syndrome
5. Vertigo
6. Ipsilateral ataxia
7. Nausea

Answer 11

Posterior inferior cerebellar artery (Wallenberg syndrome)

Question 12

Describe the artery that has been occluded in each of the following stroke syndromes:

Wernicke aphasia (fluent speech without meaning; poor comprehension and word repetition)

Answer 12

Dominant inferior MCA

Question 13

Describe the artery that has been occluded in each of the following stroke syndromes

Broca aphasia (nonfluent speech with poor repetition and normal comprehension)

Answer 13

Superior dominant MCA

Question 14

What is the most common site for ischemic/embolic stroke?

Answer 14

MCA

Question 15

What is the most common source of emboli that result in stroke?

Answer 15

Carotid atheroma

Question 16

Name the term used to describe the infarction of white matter commonly associated with hypertension, diabetes, and carotid atherosclerosis:

Answer 16

Lacunar infarction

Question 17

Name the term used to describe the infarction of gray matter commonly associated with sustained hypotension:

Answer 17

Watershed infarction (occurs at the margin of arterial territories)

Question 18

What is the peak period for cerebral edema after a stroke?

Answer 18

2-5 days

Question 19

Name three noninvasive, non-pharmacologic interventions for lowering intracranial pressure (ICP) that can be used in the setting of stroke or trauma:

Answer 19

1. Elevate the head of the bed at least 30° (maximize venous drainage).
2. Maintain normothermia.
3. Maintain PCO2 ≤35.

Question 20

Name six medical or surgical interventions for lowering ICP that can be used in the setting of stroke or trauma:

Answer 20

1. Light sedation (ie, benzodiazepines, narcotics, propofol)
2. Osmotic diuresis (mannitol, hypertonic saline)
3. Cerebrospinal fluid (CSF) diversion (ventriculostomy)
4. Chemical paralysis (non-depolarizing muscle relaxants)
5. Barbiturate coma
6. Decompressive craniectomy

Question 21

Name the term used to describe a neurologic deficit caused by ischemia that resolves within 24 h

Answer 21

Transient ischemic attack (TIA)

Question 22

What is the primary radiologic study necessary in the workup (w/u) of stroke?

Answer 22

Computed tomographic (CT) scan of the head without contrast

Question 23

What radiologic study may be useful in determining the etiology of an ischemic stoke?

Answer 23

Cerebral angiography

Question 24

What radiologic study can provide useful information about the anatomy of a stroke if angiography is contraindicated?

Answer 24

Magnetic resonance angiography (MRA)

Question 25

What oral medications have been shown to improve outcome in patients with acute ischemic stroke?

Answer 25

Aspirin, clopidogrel, ticlopidine, and Aggrenox

Question 26

What type of therapy is indicated in a patient at risk for cardioembolic stroke?

Answer 26

Anticoagulation with heparin followed by Coumadin

Question 27

What medical intervention has been shown to improve outcome in embolic stroke when administered within 3 h?

Answer 27

Tissue plasminogen activator (tPA)

Question 28

What surgical intervention is indicated for patients with symptomatic carotid stenosis causing \>70% compromise of the carotid lumen?

Answer 28

Carotid endarterectomy

Question 29

What primary preventative measures are recommended in a patient at risk for ischemic stroke?

Answer 29

Smoking cessation, antihypertensive therapy, glycemic control in diabetics, and cholesterol lowering therapy