Cerebrovascular Disease & Infections (Martin)

Question 1

Symptoms of an ACA injury

Answer 1

anterior cerebral artery - c/l leg more than the arm or face and “alien hand” syndrome - semiautomatic movements of the c/l arm NOT under voluntary movement

Question 2

Which vessel injury is associated with “alien hand” syndrome?

Answer 2

anterior cerebral artery (ACA)

Question 3

Symptoms of an MCA injury

Answer 3

middle cerebral artery - aphasia and face/arm motor loss face preference toward side of lesion

Question 4

Where would the gaze preference be for a MCA injury?

Answer 4

toward the side of the lesion

Question 5

What are the 3 main categories of cerebrovascular disease?

Answer 5

1. thrombosis
2. embolism
3. hemorrhage

Question 6

What is a major risk factor for focal ischemia?

Answer 6

atherosclerosis in hypertension

Question 7

Watershed infarcts

Answer 7

region between 2 vessels that is the MOST susceptible to ischemia and infarction; will see sickle-shaped band of necrosis

Question 8

What should you think if you see a sickle-shape band of necrosis?

Answer 8

a watershed infarct

Question 9

What are the two common sites of a water-shed infarct?

Answer 9

1. ACA - MCA: arm and leg weakness and language issues
2. MCA - PCA: visual processing

Question 10

Atherosclerosis typically leads to stenosis of which artery?

Answer 10

internal carotid artery - just beyond the carotid bifurcation

Question 11

Which vessel is most affected by an embolic infarction?

Answer 11

MCA

Question 12

Transient Ischemic attacks (TIA’s)

Answer 12

<24 hrs neurological deficit caused by temporary brain ischemia; typically a warning sign and a neurological emergency

Question 13

At what time are ischemic deficit most probably to produce permanent cell death?

Answer 13

> 10 mins

Question 14

What are the two types of strokes?

Answer 14

1. hemorrhagic (red) - emboli associated
2. ischemic (pale) - thrombus associated

Question 15

Hypertensive cerebrovascular disease produces which type of infarcts?

Answer 15

lacunar infarcts via lenticulostriate arteries

Question 16

Malignant hypertension is most commonly associated with what type of hemorrhage?

Answer 16

deep brain parenchymal hemorrhages

Question 17

Chronic hypertension is associated with what?

Answer 17

Charcot-Bouchard microaneurysms

Question 18

What is the most common cause of a subarachnoid hemorrhage (SAH)

Answer 18

rupture of a saccular (berry) aneurysm (dilation)

Question 19

A saccular aneurysm typically involves which vessel?

Answer 19

the anterior circulation via the anterior communicating artery

Question 20

“THE WORST HEADACHE I’VE HAD” should make you think what?

Answer 20

subarachnoid hemorrhage (SAH); 25-50% die; repeat bleeding is common in survivors

Question 21

What is the most common site for a arteriovenous malformation (AVM)?

Answer 21

subarachnoid space

Question 22

What is the most common route of CNS infection?

Answer 22

hematogenous - primarily arteries but facial veins possible

Question 23

herpes simplex and zoster

Answer 23

latent infection of sensory ganglia in Schwann cells and ASCEND to the CNS in SENSORY nerves

Question 24

Rabies

Answer 24

acetylcholine receptos at the NMJ and ASCENDS to the CNS via MOTOR nerves

Question 25

What is a major complication of bacterial meningitis?

Answer 25

meningococcemia with rash and b/l adrenal hemorrhage that leads to death (Waterhouse-friderichsen syndrome)

Question 26

Waterhouse-friderichsen syndrome

Answer 26

b/l adrenal hemorrhage that leads to death following a Nisseria infection (bacterial meningitis)

Question 27

A gram negative diplococci organism that causes bacterial meningitis?

Answer 27

N. meningitidis

Question 28

A gram positive diplococci organism that causes bacterial meningitis?

Answer 28

S. pneumoniae

Question 29

A gram negative pleomorphic organism that causes bacterial meningitis?

Answer 29

H. influenzae

Question 30

A gram positive cocci organism that causes bacterial meningitis?

Answer 30

S. aureus or S. epidermis

Question 31

A gram negative bacilli organism that causes bacterial meningitis?

Answer 31

E. coli

Question 32

What is the most common cause of bacterial meningitis in a newborn (0-6 months)"

Answer 32

Group B Strep

Question 33

What is the most common cause of bacterial meningitis in a child (6month-6 yrs)?

Answer 33

Strep pneumoniae

Question 34

What is the most common cause of bacterial meningitis in adolescents/young adults?

Answer 34

N. meningitidis; gram negative diplocci; watch for those in crowded populations; can cause Waterhous-Friderichsen syndrome

Question 35

What is the most common cause of bacterial meningitis in the elderly?

Answer 35

Strep pneumoniae

Question 36

CSF findings in a person with a abscess?

Answer 36

high WBCs high proteins normal glucose (unlike bacterial)

Question 37

Neurosyphilis can cause which type of hydrocephalus?

Answer 37

communicating hydrocephalus

Question 38

In viral meningitis viruses may reach the CNS through which nerves?

Answer 38

olfactory and trigeminal nerves

Question 39

Herpes simplex virus (HSV-1) typically involves which lobes?

Answer 39

necrotizing and hemorrhagic damage in inferior and medial temporal lobes

Question 40

What is diagnostic for rabies?

Answer 40

local paresthesias around the wound; infections ascends along MOTOR nerves; can see "foaming at the mouth"

Question 41

Subacute Sclerosing Panencephalitis (SSPE)

Answer 41

caused by the paramyxovirus; non immunized children following infection with measles; will have cognitive decline, spasticity of limbs and seizures

Question 42

Nonimmunized children are at risk for developing what after an acute measles infection?

Answer 42

Subacute Sclerosing Panencephalitis (SSPE); cognitive decline, spasticity of limbs and seizures

Question 43

In which population do you typically see toxoplasmosis gondii infections?

Answer 43

HIV or immunospressed; will see brain abscess and free tachyzoites and encysted bradyzoites

Question 44

Creutzfeldt-Jackob Disease (CJD)

Answer 44

prion disease rapidly progressive; PrP protein; will see spongiform change (intracellular vacuoles)