Cerebrovascular Disease/Stroke

Question 1

Vulnerable neurons in ischemic/hypoxic encephalopathy (2)

Answer 1

Hippocampus

Purkinje cells in cerebellum

Question 2

Non-hemorrhagic infarcts are usually due to ___

Answer 2

thrombus –> stable

Question 3

Hemorrhagic infarcts are usually due to ___

Answer 3

embolus –> breaks up –> reprofusion

Question 4

Which of the following does NOT present in acute cerebral infarction?
A. Red nuerons
B. Spheroid bodies
C. Vascular proliferation at border b/w necrotic and viable tissue
D. Intense neutrophilic response

Answer 4

D. Neutrophils will melt neurons

A. Coagulation necrosis
B. Axonal degeneration

Question 5

Subacute cerebral infarct present with (2)

Answer 5

• Foamy macrophages: full of lipids of necrotic neurons

* Reactive gliosis (gemistocytes): proliferation of astrocytes that participate as part of response to injury

Question 6

Remote cerebral infarct present with (2)

Answer 6

Cyst formation

Glial scarring

Question 7

T/F: Premature infants with perinatal asphyxia present with periventricular leukomalacia and multicystic encephalopathy.

Answer 7

False: Term infants present this way.

Periventricular leukomalacia = meltdown of white matter adjacent to ventricles

Premature infants present with germinal matrix hemorrhage that causes intraventricular hemorrhage.

Question 8

Most common sites of hypertensive hemorrhage

Answer 8

Basal ganglia-thalamus
Pons
Cerebellum

Question 9

Saccular Aneurysm arise where?

Answer 9

At branch points
o Anterior cerebral artery/anterior communicating artery
o Trifurcation of middle cerebral artery
o Internal carotids/posterior communicating arteries
o Posterior circulation: basilar arteries/vertebral arteries

Question 10

T/F: Amyloid angiopathy hemorrhage involves deep gray structures.

Answer 10

False. Involves primarily white matter, spares adjacent deep gray structure.

Vs. spontaneous hypertensive hemorrhage

Question 11

T/F: Ischemic strokes mostly involve arterials.

Answer 11

True: 80% arterials

Question 12

T/F: Hemorrhagic stroke loses 2 million neurons/minute

Answer 12

False. Ischemic stroke

Question 13

Causes of atherothrombotic ischemic stroke is occurs in which vessels? (3)

Answer 13

Internal carotids
Vertebrals
Basilar artery

Question 14

Causes of lacunar ischemic stroke is occurs in which vessels? (4)

Answer 14

Perforating arteries of ACA, MCA, PCA, basilar vertebral arteries

Question 15

Most common cardiac condition that causes cardioembolism?

Answer 15

Arterial fibrillation

Question 16

Name the artery responsible for the following symptoms in the ischemic stroke?
o Behavior change
o Leg weakness

Answer 16

Anterior cerebral artery (ACA)

Frontal lobe

Question 17

Name the artery responsible for the following symptoms in the ischemic stroke?
o Lack of awareness of problem = anosognosia

Answer 17

Right medial cerebral artery

Posterior frontal lobe, parietal lobe, temporal lobe

Question 18

Name the artery responsible for the following symptoms in the ischemic stroke?
Left gaze deviation

Answer 18

Left medial cerebral artery

Posterior frontal lobe, parietal lobe, temporal lobe

Question 19

Name the artery responsible for the following symptoms in the ischemic stroke?
o Left neglect
o Left sided weakness

Answer 19

Right medial cerebral artery

Posterior frontal lobe, parietal lobe, temporal lobe

Question 20

Name the artery responsible for the following symptoms in the ischemic stroke?Quadrantanopsia or hemianopsia

Answer 20

Both right and left medial cerebral artery

Question 21

Name the artery responsible for the following symptoms in the ischemic stroke?
Aphasia

Answer 21

Left medial cerebral artery

Question 22

Name the artery responsible for the following symptoms in the ischemic stroke?
Right gaze deviation

Answer 22

Right medial cerebral artery

Posterior frontal lobe, parietal lobe, temporal lobe

Question 23

Name the artery responsible for the following symptoms in the ischemic stroke?
Hemi-visual field loss = homonymous hemianopsia

Answer 23

Posterior cerebral artery

Occipital lobe

Question 24

Name the artery responsible for the following symptoms in the ischemic stroke?
Lateral medulla syndrome:
Hemiataxia (incoordination)
Vertigo from nystagmus
Ipsilateral facial, contralateral body symptoms

Answer 24

Vertebral artery

Question 25

Name the artery responsible for the following symptoms in the ischemic stroke? Medial medulla: Locked-In Syndrome

Answer 25

Anterior spinal artery

Question 26

Name the artery responsible for the following symptoms in the ischemic stroke? Unilateral incoordination

Answer 26

Posterior Inferior Cerebellar Artery (PICA)

Question 27

Name the artery responsible for the following symptoms in the ischemic stroke? Coma or locked-in syndrome

Answer 27

Basilar artery | Pons, midbrain

Question 28

Name the arteries (2) responsible for the following symptoms in the ischemic stroke? Unilateral incoordination/vertigo (nystagmus)

Answer 28

Anterior inferior cerebellar artery (AICA) | Superior cerebellar artery (SCA)

Question 29

``` Wallenberg syndrome presents with all the following EXCEPT: A. Vertigo B. Contralateral facial numbness C. Ipsilateral incoordination D. Ipsilateral Horner's E. Contralateral body numbness ```

Answer 29

B. Ipsilateral facial numbness

Question 30

Pure motor weakness is caused by which vessels (2)?

Answer 30

``` Lenticulostriates: MCA perforates (Posterior limb internal capsule) Basilar perforates (Pons) ```

Question 31

Pure sensory weakness is caused by what vessel?

Answer 31

Thalamogeniculates: PCA perforators (Lateral thalamus)

Question 32

``` Which of the following is TRUE of hemorrhagic stroke symptoms? A. Contralateral weakness B. Contralateral loss of vision C. Headache D. No impairment of consciousness ```

Answer 32

C A. Ipsilateral weakness B. Ipsilateral loss of vision D. Reduced consciousness --> coma

Question 33

Cause of subarachnoid hemorrhagic stroke?

Answer 33

Aneurysm rupture

Question 34

Cause of intraventricular hemorrhagic stroke?

Answer 34

Vessel malformation

Question 35

Cause of intraparenchymal hemorrhagic stroke?

Answer 35

Hypertension Vessel malformation Coagulopathies Infection/tumor/drugs

Question 36

Pinpoint pupils suggests ____

Answer 36

Pontine hemorrhage

Question 37

Vertigo suggests ____ hemorrhage

Answer 37

cerebellar