Cerebrovascular diseases

Question 1

what is thalamic pain syndrome?

what is the likely insulting factor? ie how does the original injury happen?

Answer 1

paradoxical pain associated with decreased sensitivity in a person recovering from a contralateral thalamic stroke in the lateral posteroventral nucleus –> “pure sensory stroke”

most likely due to hypertensive injury (just like with lacunar syndromes and motor strokes)

Question 2

describe a pt with wallenberg syndrome (aka lateral medullary syndrome)

Answer 2

ipsilateral ataxia and ipsilateral horner syndrome.

trigeminal damage may produce ipsilateral loss of facial pain/temp and ipsilateral loss of corneal reflex

damage to lateral STT produces pain/temp disturbance contralateral

dysphagia and dysphonia due to damage of CN IX and X

Question 3

most common cause of lobar hemorrhage in elderly pt w/o hx of HTN?

Answer 3

cerebral amyloid angiopathy or cognophillic angiopathy

deposition of beta-amyloid in the vessels leads to disruption and hemorrhage

**pts usually >70 and may have multiple hemorrhages

Question 4

Lamotrigine (lamictal) is used for what? and why must it be slowly titrated up?

Answer 4

anticonvulsant

go slow due to risk of rash

Question 5

sturge weber is associated with what intracranial mass?

Answer 5

leptomeningeal angioma

Question 6

aneurysm in what cerebral artery is most likely to compress CN III

Answer 6

PCA

issue with pupillary activity usually an early phenomenon

Question 7

what med is given to a pt that has suffered a subarachnoid hemorrhage in order to prevent stroke?

Answer 7

Nimodipine. because vasospasm is common following subarachnoid hemorrhage

Question 8

when should patients get a carotid endarterectomy to reduce risk of stroke? what is an alternative?

Answer 8

with stenosis of 70% or more

carotid angioplasty with stenting is alternative

Question 9

what is global aphasia?

Answer 9

impairment of comprehension, repetition, and fluency

Question 10

damage to frontal eye field results in what

Answer 10

tonic gaze deviation toward lesion.

Question 11

which hemisphere is speech dominant?

describe wernicke aphasia

Answer 11

left

fluent aphasia: pt speaking gibberish fluently and unaware. comprehension and repetition also impaired

Question 12

what is anomic aphasia? localization?

Answer 12

difficulty with word finding

least localizable - diffuse brain injruy

Question 13

what is transcortical motor aphasia? localization?

Answer 13

similar to broca but preserved repetition

left frontal white matter - spares cortex