Ch 1 - Stroke: Introduction

Question 1

What is a cerebrovascular event?

Answer 1

Signs of focal or global disturbances of cerebral function lasting >24 hrs or leading to death secondary to vascular causes

Question 2

What is a transient ischemic attack?

Answer 2

Symptoms of a CVA <24 hrs

Question 3

What are nonmodifiable risk factors for stroke?

Answer 3

Age (risk doubles each decade >55)
Sex (male>female)
Race (AA 2x>Caucasian> Asians)
Family history of stroke

Question 4

What is the most important modifiable risk factor for ischemic and hemorrhagic stroke?

Answer 4

HTN

Question 5

What are modifiable cardiac causes of stroke?

Answer 5

HTN
CHF/CAD 2x
AFib 5x
Carotid stenosis
Patent foramen ovale (PFO)

Question 6

What level of stenosis does carotid endarterectomy most beneficial?

Answer 6

70-99% carotid stenosis

Question 7

What are modifiable non-cardiac causes of stroke?

Answer 7

DM 2x
Cigarette smoking 2x
ETOH/cocaine abuse
High dose estrogens
Systemic hypercoagable diseases
Migraines
Sleep apnea
Obesity/sedentary lifestyle

Question 8

What does the middle cerebral artery supply?

Answer 8

Most lateral aspect of the hemisphere

Question 9

What does the anterior cerebral artery supply?

Answer 9

Medial aspect of the hemisphere from lamina terminalis to cuneus

Question 10

What does the posterior cerebral artery supply?

Answer 10

Inferior surface of temporal lobe and visual cortex

Question 11

Where is CSF produced?

Answer 11

Ependymal cells in choroid plexus in lateral, 3rd and 4th ventricles

Question 12

Where does CSF circulate?

Answer 12

Lateral ventricles to the foramina of Monro,
3rd ventricle, aqueduct of Sylvius, 4th ventricle, foramen of Magendie and foramina of Luschka, and subarachnoid space over brain and spinal cord.

Question 13

What are types of ischemic strokes?

Answer 13

Thrombotic
Embolic
Lacunar

Question 14

When do thrombotic strokes occur?

Answer 14

During sleep

Question 15

What is the cause of thrombotic strokes?

Answer 15

Perfusion failure distal to site of severe stenosis or occlusion of major vessels

Question 16

What is the presentation of thrombotic strokes?

Answer 16

Slow (gradual),

progressive deficit

Question 17

What precentage of thrombotic strokes precede with TIA?

Answer 17

50% in same vascular territory

Question 18

When do embolic strokes occur?

Answer 18

While awake

Question 19

What is the cause of embolic strokes?

Answer 19

Cardiac source

Question 20

What is the presentation of embolic strokes?

Answer 20

Sudden, immediate

deficit (seizures may occur)

Question 21

Where do lacunar strokes occur?

Answer 21

– putamen
– pons
– thalamus
– caudate
– internal capsule/ corona radiata

Question 22

What is the presentation of lacunar strokes?

Answer 22

Abrupt or gradual onset

Question 23

When do intracerbral hemorrhages (ICH) occur?

Answer 23

90% of cases occur when patient is calm and unstressed.

Question 24

What is the cause of intracerbral hemorrhages (ICH)?

Answer 24

HTN

Question 25

What is the presentation of intracerbral hemorrhages (ICH)?

Answer 25

Gradual onset (minutes to days) or sudden onset of local neurologic deficits

Question 26

When do subarachnoid hemorrhages (SAH) occur?

Answer 26

During strenuous activity

Question 27

What is the cause of subarachnoid hemorrhages (SAH)?

Answer 27

Ruptured aneurysms

and vascular malformations

Question 28

What is the presentation of subarachnoid hemorrhages (SAH)?

Answer 28

Sudden onset