CH33: Stroke Flashcards
1
Q
Most readily recognized factor in the genesis of primary intracerebral hemorrhage (p. 801)
A
Hypertension
2
Q
Simple measures such as the use of this drug for blood pressure control may be overall the most effective (p. 801)
A
Hydrochlorothiazide
3
Q
The presence of atrial fibrillation increases the incidence of stroke how many times? (p. 801)
A
6x
4
Q
The presence of Rheumatic Valvular disease increases the incidence of stroke how many times? (p. 801)
A
18x
5
Q
Most common cause of ischemic strokes and all the types of stroke (p. 802)
A
Cerebral embolism
6
Q
Most common vessel involved in cerebral embolism (p. 802)
A
Middle Cerebral Artery
7
Q
Atheramotaois plaques in the ascending aorta greater than this thickness is found to be associated on a statistical basis with stroke (p. 803)
A
4mm
8
Q
Migrating or traveling embolus syndrome most evident in cases of which artery (p. 803)
A
Posterior cerebral artery occlusion
9
Q
Risk of stroke with PFO alone (p. 804)
A
2%
10
Q
Risk of stroke with PFO + atrial septal aneurysm (p. 804)
A
15%
11
Q
Most common sites of atheromatous plaques (p. 805)
A
- ICA at the origin from the common carotid
- Cervical part of the vertebral arteries or at their origins at the subclavian vessels and their junction from basilar artery.
- Stem or at the main bifurcation of the MCA
- Proximal posterior cerebral artery as they wind around the midbrain
- Proximal anterior cerebral arteries
12
Q
TIAs that occur with exercise or the assumption of upright posture are particularly suggestive of (p. 807)
A
stenosis of aortic branches
dissection of the carotid artery
13
Q
TIAs that occur with hyperventilation are particularly suggestive of (p. 807)
A
moyamoya disease
14
Q
At this pressure, small pial vessels are able to dilate and to constrict in order to maintain cerebral blood flow (p. 810)
A
50 to 150mmHg
15
Q
Critical level for infarction is approximately (p. 810)
A
23ml/100g/min
16
Q
At this level, regardless of its duration, decreased CBF causes infarction (p. 810)
A
10-12ml/100g/min
17
Q
At this level marked ATP depletion, increase in extracellular K, increase in intracellular Ca, cellular acidosis (p. 811)
A
6-8 ml/100g/min
18
Q
Swelling of capillary endothelial cells which prevents the restoration of circulation (p. 811)
A
no-reflow phenomenon
19
Q
Role of excitatory neurotransmitters which are formed by glycolytic intermediates of Krebs cycle (p. 811)
A
glutamate and aspartate
20
Q
one of several calcium channels that open under conditions of ischemia and set in motion a cascade of cellular events eventuating in a neuronal death (p. 811)
A
NMDA channel
21
Q
Vitamin K dependent protease that is in combination with its cofactors protein S and antithrombin III which inhibits coagulation (p. 811)
A
Protein C
22
Q
Syndrome wherein a hypercoagulatble state does not often produce in situ arterial occlusion but it does lead to thrombotic vegetation on heart valves that precipitate strokes (p. 811)
A
Trosseau syndrome
23
Q
Bruit: angle of the jaw
A
Proximal internal carotid
24
Q
Bruit: lower in the neck
A
Common carotid or subclavian artery
25
Bruit: posteriorly in the neck
vertebral arteries
26
Transient monocular blindness occurs prior to the onset of stroke in how many percent of cases of symptomatic carotid occlusion (p. 815)
10% to 25%
27
Contralateral hemiplegia, hemihypoesthesia, homonymous sectorial hemianopia (p. 820)
Anterior choroidal artery syndrome
28
T/F Despite the small caliber of the vessel and its blood supply of deep structures, the most common cause of occlusion of the anterior choroidal artery is embolic. (p. 821)
TRUE
29
Third nerve palsy + contralateral hemiplegia (p. 824)
Weber syndrome
30
Third nerve palsy + contralateral ataxic tremor (p. 824)
Claude syndrome
31
Third nerve palsy + contralateral hemiplegia + ataxic tremor (p. 824)
Benedikt syndrome
32
Patient is unaware of being blind and denies the problem even when it is pointed out to him (p. 825)
Anton syndrome
33
Numerical segments of the vertebral artery (p. 825)
V1 from origin to the first entry into the cervical transverse foramen
V2 from the transverse foramen to the uppermost foramen
V3 dural penetration at the foramen magnum
V4 dural entry to the junction with the opposite vertebral artery and the origin of the basilar artery
34
Declares itself by cervicooccipital pain ipsilateral to the dissection and deficits of brainstem function (p. 826)
Dissection of the vertebral artery
35
Most frequent feature of lateral medullary syndrome (p. 827)
Vertigo
36
Tinnitus may be overwhelming called 'screaming' by some of our patients (p. 830)
Anterior inferior cerebellar artery infarction
37
When the position sense, two-point discrimination, and tactile localization are affected relatively MORE than pain or thermal and tactile sense (p. 831)
Cerebral lesion (if opposite, brainstem localization)
38
4 lacunar syndromes (p. 831)
Pure motor
Pure sensory
Clumsy hand- dysarthria
Ipsilateral hemiparesis-ataxia
39
Dysarthria and clumsiness syndrome (p. 831)
Paramedian midpons, posterior portion of the internal capsule apposite the affected limb
40
According to NIH study, when giving tPA, what is the risk of symptomatic cerebral hemorrhage? (p. 833)
6%
41
According to NIH study, when giving tPA, what is the risk of insignificant cerebral hemorrhage? (p. 833)
4%
42
Patients taking this medication seem to display angioneurotic edema as a side effect of tPA (p. 834)
ACE inhibitor
43
Heparin drip dose (p. 835)
100U/kg bolus then continuous drip (1,000 U/h)
44
An advantage in survival favoring the group operated (hemicraniectomy) are those operated within ___ (p. 837)
48 hours
45
SE: Neutropenia (p. 839)
Ticlopidine
46
SE: TTP (p. 839)
Clopidogrel
47
What does symptomatic TIA mean? (p. 841)
large or small strokes, or TIAs
48
Maximum benefit is accrued if CEA is performed within __ of a TIA or minor stroke (p. 841)
2 weeks
49
CEA for symptomatic lesions causing degrees of stenosis greater than ____ in diameter reduces the incidence of ipsilateral hemispheral strokes and shows greater benefit with increasing degrees of stenosis (p. 841)
70% to 80%
50
Most common symptom of hyperperfusion syndrome (p. 842)
Unilateral severe headache
51
Asymptomatic carotid stenosis should be more than ___ to be operated? (p. 843)
60% to 70%
52
Found in some patients with fibromuscular dysplasia (p. 846)
phosphatse and actin regulater 1 gene variant (PHACTR1)
53
CT scan findings in Fibromuscular dysplsia (p. 846)
series of transverse constrictions; irregular string of beds or a smooth tubular narrowing; bilateral carotid in 75% of cases
54
Why is there diltations in FMD?(p. 846)
Atrophy of the coat of the vessel wells
55
Is FMD ammenable to endarterectomy? (p. 846)
No
56
Diseases associated with vascular dissection (p. 846)
Ehlers Danlos, Mrfan syndrome, osteogenesis imperfecta, Loeys Dietz syndrome, alpha1- antitrypsin deficience
57
T/F Painful Horner syndrome is usually due to a underlying structual lesion (p. 847)
TRUE
58
Elongated but variable length, irregular narrow column of dye 1.5 to 3cm above the carotid bifurcation extending to the base of the skull (p. 848)
string sign
59
Most identifiable cause of vertebral artery dissection (p. 848)
Rapid and extreme rotational movement of the neck
60
Carotid dissection most commonly originatees in which segment (p. 848)
C1 and C2 where it is mobile but thethered as it it leaves the transverse foraen of the axis and turns sharply to enter the cranium
61
T/F Re:Cervical artery dissecion, If the dissection has produced complete occlusion of the vessel, the role of anticoagulation is les clear (p. 849)
T
62
In older patients, this is the most common initial manifestation of Moyamoya (p. 849)
SAH
63
Describes the imaging appearance of hypointense periventricular tissues in Biswanger Disease (p. 851)
leukoariois
64
Main features of Biswanger cases (p. 851)
Dementia, pseudobulbar state, gait disorder
65
Recurrent small strokes beginning in early childhood, subcortical dementia, migraine headaches (p. 852)
CADASIL
66
CADASIL+early alopecia and lumbar spondylosis with white matter changes (p. 851)
CARASIL
67
Pathology findings in CADASIL (p. 851)
small vesels n the regions of infarctions, 100 to 200mm in diameter containing basophilic granular deposits in the media with degeneration of smooth muscle fibers
68
CADASIL vs Binswanger disease (p. 851)
Anterior temporal changes are typicl of Binswanger. Migraine headaches are not a component of Binswanger.
69
Gene responsible for CADASIL (p. 851)
chromosome 19 of the NOTCH3 gene
70
Gene responsible for CARASIL (p. 851)
HTAR1 gene
71
pathologic findings in CARSAIL (p. 851)
duplication of internal elastic lamina of the cerebral vessels with narrowing of their lumens
72
T/F Use of progestin- only pills or of subcutneously implanted capsules of progestin has nt been associated with stroke (p. 855)
TRUE
73
When is stroke in pregnancy increased? (p. 855)
6 week post partum than during pregnancy itself
74
Appearance of contrast within the hemorrhage during CT angiography associated with high rate of hematoma expansion (p. 857)
spot sign
75
Etiology of ring of enhancement in CTof ICH (p. 857)
hemosiderin- filled macrohages and the reacting cells that form a capsule for the hemorrhage
76
Massive ICH means how much? (p. 857)
More than 50ml
77
Pathologic findings of ICH (p. 857)
segmental lipohyalinosis and false aneurysm
78
Giving of this anti-hypertension causes increased ICP in some studie (p. 862)
Nifedipine
79
Treatment of tpa related bleeds (p. 863)
Factor VII within 4 hours of spontaneous cerebral hemorrhage
80
Surgical evacuation of cerebellar hematoma. Size cut off (p. 863)
4cm
81
Incidence of unruptured aneursms in routine autopsies (p. 864)
2 pecent
82
Aneurysyms are multiple in how many percent of cases (p. 864)
20%
83
An accompanying saccular aneursm is found in approximately ___% of cases of cerebral AVM (p. 864)
5%
84
How many percent of sacular aneurysms lie on the anterior part of the circle of Willis (p. 865)
90-95%
85
Most common syndrome of ruptured aneurysm (p. 865)
severe generalized headache in the same instantaneous manner but remains relatively lucid with varying degreees of stiff neck
86
Convulsive seizures happen in how many percent of SAH (p. 865)
20 to 25%
87
Localized cranial pain. Aneurysm in first part of MCA (p. 865)
orbit
88
Localized cranial pain. Aneurysm in first part of PICA or AICA (p. 865)
occipital or cervical pain
89
Important in differentiating SAH from traumatic tap (p. 867)
increased pressure as high as 500mm H2O but usually closer to 250mm in SAH
90
Important in differentiating SAH from traumatic tap (p. 867)
Aside from xanthrochromia, clearing of blood as one continues to collect fluid and a marked reduction in the number of RBC in spinal fluid in traumatic tap
91
Most sensitive means of demonstrating an aneurysm (p. 867)
DSA with bilateral carotid and vertebral contrast injections
92
Percent of patiens with SAH due to aneurysmal rupture but will not have an aneurysm evident (p. 867)
5 to 10%
93
Most severe vasospasm occurs in arteries that are surronded by collections of clotted subarachnoid blood after __h (p. 868)
24 hours
94
velocity that suggests a focal vasospasm is occuring (p. 869)
over 175cm/s
95
Single bedst index of outcome in aneurysmal SAH (p. 870)
state of consciousness at the time of arteriography
96
Leading cases of morbidity and mortlity in those who survive the initial hemorrhage (p. 870)
vasospasm and rebleeding
97
Patients who are HH1 and HH2 should be operated within (p. 871)
24 hours
98
Current operative mortality of aneurysmal SAH (p. 871)
2 to 3 percent
99
Location of this unruptured intracranial aneurysms have bleeding rate many times higher than the others (p. 872)
vertebrobasilar and posterior cerebral aneurysms
100
Cut off size for giant cerebral aneurysms (p. 872)
2.5 cm
101
AVM and saccular aneurysm are asocaited in approximately in how many percent of cases (p. 873)
5%
102
T/F A systolic bruit heard over the carotid in teh neck or over the mastoid process or the eyeeballs in a young adult is suggestive of AVM (p. 874)
T
103
Risk of bleeding from a known AVM is approximately (p. 874)
3% a year
104
ARUBA findings (p. 874)
stroke occured in 10% of expectant managemetn group compared to 31%of group that had intervention
105
Types of complications of radiation occur in radiation (p. 876)
delayed radiation necrosis
| venous congestion
106
Dural fistula presentation (p. 877)
fluctuating ischemic like deficit appropriate to the cerebral or spinal location underlying the lesion or at some distance from it
107
Dural lesions (AVF) with the most risk of bleeding are found where? (p. 877
Anterior cranial fossa and tentorial incisura
108
A posible causative in familal cavernoma (p. 877)
KRIT1
109
Most common cerebral vascular malformation estimated to occur in almsot 3%of large autopsy series (p. 878)
Deep venous anomaly
110
Nex to HPN, what is the msot common cause of cerebral hemorrhage (p. 879)
Anticoagulant use
111
Top three secondary brain tumors that bleed (p. 880)
choriocarcinoma, melanoma, renal cell carcinoma
112
Basic neuropathologic changes in hypertensive encephalopathy (p. 882)
clustering of multiple micorinfarcts and petechial hemorrhages
113
Cocaine hydrochloride vs crack cocaine stroke manifestations (p. 884)
cocaine hydrochloride: prone to cause cerebral hemorrhage due to acute hypertension
crack cocaine: ischemic usually large artery occlusion
114
Pulseless disease (p. 887)
Takayasu Disease
115
Bsis in distinguishing polyarteritis vasculitis from Churg Strauss graulomatous angitis (p. 888)
sparing of the lungs
116
Subacutely evolving vasclitis with necrotizing granuloms of the upper and lower respiratory tracts followed by necrotizing glomerulonephritis are its main features (p. 888)
Wegener Granulomatosis
117
Relatively specific nd sensitive for WEgene disease but may be alpresent in intravascular lymphoma (p. 888)
cytoplsmic antineutrophil cytoplasmic antibodies (CANCA)
118
Sensitive indicator of SLE(p. 889)
anti- dsDNA
119
microangiopathy affecting mainly the brain and retina (p. 889)
Susac Syndrome
120
Psychiatric symptoms, headache, dementia, sensorineural deafness, vertigo, impariment of vision (p. 889)
Susac Syndrome
121
Relapsing iridocyclitis, recurrent oral and genitalulcers (p. 889)
Behcet Disease
122
Formation of sterile pustule t the site of needle prick in Behcet diseae (p. 890)
Pathergy test
123
Essential pathologic finding in DIC (p. 892)
widespred fibin thrombi in smll vessels resulting in neumerous small infarctions of many organs including the brain (p. 893)
124
Antibodies in APAS (p. 893)
Lupus anticoagulant, anticoardiolipin, b2- glycoprotein 1
125
Most specific antibody in APAS (p. 893)
b2- glycoprotein
126
Antibody which correlates the risk of thrombosis and specificit for the syndrome is higher for IgG than for IgM autoantbodies (p. 890)
anticardiolipin antibody
127
Most frequent neurologic abnormality in APAS (p. 893)
TIA
128
Arteriopathy producing deep blue-red skin lesions of livedo reticularis and livedo racemosa in assocation ith multiple ischemic strokes (p. 893)
Sneddon syndrome
129
TTP is caused by acquired circulating IgG inhibitor of the VWF cleaving protease called (p. 894)
ADAMTS13
130
A high proportion of patients with polycythemia vera will have mutations in (p. 894)
JAK2
