Core Diagnoses

Question 1

Demographic stroke risk factors

Answer 1

Age (2/3 happen in those >65)
M>F
Black>Latino>White
Genetic conditions (like VHL)

Question 2

Modifiable stroke risk factors

Answer 2

HTN (Systolic or Diastolic)
Atrial fibrillation
Diabetes
Dyslipidemia
Physical Inactivity
Effing smoking, dude

Question 3

Four key features of stroke

Answer 3

Sudden onset
Focal involvement of the CNS
Lack of rapid resolution
Vascular cause

Question 4

Time course of a TIA

Answer 4

Neurologic deficits resolve completely in a short period (usually within 1 hour)

Question 5

Time course of a stroke-in-evolution

Answer 5

Also known as a progressing stroke.

Deficits worsen as the patient is seen

Question 6

Time course of a Completed stroke

Answer 6

Deficits persist.

Question 7

Ischemic stroke

Answer 7

Occlusion of a blood vessel interrupts the flow of blood to a region of the brain
Neurologic deficits appear in those regions

Question 8

Hemorrhagic stroke

Answer 8

Less predictable focal involvement. Complications, such as ICP, cerebral edema, parenchymal compression, blood vessel compression, and/or dispersion of blood through subarachnoid space or ventricles can impair sites remote from the hemorrhage

Question 9

What affects the brain in a more diffuse fashion, producing global cerebral dysfunction?

Answer 9

Global cerebral ischemia (usually from cardiac arrest)

Subarachnoid hemorrhage

Question 10

Structures supplied by the anterior circulation

Answer 10

Carotid arteries supply:

Most of the cerebral cortex & subcortical white matter
Basal ganglia
Internal capsule

Question 11

Vessels in the anterior circulation

Answer 11

Internal carotid

Branches:
Anterior choroidal
Anterior cerebral
Middle cerebral
Lenticulostriate (deep penetrating, off of the MCA)

Question 12

Symptoms commonly associated with anterior circulation strokes

Answer 12

Hemispheric dysfunction.

Aphasia
Apraxia
Agnosia

Less specific:
Hemiparesis
Hemisensory disturbances
Visual field defects

Question 13

Aphasia

Answer 13

No talky good

Question 14

Apraxia

Answer 14

No motor planny good

Question 15

Agnosia

Answer 15

No recognizey good

Question 16

Structures supplied by posterior circulation

Answer 16

Brainstem
Cerebellum
Thalamus
Portions of occipital lobes
Portions of temporal lobes

Question 17

Posterior circulation vessels

Answer 17

Vertebral arteries
Basilar artery

Branches off these structures:
PICA
AICA
SuCeA
PCA
Branches:
Thalamoperforate, thalamogeniculate

Question 18

Anterior Choroidal Territory

Answer 18

Hippocampus
Globus pallidus
Lower internal capsule

Question 19

ACA Territory

Answer 19

Medial frontal cortex
Medial parietal cortex
Subjacent white matter
Anterior corpus callosum

Question 20

MCA Territory

Answer 20

Lateral frontal cortex
Lateral parietal cortex
Lateral occipital cortex
Lateral temporal cortex
Subjacent white matter

Question 21

Lenticulostriate Territory

Answer 21

Caudate
Putamen
Upper internal capsule

Question 22

PICA Territory

Answer 22

Medulla

Lower cerebellum

Question 23

AICA Territory

Answer 23

Lower pons
Middle pons
Anterior cerebellum

Question 24

SuCeA Territory

Answer 24

Upper pons
Lower midbrain
Upper cerebellum

Question 25

PCA Territory

Answer 25

``` Medial occipital cortex Medial temporal cortex Subjacent white matter Posterior corpus callosum Upper midbrain ```

Question 26

Thalamoperforate Territory

Answer 26

Thalamus

Question 27

Thalamogeniculate Territory

Answer 27

Thalamus

Question 28

Symptoms of posterior circulation strokes

Answer 28

``` Brainstem dysfunction Cerebellar dysfunction Coma Drop attacks Vertigo Nausea Vomiting Cranial nerve palsies Ataxia Crossed sensorimotor defects ``` Less specific: Hemiparesis Hemisensory disturbances Visual field deficits

Question 29

Stereotypic TIAs

Answer 29

Recurrent TIAs with identical clinical features Caused by thrombosis or embolism arising from the same site

Question 30

How many patients with TIAs go on to have a stroke within 5 years?

Answer 30

1/3

Question 31

How do you definitively diagnose the difference between ischemic and hemorrhagic strokes?

Answer 31

CT or MRI!

Question 32

What are the causes of ischemic stroke?

Answer 32

Cardiac embolism (50%) Large artery occlusion (25%) Small artery occlusion (10%) Crpytogenic/Unknown (15%)

Question 33

Mild ischemia with rapid reperfusion (such as cardiac arrest)

Answer 33

Selective vulnerability of certain neuronal populations

Question 34

Severe ischemia

Answer 34

Selective neuronal necrosis Mos or all neurons die Glia and vascular cells are preserved

Question 35

Complete/permanent ischemia (such as stroke without reperfusion)

Answer 35

Pannecrosis All cell types affected Chronic cavitary lesions

Question 36

Thrombotic strokes are often preceded by

Answer 36

TIAs

Question 37

Embolic strokes

Answer 37

Produce neurologic deficits that are maximal at onset

Question 38

Intracerebral hemorrhage

Answer 38

Causes more severe headache and depression of consciousness than ischemic stroke Deficits that don't correspond to a single blood vessel