CVD Flashcards
1
Q
Oculomotor palsy + c/l hemiplegia
A
Weber syndrome
2
Q
Oculomotor palsy + c/l ataxia & tremor
A
Claude syndrome
3
Q
Oculomotor palsy + c/l ataxia, tremor + c/l weakness
A
Benedikt syndrome
4
Q
CN IV palsy + gaze paralysis + nystagmus + ataxia = ?
Usual cause?
A
Nothnagel syndrome
Tumor
5
Q
CN VII and VI palsy, c/l hemiplegia, gaze palsy
A
Millard Gubler, Raymond Foville Syndrome
6
Q
Paralysis of soft palate and vocal cord + c/l hemianesthesia
A
Avellis syndrome
7
Q
Paralysis of soft palate, vocal cord + c/l hemianesthesia + ipsilateral tongue paralysis
A
Jackson syndrome
8
Q
I/L V IX X XI palsy
Horner
Cerebellar ataxia
C/l loss of pain and temperature sense
A
Wallenberg syndrome
9
Q
Alexia w/o agraphia. Localize:
A
Left PCA occlusion in a r-handed pt
Posterior corpus callosum + left occipital
10
Q
What is the balint syndrome?
A
Simultagnosia
Oculomotor apraxia
Optic ataxia
11
Q
Most common locations of lacunes:
A
- Putamen, caudate
- Thalamus
- Basis pontis
- Internal capsule
- Deep central WM
12
Q
Most frequent symptomatic forms of lacunar stroke
A
Pure motor hemiplegia
Pure sensory stroke
Clumsy-hand dysarthria
Ipsilateral hemiparesis-ataxia
13
Q
Side effect of rtpa for pts taking ACE inhibitors
A
Angioneurotic edema
14
Q
Drug that inhibits plt cyclooxygenase, prevents production of thromboxane a2, prostacyclin
A
Aspirin
15
Q
“Warfarin was non-superior to ASA in stroke prevention
ASA w fewer GI bleeds and stroke prevention. “
Wc trial?
A) WARSS
B) WASID
C) IST
D) CAST
A
B. WASID
WARSS - administer ASA in all cases of stroke
IST, CAST- ASA goven w/in 48h of stroke, modest reduction in mortality and stroke recurrence
16
Q
Antiplatelet with a side effect of TTP
A
Clopidogrel
17
Q
Antiplatelet w/ a side effect of Neutropenia
A
Ticlopidine
18
Q
Trial recommending the use of HMG CoA Reductase Inhibitors:
A) WASID
B) CHANCE
C) POINT
D) SPARCL
A
D. SPARCL
WASID - ASA
CHANCE & POINT - dual antiplatelet
19
Q
Wc patient population stands to benefit from PFO closure?
A
Younger pts
Mod-large shunts
Atrial septal aneurysms
20
Q
Segment that most often lends itself to endarterectomy or stenting:
A) Common carotid
B) Carotid sinus
C) Innominate
D) Proximal subclavian
A
B) Carotid sinus
The rest are also alternative sites
21
Q
Carotid endarterectomy recommended for lesions w/ stenosis of _%?
A
> 70-80%
22
Q
Optimal timing of carotid endarterectomy after stroke
A
Within 2 weeks of TIA or minor stroke
23
Q
Most common symptom of hyperperfusion syndrome (Post endarterectomy)
A
Unilateral severe headache
24
Q
(Per adams)
Long-term morbidity sx of Left frontal lobe lesions
A
Fatigability
Depression
25
Posture assumed by the arm and leg post-stroke
Arm: flexed adducted
Leg: extended
26
Percentage of patients post-stroke who experience seizures
10%
27
Most frequently involved in FMD
ICA, extracranial part
28
String of beads is found in?
Fibromuscular dysplasia
29
Double lumen sign is found in?
ICA dissection
30
String sign
ICA dissection
31
Most common site affected in vertebral artery dissection
C1-C2
32
Where is the pain a/w MCA dissection?
A) Retrorbital
B) Occipital
C) Occipital + supraorbital
A) Retrorbital
B) Occipital - BASILAR
C) Occipital + supraorbital - VERTEBRAL
33
Most common presentation of Moyamoya disease in
A) Children
B) Adults
A) Children: Hemiparesis
B) Adults:
SAH
34
Moyamoya disease is a/w segmental stenosis or occlusion of ___?
TERMINAL INTRAcranial parts of both ICAs
35
Moyamoya disease is a/w which syndrome?
Down
& certain HLA types
(Chromosome 17q)
36
What are the three main clinical features of Binswanger disease?
Dementia
Pseudobulbar state
Gait disorder
37
Genetic abnormality in CADASIL?
NOTCH 3 gene
Chromosome 19
(Missense mutation)
38
Genetic locus in CADASIL is also found in?
Familial hemiplegic migraine
Remember: hx of migraine w/ sx, TIAs attributed to migraines in CADASIL
39
Clinical presentation of CADASIL
Recurrent small strokes in early adulthood -> subcortical dementia
40
Clinical presentation of CARASIL
Early alopecia
Lumbar spondylosis
WM changes typical of CADASIL
41
Genetic abnormality in CARASIL
HTAR1 gene
42
Genetic abnormality in activated protein C RESISTANCE
Leiden factor V mutation
43
Genetic abnormality in Protein C DEFICIENCY
Protein C gene
44
Genetic abnormality in Marfan Syndrome
Fibrillin 1
45
Genetic abnormality in Sickle cell syndrome
Globin genes
46
Genetic abnormality in hyperhomocysteinemia
MTHFr
47
Genetic abnormality in Fabry disease
Alpha-galactosidase
48
Most common inherited deficiencies of naturally occurring anticoagulant factors as a cause of stroke
Factor V Leiden mutation
49
Which is not a likely cause of stroke?
A. Mitral valve prolapse
B. Inflammatory bowel disease
C. Migraine + OCPs
A. MVP
50
Risk of cerebral infarction and ICH post delivery is highest during which time?
6-week period post-delivery
51
What is the presentation of stroke associated with cardiac surgery?
Acute encephalopathy (2/2 multiple small emboli)
52
Most frequent cause of stroke
A) Embolic
B) Thrombotic
C) Hemorrhagic
A) Embolic
Thrombotic (2nd)
Hemorrhagic (3rd)
53
Most common location of intracerebral hemorrhage?
Putamen and adjacent internal capsule (50%)
2. Lobar hemorrhages
3. Thalamus
4. Cerebellar hemisphere
5. Pons
54
When is hemosiderin observed around clot margins in ICH?
5-6 days
55
What do you call the sign wherein there's an appearance of contrast within the hemorrhage on CT angio? This is associated with what?
Spot sign.
Associated with a high rate of hematoma expansion.
56
Eye signs in ICH.
```
Match:
A. Putaminal
B. Thalamic
C. Pontine
D. Cerebellar
```
A. Opposite the paralysis
B. Fixed, pupils tiny but reactive
C. Opposite the lesion, ocular bobbing
D. Downward, unreactive pupils
Putaminal - opposite the paralysis
Thalamic - downward, unreactive pupils
Pontine - fixed, tiny pupils but reactive
Cerebellar - opposite the lesion, ocular bobbing
57
Eye pattern in skew deviation 2/2 thalamic hemorrhage
The eye ipsilateral to the lesion is higher!
Others:
Pseudoabducens palsies (inward and downward)
Palsies of gaze
Absence of convergence
58
What are the components of the ICH score?
```
GAS Location
GCS
Age
Size of hemorrhage
Location
```
GCS
3-4: 2
5-12: 1
13-15: 0
Age
80 and above: 1
Size
> 30: 1
< 30: 0
Location
Infratentorial 1
Intraventricular 1
59
What is the estimated mortality rate for pt w/ an ICH score of 4?
97%
```
5 - 100%
4 - 97%
3 - 72%
2 - 26%
1 - 13%
0 - 0
```
60
What is the estimated mortality rate for pt w/ an ICH score of 3?
72%
```
5 - 100%
4 - 97%
3 - 72%
2 - 26%
1 - 13%
0 - 0
```
61
What is the cutoff size for cerebellar hematoma to merit surgical evacuation?
4cm or more
| or vermian location
62
Aneuryms can be secondary to developmental defects in which layer/s of the cerebral arteries?
Media, elastica
63
Aneurysms, when secondary to hemodynamic destruction, will have which component of the arteries affected?
Internal elastic membrane
64
Aneurysmal size that is considered prone to rupture?
10mm or more
65
What are the 4 most common sites of aneurysms?
1. Acomm, proximal
2. Pcomm origin (from ICA)
3. MCA, first major bifurcation
4. ICA bifurcation (into MCA, ACA)
66
Incidence of convulsive seizures in SAH
10-25%
67
Clinical finding in a supraclinoid aneurysm?
Monocular visual field defect
68
Hunt hess score for.a patient with no symptoms and stiff neck?
H&H 1
69
Hunt and hess score for a patient with mild focal deficit?
H&H III
70
Hunt and hess score for a confused patient?
H&H III
71
Hunt and hess score for a pt with severe HA and nuchal rigidity?
H&H II
72
Hunt & hess score for a pt in stupor & with decerebrate posturing?
H&H IV
73
Hunt & hess score for a patient in deep coma?
H&H V
74
H&H score for a drowsy patient?
H&H III
75
Most sensitive means of demonstrating an aneurysm
Digital subtraction angiography
76
How long after an SAH can you find blood on the CSF
within 30 minutes or sooner
77
Peak incidence of rebleeding in aneurysmal SAH?
First 24 hours
78
When does vasospasm occur after aneurysmal SAH?
3-10 days after rupture
79
Suspected location of aneurysm if you see SAH within the anterior perimesencephalic cistern?
Pcomm or distal basilar artery
80
Single best index of outcome in aSAH patients
State of consciousness at the time of arteriography.
81
Advised intervention for Hunt & Hess IV patients
Counseled against early operation
82
Advised intervention for Hunt & Hess II patients
Obliteration of aneurysm within 24 hours
83
Syndrome of unilateral subhyaloid hemorrhage to aSAH
Terson Syndrome
84
Definition of Giant Cerebral Aneurysms in terms of size?
> 2.5 cm in diameter
85
Clinical presentation of convexity SAH
Younger - HA
Older - TIA
86
Genetic abnormality in AV Malformations
KRAS in endothelial cells
87
Most common clinical presentation of AVM
SAH (50%)
Others:
2. Sz
3. HA
4. Focal deficits
88
Spetzler Martin score for an AVM 5mm in size, in an eloquent site, w/o venous drainage to deep veins
2 + 1 + 0 = 3
```
Small (1-3mm): 1
Medium (3-6mm): 2
Large (>6mm): 3
Eloquent: 1
Venous drainage to deep veins: 1
```
89
Ideal management for a patient with an AVM of 6mm, in an eloquent area, with venous drainage to deep veins
Not resected
SM III - surgical w/ preceding embolization
SM IV-V: not resected
90
Most common cerebral vascular malformation?
Deep (developmental) venous anomaly
91
In CAA, where is the amyloid deposited in the blood vessels?
Media and adventitia (small vessels)
92
Is CAA more common anteriorly or posteriorly?
Posteriorly
93
Pathologic findings within the arterial and capillary walls in pts w/ hypertensive encephalopathy
Fibrinoid necrosis
94
Nonbacterial thrombotic endocarditis causing large strokes in SLE patients
Libman-Sacks Endocarditis
95
Sensitive indicator for SLE
anti-dsDNA
96
Microangiopathy affecting the brain & retina. Findings of multiple retinal artery branch occlusions. Central Corpus Callosum WM lesions.
Susac Syndrome
97
Most common and most serious disorder of coagulation affecting the nervous system
Disseminated intravascular coagulation
98
Major target of antibodies in APAS (Hughes Syndrome)
B2-glycoprotein 1
99
Main laboratory feature of APAS
Prolonged PTT
100
Most frequent neurologic abnormality in APAS
TIA
| often amaurosis fugax
101
Genetic abnormality in TTP
ADAMTS13
102
Genetic abnormality in Polycythemia Vera
JAK2
103
Independent predictors of pneumonia (post-stroke) except
```
A) Age > 65 years
B) Dysarthria
C) Expressive aphasia
D) MRS of 3 or more
E) Failed bedside swallow test
```
D) MRS of 4 or higher
Independent predictors of pneumonia (post-stroke):
1. Age > 65 years
2. Dysarthria
3. Expressive aphasia
4. MRS of 4 or more
5. Failed bedside swallow test
104
Main mechanism of neuronal injury in the ischemic core?
```
A) Necrosis
B) Apoptosis
C) Free radical injury
D) Metabolic Acidosis
E) Mitochondrial dysfunction
```
A) Necrosis - ischemic core
* Apoptosis: main mechanism in the penumbra!
105
CBF in ischemia
12-23 ml/100g/min
106
CBF in infarction
12 ml/100g/min and below
107
CBF where we find histologic signs of necrosis
6-8ml/100g/min
108
Normal CBF
55ml/100g/min
109
CBF where we find electrographic changes (electrophysiologic failure)
30ml/100g/min
110
CBF where we have metabolic failure (ion pumps)
15ml/100g/min
111
Most specific symptom of transient ischemia in the carotid circulation
Amaurosis fugax
112
Fundoscopic finding in amaurosis fugax?
Fibrin platelet embolus in a branch of the retinal artery on fundoscopic examination
113
Most common location of intracranial aneurysms
Anterior communicating artery (30%)
Pcomm (25%)
MCA (20%)
ICA Bifurcation (7.5%)
114
Most frequently affected nerve in carotid dissection
Hypoglossal nerve
115
Localization of dysarthria clumsy-hand syndrome?
Basis pontis (junction of upper 1/3 and inferior 2/3) 2/2 x paramedian basilar artery branch
116
Localization of pure motor hemiparesis?
Posterior limb of internal capsule (MC)
Others: CR, Pons, Medullary pyramid
117
Localization of ataxia hemiparesis?
Corona radiata, IC, or pons
118
What is the sensitivity of modern CT scanners for detecting SAH in
A) the first 12 hours?
B) the first 24 hours?
First 12 hours: 100% sens
| First 24 hours: 93% sens
119
Most common clinical presentation of AVM
Intracranial hemorrhage
120
Most common cause of all types of stroke
Cerebral Embolism
121
Most frequently involved artery in cerebral embolism
MCA, superior division
122
Characteristic occurrence of stroke during sleep
a. Thrombotic
b. Embolic
a. Thrombotic
123
TIAs induced by hyperventilation can be seen in?
Moyamoya disease
124
TIAs w/ exercise or assumption of upright posture can be seen in (multiple)?
Takayasu arteritis
| Dissection: carotid, aortic arch
125
What is the formula for CPP?
CPP = MAP - ICP
Goal: 50-70
126
What is the formula for CBF?
CBF = CPP/CVR
127
ICA dissection presenting as Unilateral HA + ipsilateral Horner?
_____ syndrome
Raeder Syndrome
128
Gene implicated in cavernous malformations?
CCM1
129
Gene implicated in cerebral amyloidosis?
Apo E4
130
Which is associated with stroke:
Estrogen or Progresterone?
Estrogen
