Hi - Cerebrovascular Disease / Trauma

Question 1

Define stroke

Answer 1

> 24hours
- focal/global loss of cerebral function
- inadequate vascular perfusion

Question 2

Most common site for cerebral thrombosis

Answer 2

1. Carotid bifurcation
2. Basilar artery

Question 3

Most common site for cerebral embolus

Answer 3

Middle cerebral artery

Question 4

Typical site of embolism in TIA?

Answer 4

ophthalmic branch of internal carotid

Question 5

Ix in TIA to attempt to confirm Dx?

Answer 5

Carotid USS

Question 6

Initial management of TIA

Answer 6

Aspirin + dipyridamole +/- carotid endarterectomy

Question 7

If <3h since stroke, what is the management

Answer 7

thrombolytics + aspirin +/- dipyridamole

Question 8

Cause of global cerebral ischemia

Answer 8

Failure of systemic circulation eg HF

Question 9

3 non-traumatic forms of cerebral haemorrhage?

Answer 9

• Intraparenchymal haemorrhage
• Subarachnoid haemorrhage
• Arteriovenous malformations

Question 10

Main RF for intraparenchymal haemorrhage

Answer 10

Hypertension

Question 11

Most common site of intraparenchymal haemorrhage

Answer 11

Basal Ganglia

Question 12

RFs for subarachnoid haemorrhage

Answer 12

PCKD
Ehlers Danlos
Aortic Coarctation

Question 13

Most common cause + site of subarachnoid haemorrhage

Answer 13

Rupture of berry aneurysm
80% Carotid bifurcation, 20% vertebro-basillar circulation

Question 14

Tx of subarachnoid haemorrhage from rupture berry aneurysms?

Answer 14

coil - stops blood flow through weak vessel area

Question 15

what is coup

Answer 15

where impact occurs

Question 16

what is contracoup

Answer 16

opposite side to where impact occurred

Question 17

Contusion - tends to affect which lobes?

Answer 17

Frontal and temporal

Question 18

2 main types of cerebral oedema & definitions

Answer 18

• Vasogenic (disruption of BBB)
• Cytotoxic (2ndary to cellular injury eg hypoxia)

Question 19

How does cerebral oedema resolve itself? i.e. where does the fluid go - state 3 ways

Answer 19

1) into blood via AQP4 in foot processes
2) into subarachnoid CSF
3) into ventricles

Question 20

Normal CSF flow in the brain

Answer 20

Choroid plexus –> lateral vent –> 3rd vent –> 4th vent –> spinal cord OR subarach space

Question 21

2 types of hydrocephalus

Answer 21

1) Communicating (problem with CSF resorption into venous sinuses)
2) Non-communicating (obstruction to CSF flow)

Question 22

What is a cavernous angioma

Answer 22

Collection of large weak capillaries with no parenchyma between them, making a cavity

Question 23

Average age of presentation of a cavernous angioma? how do they present?

Answer 23

> 50yo with headache/haemorrhage/focal neuro Sx

Question 24

apperance of cerebral oedema at post mortem

Answer 24

swollen brain with no visible sulci, enlarged gyri
arachnoid tight over parenchyma

Question 25

Tx of hydrocephalus in neonates

Answer 25

Catheterise ventricle to drain CSF

Question 26

Normal ICP

Answer 26

7-15mmHg

Question 27

Where does the brain herniate when raised ICP (3)

Answer 27

Subfalcine - under falx cerebri between superior cortex Transtentorial / uncal - medial temporal lobe goes into posterior fossa Tonsillar - brainstem through foramen magnem

Question 28

What is an AVM

Answer 28

Blood passes quikcly from artery to vein through engorged capillaries. Decreases perfusion to tissue around it

Question 29

How do AVMs present

Answer 29

2-5th decade Haemorrhage - massive bleeding due to high pressure Seizure, headache, focal neuro signs

Question 30

How does presentation of AVM and cavernous angioma differ?

Answer 30

AVM is high pressure so massive quick bleed, CA is low pressure so slow / recurrent bleeds

Question 31

What diameter of berry anueyrsm is a risk?

Answer 31

6-10mm

Question 32

Causes of infarct stroke

Answer 32

cerebral atherosclerosis is main one HTN Smoking DM

Question 33

Where do stroke emboli vs thrombus come from?

Answer 33

Emboli from MCA branches Thrombus from carotid bifurcation

Question 34

Contrast histology of infarct vs haemorrhagic stroke

Answer 34

Infarct - tissue necrosis, permenant, no recovery Haemorrhage - fewer macrophages, limited tissue damage with some recovery

Question 35

Prognoses of TBI

Answer 35

19% vegetative 31% good recovery

Question 36

2 types of TBI

Answer 36

Missle and non missle

Question 37

Signs of skull base fracture

Answer 37

Ottorrhoea / rhinorrhoea - CSF through ear/nose Battle's sign - haematoma below ear

Question 38

What is diffuse axonal injury

Answer 38

Tearing of axons due to shear/tensile forces that occur at moment of injury

Question 39

What brain area is vulnerable to diffuse axonal injury

Answer 39

Midline structures eg corpus callosum