Lec 2: Stroke Syndrome

Question 1

Stroke prevalence in the Philippines

a. 1.4 per 100
b. 1.4 per 1000
c. 14 per 100
d. 0.14 per 100
e. 140 per 1000

Answer 1

A. 1.4 per 100

Question 2

Previous stroke increases chance of another stroke by:
A. 5x
B. 10x
C. 15x
D. 20x

Answer 2

B. 10x

Question 3

Episode of neurologic dysfunction caused by focal brain or spinal or retinal ischemia without evidence of acute infarction (by imaging)

Answer 3

TIA

Question 4

The probability of stroke occurring within 30 days after a TIA

Answer 4

7-15%

Question 5

Thrombi are dissolved by substances such as

Answer 5

Protein C and Protein S

Question 6

transient monocular blindness; retinal artery affected

Answer 6

amaurosis fugax

Question 7

What type of hemorrhagic stroke? Commonly caused by uncontrolled hypertension

Answer 7

Intracerebral hemorrhage

Question 8

What type of hemorrhagic stroke? Base of the brain

Answer 8

Subarachnoid hemorrhage

Question 9

What type of hemorrhagic stroke? Commonly caused by trauma

Answer 9

Subarachnoid hemorrhage

Question 10

What type of Intracranial hemorrhage? Typically biconvex in shape

Answer 10

Extradural/epidural

Question 11

What type of Intracranial hemorrhage? Crescent shaped/concave configuration

Answer 11

Subdural

Question 12

What type of Intracranial hemorrhage? Normally contains CSF

Answer 12

Subarachnoid

Question 13

common cause of stroke in the young

Answer 13

over-the-counter decongestants

Question 14

small vessels involved in hypertensive ICH

Answer 14

1. Lenticulostriate arteries
2. Thalamoperforant
3. Thalamogeniculate
4. Basilar penetrants

Question 15

Most common site affected by ICH

Answer 15

Putamen (40-50%)

Question 16

What type of ICH? Usually presents with contralateral hemiparesis

A. Putaminal Hemorrhage
B. Thalamic Hemorrhage
C. Pontine Hemorrhage
D. Cerebellar Hemorrhage

Answer 16

A.

Question 17

What type of ICH? Presents with prominent sensory deficit involving all modalities

A. Putaminal Hemorrhage
B. Thalamic Hemorrhage
C. Pontine Hemorrhage
D. Cerebellar Hemorrhage

Answer 17

B (Thalamus is involved in sensory perception and in motor coordination)

Question 18

What type of ICH? Presents with deep coma with quadriplegia

A. Putaminal Hemorrhage
B. Thalamic Hemorrhage
C. Pontine Hemorrhage
D. Cerebellar Hemorrhage

Answer 18

C

Question 19

What type of ICH? Presents with occipital headache,
repeated vomiting, nystagmus and ataxia of gait

A. Putaminal Hemorrhage
B. Thalamic Hemorrhage
C. Pontine Hemorrhage
D. Cerebellar Hemorrhage

Answer 19

D

Question 20

What is the management for 2 hours post ictus?

A. conservative or medical
B. surgery

Answer 20

A.

Question 21

What is the management for 24 hours post ictus?

A. conservative or medical
B. surgery

Answer 21

B. hematoma has grown big and surgery is indicated

Question 22

What is the order of events in hemorrhagic stroke?

Answer 22

Vascular rupture -> Hematoma formation -> Hematoma expansion -> Edema formation

Question 23

What is the function of Hibernating penumbra?

Answer 23

Causes hypometabolism to conserve energy

Question 24

states that, in an incompressible cranium, the blood, CSF, and brain tissue exist in a state of volume equilibrium, such that any increase in volume of one of the cranial constituents must be compensated by a decrease in volume of another

Answer 24

Monro-Kellie hypothesis

Question 25

Patient is GCS 5. Would you recommend surgery?

Answer 25

Yes

Question 26

Volume of hematoma is 60cc. Would you recommend surgery?

Answer 26

Yes (Surgery if >50, Medical if <30)

Question 27

When do you treat BP in ICH?

Answer 27

Treat if SBP >180 (Lower to 140 mmHg in 1st week)

Question 28

Thin-walled focal dilatations that protrude from the arteries of the Circle of Willis

Answer 28

Aneurysmal Subarachnoid Hemorrhage

Question 29

Signs of inc ICP

Answer 29

1. Neck rigidity 2. focal deficits (CN palsies) 3. Meningeal signs

Question 30

What is the Hunt & Hess Scoring? Coma, decerebrate rigidity, moribound appearance

Answer 30

5

Question 31

What is the Hunt & Hess Scoring? Moderate to severe headache, nuchal rigidity, CN palsy

Answer 31

2

Question 32

What is the Hunt & Hess Scoring? Drowsiness, confusion, mild focal signs

Answer 32

3

Question 33

gold standard for diagnosing source of SAH

Answer 33

4 vessel cerebral angiogram

Question 34

episode of neurologic dysfunction caused by focal brain or spinal or retinal ischemia without evidence of acute infarction (by imaging)

Answer 34

Transient Ischemic Attack

Question 35

``` Manifestations of anterior circulation stroke EXCEPT: A. aphasia B. Nystagmus C. Sensory alteration D. Mononuclear blindness E. Facial droop ```

Answer 35

B. Nystagmus

Question 36

``` Manifestations of posterior circulation stroke EXCEPT: A. vertigo B. Diplopia C. Unilateral weakness D. nystagmus E. Dysphagia ```

Answer 36

C. weakness for posterior circulation stroke is usually crossed ie. weakness in the left side of the face and right arms and legs