N E U R O L O G Y

Question 1

Molecular cell deaths that lead to ischemia:

Answer 1

Failure of ATP production - Lactic Acid Accumulation

Free radical formation - peroxidation, disruption of the outer cell and mitochondrial membrane

Glutamate and aspartate released by ischemic cells cause intracellular influx of Na and Ca

Question 2

Size range of the arteries in Lacunar infarct

Size range of cavities produced

Answer 2

50-200 micron

3-15mm (diameter)

Question 3

Location of Intracerebral hemorrhage

Answer 3

Putamen and adjacent internal capsule
Lobar
Thalamus
Cerebellum
Pons

Question 4

Location of lacunar infarct

Answer 4

Putamen and Caudate
Thalamus
Basis Pontis
Internal capsule
Deep in the central hemispheral white matter

Question 5

Percentage of embolic infarcts that develop seizures

Answer 5

10%

Question 6

Hollenhorst plaques

Answer 6

Crystalline cholesterol sloughed off from an atheromatous ulcer

Question 7

Arteriosclerosis dementia

Answer 7

Binswanger subcortical leukoencephalopathy

Question 8

SPARCL Trial

% of Stroke prevention by Atorvastatin

Answer 8

3%

Question 9

Raeder Syndrome

Answer 9

ICA Dissection
Ipsilateral Horner Syndrome
Unilateral Headache

Question 10

Vertebral artery dissection most common location (most mobile area)

Answer 10

C1-C2

Question 11

Arterial dissection that can cause Subarachnoid Hemorrhage

Answer 11

Vertebral artery dissection

Question 12

Moyamoya components

Answer 12

Cerebral rete mirabile
- small anastomotic vessels around and distal to the circle of Willis

Segmental stenosis or occlusion of the terminal intracranial parts of both ICA

Question 13

Binswanger Disease Components:

Answer 13

Dementia
Pseudobulbar state
Gait disorder

Question 14

Stroke in the young etiology

Answer 14

Shabu
OCPs
APAS
PFO
Dissection

Question 15

Thrombotic vessel histopathology

Answer 15

Nodular intimal hyperplasia of eccentric distribution with increased mucopolysaccharides and replication of the internal lamina

Question 16

Degeee of stenosis that needs carotid endarcterectomy (NASCET ECST Trial)

Answer 16

70-80%

Question 17

Spot sign on CTA

Answer 17

Associated with hematoma expansion

Appearance of contrast within the hemorrhage during CTA

Question 18

MRI of ICH
Blood products and T1-T2 findings
(Osborne)

Answer 18

Hyperacute - oxyhemoglobin (iso-bright)
Acute - deoxyhemoglobin (bright-dark)

Early subacute -intracellular methemoglobin (bright - dark)
Late subacute -extracellular methemoglobin (bright - bright)

Chronic - hemosiderin (dark - dark)

Question 19

Lacunar stroke syndromes

Answer 19

Pure motor - internal capsule/corona radiata
Pure sensory - lateral thalamus/parietal white matter

Clumsy hand dysarthria - paramedian mid pons (contralateral to the clumsy hand)

Ipsilateral hemiparesis ataxia - pons/mb/internal capsule

Question 20

Hyperperfusion syndrome from Carotid endarcterectomy most common symptom

Answer 20

Unilateral severe HA

Focal deficit
Seizures
Cerebral edema/hemorrhage

Question 21

Hypertensive bleeds arteriolar wall

Answer 21

Segmental lipohyalinosis

Primary Hypertension hemorrhage are also associated with the false aneurysm (Charcot Bouchard)

Question 22

Unruptured aneurysm

Risk of rupture

Answer 22

10% in 25mm

Question 23

CVD among different ages

Prenatal
Perinatal and post natal
Infancy and childhood
Late adult

Answer 23

Prenatal -Unilateral cerebral infarction

Perinatal and post natal -etat marbe: Cardiorespiratory failure and generalized ischemia

Infancy and childhood - MELAS

Late adult - Binswanger disease

Question 24

Cerebral blood flow rates

__ml/ 100g/ min

Answer 24

Normal
55

Critical level for infarction , reversible after a short period of time
23

Critical level of hypoperfusion that abolishes function that leads to tissue damage regardless of its duration. EEG is slowed
12-23

Causes infarction regardless of duration
Below 10-12

Causes marked ATP depletion
Increased extracellular K, intracellular Ca
Cellular acidosis
6-8

Question 25

Lipid profile that conferes most risk for stroke

Answer 25

LDL followed by TG

Question 26

Atheromatous plaque

Answer 26

ICA -origin from the common carotid artery VA -cervical part at the junction to form basilar MCA -stem or at the bifurcation PCA -proximal ACA -proximal

Question 27

Atherothrombosis vs Embolism | Which is more common?

Answer 27

Embolism

Question 28

ICA lumen | Critical residual size before stroke occurs

Answer 28

<2mm Normal : 5-10mm

Question 29

CHA2 DS2 - VASc scoring

Answer 29

CHF / EF <35% HPN Age (>65 = 1 ; >75 =2) DM Stroke/TIA previous (=2) Vascular disease: -coronary/peripheral Sex

Question 30

PFO stroke risk

Answer 30

2% 15% - if with septal aneurysm

Question 31

AF patients | stroke risk

Answer 31

6x more than with normal cardiac rhythm

Question 32

Osler Weber Rendu disease mechanism for stroke

Answer 32

Pulmonary shunts result in conduits

Question 33

TIA | 5 year stroke risk

Answer 33

23%

Question 34

ABCD score

Answer 34

``` Age >= 60 BP >=140/90 Clinical : hemiparesis 2 Speech only 1 Duration : 60min 2 10-59 1 DM ```

Question 35

After first attack of TIA | % of stroke risk

Answer 35

20% in a month | 50% in a year

Question 36

Capsular Warning Syndrome

Answer 36

Escalating episodes of weakness in the face, arm, and leg culminating in a capsular lacunar stroke