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Flashcards in Neuro V Deck (60):
1

Most common site of berry aneurysm

Junction of anterior communicating and ACA.

2

berry aneurysm RF's

1) advanced age
2) HTN
3) smoking
4) race (increased risk in blacks)

3

Locations of charcot-bouchard aneurysms

Micro aneurysms in basal ganglia + thalamus

4

Imaging and charcot-bouchard aneurysms

They're too small to see on angiograms.

5

Etiology of charcot-bouchard aneurysms

HTN

6

Complications of ACA berry aneurysms?

1) compression of ACA can lead to bitemporal hemianopia; visual acuity deficits.
2) ACA rupture can lead to lower extremity hemiparesis, sensory deficits.

7

Complications of PCA berry aneurysms?

Compression may cause CN III palsy (blown pupil).

8

Complications of MCA berry aneurysms?

Rupture may cause ischemia in MCA distribution --> contralateral upper extremity and facial hemiparesis, sensory deficits.

9

What is central post-stroke pain syndrome? Presentation? Epidemiology?

1) Neuropathic pain due to thalamic lesions.
2) Initial paresthesias followed in weeks to months by allodynia (ordinarily painless stimuli cause pain) and dysesthesia.
3) happens to 10% of stroke patients.

10

Epidural hematomas due too.

middle meningeal artery rupture

11

middle meningeal branches from...

maxillary artery

12

Epidurals and suture lines?

DO NOT cross

13

epidural setting

often secondary to skull fracture

14

epidural complications

Rapid expansion under systemic arterial pressure can lead to transtentorial herniation + CN III palsy.

15

lucid interval...

epidural

16

Subdural hematoma etiology...

ruptured bridging veins

17

Chronic vs acute subdural on CT

1) acute (traumatic, high-energy impact) --> hyper dense on CT
2) Chronic --> hypodense on CT

18

Subdurals seen in..

1) mild trauma or high-energy trauma
2) cerebral atrophy
3) elderly
4) alcoholism
5) shaken babies

19

Subdurals and suture lines?

Cross suture lines.

20

Impt clinical finding for subarachnoid hemorrhage

bloody or yellow (xanthochromic) spinal tap.

21

When does vasospasm occur?

4-10 days after subarachnoid

22

Other impt subarachnoid sequela...

Communicating and/or obstructive hydrocephalus.

23

Intraparenchymal hemorrhage caused by...

1) most commonly systemic HTN
2) amyloid angiopathy
3) vasculitis
4) neoplasm
5) secondary to repercussion injury in ischemic stroke.

24

Location of intraparenchymal hemorrhage...

Typically basal ganglia + internal capsule but can be lobar.

25

Charcot-Bouchard and intraparenchymal hemorrhage

Rupture charcot-bouchard in lenticulostriate vessels in internal capsule can cause intraparenchymal hemorrhage.

26

When does irreversible damage occur after a stroke?

5 minutes of hypoxia

27

Most vulnerable brain regions to ischemic stroke

1) hippocampus
2) neocortex
3) cerebellum
4) watershed areas

28

Stroke algorithm

1) get imaging: Noncontrast CT to exclude hemorrhage
2) tPA

29

When can CT detect ischemic changes?

6-24 hrs

30

When can diffusion-weighted MRI detect ischemia?

3-30 minutes

31

Histologic features 12-48 hours after infarct in brain:

red neurons

32

Histologic features 24-72 hours after infarct in brain:

necrosis + neutrophils

33

Histologic features 3-5 days after infarct in brain:

macrophages (microglia)

34

Histologic features 1-2 weeks after infarct in brain:

Reactive gliosis + vascular proliferation

35

Histologic features >2 weeks after infarct in brain:

Glial scar

36

Most common location of thrombotic stroke

MCA

37

Where do thrombotic strokes usually occur?

on top of atherosclerotic plaques

38

Common scenario for hypoxic stroke:

Common during cardiovascular surgery

39

Window for tPA treatment

within 3-4.5 hours of onset, proved no hemorrhage risk

40

How do you reduce stroke risk

1) aspirin + clopidogrel
2) control BP
3) get blood sugars under control
4) control lipids
5) treat conditions that increase risk (a fib)

41

TIA prognosis

Most resolve in less than 15 minutes but you can get deficits due to focal ischemia.

42

Venous sinus thrombosis presentation

signs/symptoms of increased ICP (eg. headache, seizures, focal neurologic deficits).

43

Venous sinus thrombosis sequela

venous hemorrhage

44

Venous sinus thrombosis associations

Hyper coagulable states (pregnancy, OCP use, factor V leaden)

45

Identify all venous sinuses

470

46

Where does internal jugular vein pass through?

jugular foramen

47

cerebral aqueduct connects

3rd ventricle --> 4th ventricle

48

foramen of monro connect

lateral ventricles with 3rd ventricle

49

psuedotumor cerebri

idiopathic intracranial HTN. Increased ICP with no apparent cause on imaging.

50

RFs for pseudotumor cerebri

1) being a woman of childbearing age
2) vitamin A excess
3) danazol
4) tetracycline

51

pseudotumor cerebri presentation

1) headache
2) diplopia (usually from CN VI palsy)
3) *no change in mental status
4) papilledema
5) increased opening pressure on LP, which will also relieve headache.

52

pseudotumor cerebri treatment

1) weight loss
2) acetazolamide
3) topiramate
4) invasive procedures for refractory cases (eg, repeat LP, CSF shunt placement, optic nerve fenestration surgery).

53

hydrocephalus caveat

ICP not always increased

54

Common cause of communicating hydrocephalus

arachnoid scarring post-meningitis

55

communicating hydrocephalus presentation

1) increased ICP
2) papilledema
3) herniation

56

NPH characteristics

1) *episodic CSF pressure elevation.
2) *No increase in subarachnoid space volume.

57

pathophys of NPH

Expansion of ventricles distorts the fibers of the corona radiate.

58

Characteristic finding in NPH other than triad?

Magnetic gait (feet appear stuck to floor)

59

dysesthesia

abnormal sensation

60

uncal/transtentorial herniation

uncal is a common type of transtentorial herniation.