Stroke

Question 1

What is the proportion of hemorrhagic and ischemic strokes to the total strokes in US?

Answer 1

17% hemorrhagic

83% ischemic

Question 2

Non-modifiable risk factors for stroke

Answer 2

Age
Sex
Ethnicity
Family History

Question 3

Modifiable Risk Factors for Stroke (maximum RR high to low)

Answer 3

Diabetes, Atrial Fibrillation, Hypertension, Hyperlipidemia, Carotid Stenosis, Smoking

Question 4

Sudden Symptoms of a Stroke

Answer 4

• Numbness/ weakness of FACE, ARM, or LEG especially on one side of the body
• confusion or trouble speaking or understanding SPEECH
• trouble seeing in one or both EYES
• trouble WALKING, dizziness, or loss of BALANCE or coordination
• severe HEADACHE with unknown cause

Question 5

Ischemic Stroke subtypes (most common to least common)

Answer 5

Embolic Stroke (33%), Large Vessel Thrombosis (30%) , Small Vessel Thrombosis (20%)

Question 6

Hemorrhagic Stroke subtypes (most common to least)

Answer 6

Intracerebral hemorrhage (10%) 
Subarachnoid hemorrhage (7%)

Question 7

What is leading cause of disability?

Answer 7

stroke

Question 8

Middle Cerebral Artery distribution

Answer 8

lateral surface of cortex and insla including Brocha’s Motor Speech Area

Question 9

Which fissure on left hemisphere is associated with language?

Answer 9

Sylvian

Question 10

Is inferior temporal lobe supplied by MCA?

Answer 10

No it is supplied by posterior cereebral artery

Question 11

What arteriy between precentral and postcentrul gyri ? what part of the body is this associated with?

Answer 11

Central artery, arm, hand , and face

Question 12

What two behavioral functions are associated with MCA?

Answer 12

Reception and Exp. Language

Question 13

Is posgerior temporal artery associated with reception or language?

Answer 13

recepion

Question 14

what surface is supplied by anterior cerebral artery?

Answer 14

medial surface of parietal and frontal lobes

Question 15

Sensory loss in leg and food could be due to a stroke in what artery?

Answer 15

Anterior Cerebral

Question 16

Visual cortex is supplied by what artery?

Answer 16

Posterior Cerebral

Question 17

Basilar artery supplies what parts of brain?

Answer 17

brainstem and cerebellum

Question 18

What portions of the parietal and temporal lobes supplied by the Posterior Cerebral Artery

Answer 18

Medial

Question 19

Anterior and posterior midbrain is supplied by what artery

Answer 19

Posterior cerebral

Question 20

What portion of thalamus is supplied by PCA?

Answer 20

posterior

Question 21

A lacunar stroke occurs from blocking off what MCA branch?

Answer 21

Lenticulostriate Arteries

Question 22

In a cross-sectional CT scan, is white matter darker or lighter than grey matter? more lateral or medial

Answer 22

darker and more medial

Question 23

Left MCA stroke common presentation

Answer 23

Right hemiparesis : Face=Hand>Arm> Leg
Expressive and Receptive Aphasia
Anterior division: left head and eye deviation
Posterior Division: Visual field deficit, aphasia

Question 24

Why do is leg hemiparesis affected in LMCA stroke?

Answer 24

leg nuerons cuth through cortex provided by MCA

Question 25

Damage to the non dominant hemisphere of the MCA leads to what clinical manifestation?

Answer 25

Contralateral neglect caused by Right MCA stroke

Question 26

Anterior Division of MCA stroke leads to what presentation

Answer 26

right head and eye deviation

Question 27

RMCA Posterior Division Stroke leads to

Answer 27

Visual field deficit and neglect

Question 28

complete loss of sensation of the contralateral face, arm, trunk, and leg

Answer 28

Hemihypaesthesia

Question 29

Bilateral PCA stroke presentation

Answer 29

Visual field deficit or cortical blindness if bilateral. May have hemihypaesthesia

Question 30

Brainstem stroke occurs in which artery?

Answer 30

Basialr

Question 31

3 main presentaitons of Basilar artery stroke

Answer 31

Altered Cosciousness or Coma often bilateral signs cranial nerve signs and "crossed: signs

Question 32

Lacunar Syndrome in Internal capsule presentation

Answer 32

Pure motor hemiplegia (FAce=Arm=Leg/because nerves bundle at capsule)

Question 33

Lacunar Syndrome at thalamus presentation

Answer 33

Pure sensory Hypaesthesia (Face=Arm=Leg)

Question 34

Lacunar Syndrome at Pons presentation

Answer 34

Dysarthria Clumsy Hand Syndrome

Question 35

Lacunar Syndromes presentation ``

Answer 35

Ataxic Hemiparesis

Question 36

What color is a lacunar stroke on CT? why?

Answer 36

black because damaged area is replaced by CSF

Question 37

Aphasia usually corresponds to

Answer 37

left hemispheric stroke (right sided weakness)

Question 38

Vertical nystagmus is what pathology until proven otherwise

Answer 38

brainstem ischemia

Question 39

What area of brain is involved if crossed signs are seen ?

Answer 39

brainstem

Question 40

Vertigo is almost always associated with what?

Answer 40

Cranial nerve deficits, rarely stroke

Question 41

patients usually look towards or away from lesion in frontal eye fields?

Answer 41

towards

Question 42

Lacunar stroke and a blown open lentiustrates can be caused by what? will lead to what?

Answer 42

caused by hypertension and blown up arteries(not blocked) and can lead to intracerebral hemorrhage

Question 43

Classify a hemorrhage with blood in Sylvian fissure /intrahemispheric fissure

Answer 43

Subarachnoid

Question 44

Bleeding in between dura and brain is known as

Answer 44

Subdural Hematoma

Question 45

An older blood clot is less or more dense in a CT scan

Answer 45

less (Hypodense) because tissue is ischemic

Question 46

What are some early CT changes of stroke?

Answer 46

``` early infarct signs hypodensity of white or grey matter Obliteration of cortical sulci Obscured basal ganglia Loss of insular ribbon ```

Question 47

A stroke supplying the medial hemisphere of occipital lobe would belong to what aretery

Answer 47

PCA

Question 48

Thrombus in MCA would be hypo or hyperdense?

Answer 48

hyper

Question 49

A hyperdense region in CT can indicate..

Answer 49

Tumor or thrombus

Question 50

when can restoration of blood flow reduce chance of stroke?

Answer 50

If the neurons get 50% of blood from the arteries. (If it relies on 80-90% it would die within minutes of blood flow loss)

Question 51

Thrombolytic Therapy Inclusion Criteria

Answer 51

``` Acute Ischemic stroke (not mimic) Less than 80 yo Less than 3 hours onset CT normal or indicates early focal infarction Less than 24 in NIHSS Absence of excluisonary ccritrreia Informed consent ```

Question 52

Thrombolytic Therapy Exclusion Criteria:

Answer 52

``` Hemrrhage or very large infarction CT sign Undetermined Onset time Uncontrollablle HTN or blood sugar Recent Trauma, Major Surgery or Bleeding Abnormal Coagulation Profile Rapidly Resolving Deficit Hemodynamic Compromise from MI ```

Question 53

Lenticulastriate arteries supply

Answer 53

Basal Ganglia Amygdala Internal Capsule Anterior Thalamu

Question 54

Anterior choroidal artery supply

Answer 54

Hippocampus Anterior choroid plexus Posterior internal capsule

Question 55

Posterior Communiccating Branches supply

Answer 55

anterior midbrain crus cerebri thalamus

Question 56

Crus cerbebri is supplied partially by which 3 arteries?

Answer 56

Basilar branches, Posterior Cerebral, Posterior communicating branches

Question 57

Basilar branches supply

Answer 57

pons and anterior midbrain

Question 58

Anterior inferior cerebellar arteries supply

Answer 58

Inferior surface of cerebellar cortex and dorsolateral pons, rostral medulla

Question 59

Posterior Inferior cerebellar arteries supply

Answer 59

dorsolateral medulla and pons, medial cerebellum cerebellar cortex

Question 60

Anterior Spinal artery supply

Answer 60

Ventral 2/3 spinal cord and medial medulla

Question 61

Symptoms of top of basilar occlusion

Answer 61

bilateral blindness, | memory loss, somatosensory loss, coma and death