Stroke

Question 1

What is the definition of stroke?

Answer 1

Sudden onset of impairment in neurological functioning due to severe decreased of blood supply to the brain

Question 2

What is the definition of TIA?

Answer 2

Brief episode of neurologic dysfunction (typically < 1 hour) cause by focal brain ischemia but without evidence of infarct on brain imaging

Question 3

What is a perinatal stroke?

Answer 3

Stroke between 20 wks of gestation and first 28 days of life

Question 4

What is the cause of ischemic stroke?

Answer 4

Obstruction of blood flow at the site of occlusion (thrombus) or at a distance (embolus)

Question 5

What circulation is most frequently affected by ischemic stroke (anterior or posterior)

Answer 5

Anterior, 80% of cases

More common in adults and children

Question 6

Which type of stroke is more common in adults?

Answer 6

Ischemic

Question 7

Which type of stroke is associated with higher mortality?

Answer 7

Hemorrhagic

Subarachnoid hem - 50% in first 6 months

Question 8

What is the most common etiology for deep intracerebral hemorrhages?

Answer 8

Hypertension (50%)

Question 9

What are two most common causes of stroke in young adults?

Answer 9

Aneurysms and anteriovenous malformations (AVMs, typically congenital)

ACoA aneurysm -most common cause of subarachnoid hem

Question 10

Which type of stroke is most common in children?

Answer 10

Both are equally common

Question 11

What are two major forms of infarction in children?

Answer 11

Arterial ischemic stroke (MCA most common) and sinovenous thrombosis (more common in neonates)

Question 12

What is the critical time for neuronal damage in case of ischemia?

Answer 12

6-8 minutes of blood flow below critical levels

Question 13

What is the critical time for recovery from ischemia?

Answer 13

6 hours, if blood flow is restored within that time, neurons surrounding ischemic penumbra may recover

Question 14

What is the time window for TPA treatment?

Answer 14

3 hours

Question 15

What are some consequences of hemorrhagic stroke?

Answer 15

Intracranial pressure and herniation

Question 16

Which drug is associated with increased stroke risk?

Answer 16

Cocaine

Question 17

What is the most common cause of intracranial hem in children?

Answer 17

Trauma

Question 18

What are common risk factors of perinatal stroke?

Answer 18

Maternal infertility, preeclapmsia, prolonger membrane rupture, chorioamnionitis

Question 19

Does the incidence of childhood stroke differ in boys and girls?

Answer 19

Yes, higher in boys

Question 20

What is current mortality rate for stroke?

Answer 20

10% for ischemic and 25-35% for hem stroke

Question 21

Which stroke is more commonly associated with LOC and coma?

Answer 21

Hemorrhagic

Question 22

What infarct location is commonly associated with hemiparesis?

Answer 22

Superior MCA branch

Question 23

What infarct location(s) are associated with visual field cuts?

Answer 23

Inferior MCA branch

PCA

Question 24

What is the most common presentation of arterial ischemic stroke in childhood?

Answer 24

Seizures, then hemiparesis, AMS, and focal neurological signs

Question 25

What infarct locations are associated with face and arm weakness?

Answer 25

MCA superior division (contralateral)

Question 26

What type of aphasia is associated with left MCA stem infarct?

Answer 26

Global aphasia

Question 27

What infarct location is associated with pure motor hemiparesi of the upper motor neuron type?

Answer 27

MCA deep territory (contralateral)

Question 28

What infarct location is associated with constructional apraxia, neglect, and spatial difficulties?

Answer 28

Right MCA inferior division

Question 29

What infarct location is associated with left weakness and transcortical aphasia?

Answer 29

Left ACA

Question 30

What are deficits associated with left PCA stroke?

Answer 30

Right homonymous hemianopia | Alexia w/o agraphia with extension to the CC splenium

Question 31

WHat neuroimaging method can detect infarct within minites from symptom onset?

Answer 31

Diffusion-weighted MRI

Question 32

Is CT sensitive to acute intracerebral hem?

Answer 32

Yes

Question 33

Is CT sensitive to ischemic damage?

Answer 33

Not in first 24 hours

Question 34

What time frame is associated with most recovery post-stroke?

Answer 34

12 months, negatively accelerating course (greater btw 1-3 months, etc)

Question 35

What is the prevalence of aphasia following LH stroke by hand preference?

Answer 35

99% in right-handers, 60-70% in left-handers

Question 36

What is the triad of symptoms associated with ACoA hemorrhage?

Answer 36

Impaired episodic memory (Korsakoff-like), confabulation, and personality change

Question 37

What is a vasospasm?

Answer 37

Acute narrowing of a cerebral vessel that reduces the blood flow and increases risk for stroke?

Question 38

What is amyloid angiopathy hemorrahe?

Answer 38

Intracranial hem due to cerebral amyloid angiopathy or deposition of beta-amyloid in small and mid-sized arteries

Question 39

What is brain herniation?

Answer 39

Life-threatening brain displacement from the central cranial vault through the tentorial notch or foramen magnum?