Unit 2: TBI and Stroke

Question 1

L1: Which pathologic finding? Concussion with catastrophic cerebral congestion and increased intracranial pressure due to pathologic dysregulation of intracranial vessels

Answer 1

Second Impact Syndrome

Question 2

L1: Which pathologic finding? Downward pressure centrally that causes bilateral uncal herniation

Answer 2

Central herniation

Question 3

L1: Which pathologic finding? Intracraial bleeding resulting from tearing of bridging veins that connect the cortical surface to the sagittal sinus

Answer 3

Subdural Hematoma

Question 4

L1: Which pathologic finding? Protrusion of the cerebellar tonsils down into the foramen magnum, which can produce Cushing’s reflex by medullary compression

Answer 4

Tonsillar herniation

Question 5

L1: Which pathologic finding? Uncus crosses the tentorial edge and pushes into the posterior fossa, compressing on midbrain, cerebral peduncle, and ispilateral, oculomotor nerve

Answer 5

Uncal herniation

Question 6

L1:Which pathologic finding? Intracranial bleeding frequently resulting from fractures near the middle meningeal artery

Answer 6

Epidural Hematoma

Question 7

L2: ______ infarcts appear on Diffusion Weighted Imaging (DWI) MRI.

Answer 7

New

Question 8

L2: ______ infarcts appear on FLAIR T2-weighted MRI.

Answer 8

Old

Question 9

L2: Imaging protocol for suspected stroke: _______ > _______ > ________

Answer 9

Noncontrast CT; Perfusion CT; CT angiogram

Question 10

L2: On CT scan, hemorrhagic strokes appear _____ (whiter/darker), or more radio______, than surrounding brain tissue.

Answer 10

whiter; -paque

Question 11

L2: On CT scan, ischemic strokes appear _____ (whiter/darker), or more radio_____, than surrounding brain tissue.

Answer 11

darker; -lucent

Question 12

L2: On MRI, infarcts appear ______.

Answer 12

white

Question 13

L2: On perfusion CT, at-risk tissue shows _____ time to perfusion, ______ time to peak, and ______ blood flow

Answer 13

increased; increased; normal

Question 14

L2: On perfusion CT, completed infarcts show ______ time to perfusion, _______ time to peak, and ______ blood flow

Answer 14

increased; increased; decreased

Question 15

L2: Surgical Treamtment for ischemic strokes

Answer 15

Endarterectomy

Question 16

L2: Treatment for hemorrhagic stroke prevention

Answer 16

Aneurysm clipping or coiling

Question 17

L2: Treatment for ischemic stroke resuscitation

Answer 17

t-PA

Question 18

L2: What is a sign visible on imaging that demonstrates axonal injury has occurred?

Answer 18

Hemorrhage

Question 19

L2: Which pathologic finding? A brief episode of neurologic dysfunction caused by focal brain or retinal ischemia with clinical symptoms typically lasting less than one hour, without evidence of acute infarction

Answer 19

Transient Ischemic Attack (TIA)

Question 20

L2: Which pathologic finding? Arterial media hyptrophy that can result or occlusion or stenosis, commonly in the carotid artery

Answer 20

Fibromuscular Dysplasia

Question 21

L2: Which pathologic finding? Associated with arterial dissection and intracranial saccular aneurysms

Answer 21

Fibromuscular Dysplasia and Moya Moya Disease

Question 22

L2: Which pathologic finding? Can cause a duret hemorrhage in which the ascending reticular activating system is disrupted

Answer 22

Uncal herniation

Question 23

L2: Which pathologic finding? Cingulate gyrus is pushed away by a mass effect and herniates beneath the falx cerebri

Answer 23

Subfalcine herniation

Question 24

L2: Which pathologic finding? Edema resulting from brain swelling due to breakdown of the blood-brain barrier

Answer 24

Vasogenic edema

Question 25

L2: Which pathologic finding? fixed focal neurological deficit attributable to arterial or venous territory, typically lasting longer than 24 hours with evidence of acute infarction

Answer 25

Ischemic Stroke

Question 26

L2: Which pathologic finding? Focal occlusion of the middle cerebral artery due to intimal hyperplasia

Answer 26

Moya Moya Disease

Question 27

L2: Which pathologic finding? Intracranial bleeding resulting from translational acceleration changes

Answer 27

Subdural Hematoma

Question 28

L2: Which pathologic finding? Intracranial bleeding that occurs on the rough bony surface of the anterior fossa or along the edge of the sphenoid greater wing

Answer 28

Subdural Hematoma

Question 29

L2: Which pathologic finding? No gross findings on CT, retraction balls on microscopic analysis

Answer 29

Diffuse Axonal Injury (DAI)

Question 30

L2: Which pathologic finding? Presents following injury with a lucid interval followed by progressive obtundation and coma

Answer 30

Epidural Hematoma

Question 31

L2: Which pathologic finding? Presents with severe short-onset headache with mortality in the majority of patients

Answer 31

Subarachnoid hemorrhage

Question 32

L2: Which pathologic finding? Results from high velocity rotational acceleration injury

Answer 32

Diffuse Axonal Injury (DAI)

Question 33

L2: Which pathologic finding? Stroke most commonly occurring in the basal ganglia, thalamus, pons, or cerebellum

Answer 33

Intracranial hemorrhage

Question 34

L2: Which pathologic finding? Swelling of astrocytes in response to extracellular hyperkalemia and high potassium uptake

Answer 34

Cytotoxic edema

Question 35

L2: Which pathologic finding? Type of stroke most commonly caused by trauma and ruptured aneurysm in atraumatic patients

Answer 35

Subarachnoid hemorrhage

Question 36

L2: Which vascular involvement? Stroke resulting in lower extremity numbness and weakness

Answer 36

Anterior cerebral artery

Question 37

L2: Which vascular involvement? Stroke resulting in upper extremity asymmetric weakness

Answer 37

Middle cerebral artery

Question 38

L2: Which vascular involvement? Stroke with acute onset movement disorders of asymmetric distribution

Answer 38

Small vessels

Question 39

L2: Which vascular involvement? Stroke with coma

Answer 39

Basilar artery

Question 40

L2: Which vascular involvement? Stroke with vision disturbances

Answer 40

Posterior cerebral artery

Question 41

L3: Domains of Scoring in the Glasgow Coma Scale

Answer 41

Eye Opening, Motor Response, Verbal Response

Question 42

L3: Mechanisms of reducing intracranial pressure (3)

Answer 42

osmotic diuretic (mannitol), drain CSF, induce coma (barbiturates)

Question 43

L3: New infarcts appear on ______ MRI.

Answer 43

Diffusion-Weighted Imaging (DWI)

Question 44

L3: Old infarcts appear on ________ MRI.

Answer 44

FLAIR T2-weighted

Question 45

L3: Treatment for ischemic stroke prevention (3)

Answer 45

Aspirin, thienopyridines, anticoagulants