Vascular Neurology Flashcards
(103 cards)
1
Q
What are the factors of ABCD2 in TIA and what does it measure?
A
ABCD2 score provides an evaluation of this risk of stroke.
Age of 60 years or more (1 point); Blood pressure of 140/90 mm Hg or greater (1 point); Clinical symptoms (1 point for speech impairment without weakness and 2 points for focal weakness); Duration of symptoms (1 point for 10 to 59 minutes and 2 points for 60 minutes or more) Diabetes (1 point).
2-day risk of stroke 0-1 = 0% 2-3= 1.3% 4-5= 4.1% 6-7=8.1%
2
Q
What is the maximum score of NIHSS?
A
maximum score is 42, with higher scores representing worse neurologic deficits
3
Q
In a patient presenting with acute neurologic symptoms, the first thing to do is to obtain a brain CT scan to rule out an intracranial hemorrhage (ICH). True or False?
A
True
4
Q
What is the tPA dose and mode of giving it?
A
The dose is 0.9 mg/kg, with a 10% bolus and the rest over 1 hour, with a maximum dose of 90 mg.
5
Q
In venous sinus thrombosis, what is the most frequent symptom?
A
Headache, 90% of cases
6
Q
Thrombosis of Sagittal Sinus leads to?
A
infarcts in the parasagittal cortex bilaterally along the sinus
7
Q
What are the components of Lateral Medullary Syndrome What is the vessel involved? Eponym?
A
Wallenberg’s syndrome
Due to occlusion of the posterior inferior cerebellar artery (PICA)
components:
- Vestibular nuclei, causing vertigo, nystagmus, nausea, and vomiting.
- Descending tract and nucleus of the fifth cranial nerve, producing impaired sensation on the ipsilateral hemiface.
- Spinothalamic tract, producing loss of sensation to pain and temperature in the contralateral hemibody.
- Sympathetic tract, manifesting with ipsilateral Horner’s syndrome with ptosis, miosis, and anhidrosis.
- Fibers of the ninth and tenth cranial nerves, presenting with hoarseness, dysphagia, ipsilateral paralysis of the palate and vocal cord, and decreased gag reflex.
- Cerebellum and cerebellar tracts, causing ipsilateral ataxia and
lateropulsion.
- Nucleus of the tractus solitarius, causing loss of taste.
8
Q
What is most common site of a vertebral dissection?
A
at the level of C1-C2 (artery is mobile as it is leaving the transverse foramina and entering cranium)
9
Q
What is the gold standard diagnostic test for an arterial dissection? Findings?
A
catheter angiogram to evaluate the cervicocerebral arteries
Findings: narrowing of the vessel, the extension of the dissection with an intimal flap, or double lumen
10
Q
What is the risk for symptomatic ICH after rTPA?
A
6.4%
11
Q
What is the etiology of transient monocular blindness or amaurosis fugax?
A
which may be caused by atherosclerotic stenosis of the ipsilateral ICA.
Retinal artery originates from the ophthalmic artery, which is a branch of the ICA. Transient occlusion of the retinal or ophthalmic arteries may manifest as amaurosis fugax.
12
Q
In AICA infarct, what is the most striking symptom?
A
hearing loss has been attributed to involvement of the lateral pontomedullary tegmentum
13
Q
What may produce bilateral thalamic infarction?
A
Occlusion of the artery of Percheron (a single artery called the artery of Percheron will arise from the P1 segment on one side and will supply the medial thalami bilaterally)
Thrombosis of the deep venous structures
14
Q
What does the recurrent artery of Heubner supply? It is a branch of?
A
recurrent artery of Heubner is a branch of the ACA that supplies the anterior limb of the internal capsule, the inferior part of the head of the caudate, and the anterior part of the globus pallidus.
15
Q
What are the common locations of lacunar infarction?
A
Lacunar infarcts occur in the putamen, caudate nuclei, thalamus, basis pontis, internal capsule, and deep hemispheric white matter.
16
Q
What are the syndromes of lacunar infarction and location?
A
Pure motor: lenticulostriate branch (posterior limb of internal capsule); lacunes of ventral pons
Pure sensory: lacune in thalamus
Clumsy-hand dysarthria: lacune in the paramedian pons; lacune in posterior lmb of internal capsule
ataxic hemiparesis: lacune in pons, midbrain, internal capsule or parietal white matter
17
Q
Lacunar infarct may produce sudden onset symptoms; however, it is not infrequent to see a stepwise “stuttering” progression of the neurologic deficits over minutes, and sometimes over hours to even days. True or False?
A
True
18
Q
What are the structures that Lenticulostriate branches of MCA supplies?
A
These lenticulostriate branches provide vascular supply:
- putamen
- part of the head and body of the caudate nucleus
- the outer globus pallidus
- the posterior limb of the internal capsule
- the corona radiata
19
Q
In the superior division of MCA, what are the symptoms?
A
Contralateral hemiparesis affecting mainly arm and face (lateral hemispheric surface)
Eye deviation ipsilateral (frontal eye fields)
Broca’s or motor aphasia (dominant inferior frontal gyrus)
20
Q
What is the presentation of an ACA occlusion distal to the anterior communicating artery?
A
- contralateral sensorimotor deficits of the lower extremity, sparing the arm and face
- urinary incontinence due to involvement of the medial micturition center in the paracentral lobule;
- deviation of the eyes to side of the lesion and paratonic rigidity occur.
21
Q
What does artery of Heubner supply?
A
- anterior limb of the internal capsule
- the inferior part of the head of the caudate nucleus
- anterior part of the globus pallidus.
22
Q
What are the four major arteries supplying the thalamus?
A
- Thalamoperforating or Paramedian artery- originates from P1 segment of PCA –> medial aspect of thalamus; dorsomedial nucleus
- Thalamogeniculate artery - originates from P2 segment of PCA –> lateral aspect of thalamus; ventral lateral group nuclei
- Posterior choroidal artery –> originates from P2 segment of PCA ; posterior aspect of the thalamus; pulvinar
- Tuberothalamic artery (Polar Artery) - originating from posterior communicating artery –> anterior portion of thalamus; ventral anterior nucleus
ANTERIOR CHOROIDAL ARTERY DOES NOT SUPPLY THE THALAMUS
23
Q
What does superior cerebellar artery (SCA) supply?
A
-superior half of the cerebellar hemisphere (superior vermis, superior cerebellar peduncle, upper lateral pons)
24
Q
What does anterior inferior cerebellar artery (AICA) supply?
A
inferolateral pons, middle cerebellar peduncle, and a strip of the ventral cerebellum between the posterior inferior cerebellar and superior cerebellar territories
25
What does posterior inferior cerebellar artery (PICA) supply?
lateral medulla, most of the inferior half of the cerebellum and the inferior vermis
26
What cortical part is affected in Wernicke's aphasia (receptive)?
posterior aspect of the superior temporal gyrus
27
Anterior choroidal artery arise from ____ and supplies _____.
ICA just above the origin of the posterior communicating artery;
internal segment of the globus pallidus
part of the posterior limb of the internal capsule
part of the geniculocalcarine tract
choroid plexus of lateral ventricle (temporal horn)
28
What are the segments of ACA?
A1 segment - from the ICA terminus to the anterior communicating artery
A2 segment- from the anterior communicating artery to the bifurcation into pericallosal and callosomarginal arteries
A3 segment- distal branches after this bifurcation
29
What are the clinical manifestations of watershed infarcts?
- proximal weakness, affecting the proximal upper and proximal lower extremities, with weakness at the shoulder and at the hip
- in severe cases, “person-in-a-barrel” syndrome
30
What is medial medullar syndrome? What is the occlusion?
caused by occlusion of the vertebral artery or one of its medial branches
affecting the pyramid: contralateral arm and leg weakness, sparing the face
medial lemniscus: contralateral loss of sensation to position and vibration
emerging hypoglossal fibers: ipsilateral tongue weakness
31
65/Female
complains of headaches, associated with generalized constitutional symptoms, jaw claudication, and tenderness of the scalp around the temporal artery. Diagnosis and management?
Temporal Arteritis/Giant Cell Arteritis
CBC: Leukocytosis
Elevated ESR and CRP
Biopsy of temporal artery (granulomatous inflammation)
If with visual manifestation: Start steroids ASAP
32
49/F presents with acute contralateral hemiplegia with ipsilateral facial palsy. Diagnosis?
Millard–Gubler syndrome (pons: corticospinal tract + CN VII nerve/nucleus)
33
49/F presents with acute contralateral hemiplegia with ipsilateral facial palsy with conjugate gaze paralysis. Diagnosis?
Foville syndrome
| pons: corticospinal tract + CN VII nerve/nucleus + MLF
34
Posterior circulation aneurysms have a lower risk of rupture when compared with anterior circulation aneurysms. True or False?
False.
| Posterior circulation have higher risk of rupture
35
What are the risks of Aneurysmal rupture?
```
Size >7mm
Aneurysmal location (posterior>>anterior)
smoking
uncontrolled hypertension
previous history of aneurysmal rupture
```
36
Occipital strokes in the dominant hemisphere may manifest with...
alexia (inability to read)
anomia
achromatopsia (color anomia)
other visual agnosias
37
Benedikt's Syndrome, components and location?
ipsilateral third nerve palsy (CN III fascicle)
contralateral involuntary movements such as tremor and choreoathetosis (red nucleus, brachium conjunctivum)
mesencephalic tegmentum in its ventral portion
38
What is the trial involved with intracranial stenosis and antiplatelet vs anticoagulation?
Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial
39
What is the target INR for warfarin anticoagulation? Also, what is the targe for those on mechanical valves?
INR between 2.0 and 3.0
| If with MV: INR is 2.5 to 3.5
40
Which trial studied the effect of atorvastatin at a dose of 80 mg daily in patients with a recent (within 6 months) TIA or stroke, with low-density lipoprotein (LDL) between 100 and 190 mg/dL?
Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL)
41
Which trial compared best medical therapy versus intracranial stenting in patients with intracranial stenosis (70% to 99% stenosis) and recent stroke or TIA, demonstrating that medical therapy is superior.
SAMMPRIS (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) trial
42
The Alberta Stroke Program Early CT Score (ASPECTS) is calculated based on findings on standard noncontrast CT scan of the brain and provides a reproducible grading system to assess early ischemic changes in patients with acute ischemic strokes of the posterior circulation. True or False?
False. ASPECTS is for anterior circulation.
43
What are the requirements for ASPECT scoring?
two axial cuts are obtained on the CT: (one at the level of the basal ganglia and thalamus, and another more cranial cut where these structures are not appreciated)
There are 10 regions of interest, of which 4 are deep and defined as the caudate, the internal capsule, the lentiform nucleus, and the insular region, and 6 regions are cortical.
Maximum: 10points
Lowest: 0 points
44
What is the interpretation of ASPECT Scoring?
The lower the number of points the larger the infarct that is already being seen on CT.
The ASPECTS correlates inversely with the severity of the stroke, and patients with low scores should not be treated with thrombolytic agents. An ASPECTS score of 7 or less correlates with increased dependence and death.
45
What is NASCET Trial? North American Symptomatic Carotid Endarterectomy Trial (NASCET)
patients with 70% to 99% symptomatic carotid stenosis, the 2-year ipsilateral stroke rate was 26% with medical treatment versus 9% with CEA.
symptomatic carotid stenosis of 70% to 99% should be revascularized
Patients with symptomatic stenosis of 50% to 69% may also benefit from CEA, with greater impact in men versus women, in those with previous strokes versus TIAs, and with hemispheric versus retinal symptoms
46
Based from Asymptomatic Carotid Atherosclerosis Study (ACAS) and Asymptomatic Carotid Surgery Trial (ACS), what is the percentage cut-off of ICA stenosis that will benefit with CEA than medical treatment?
patients with more than 60% stenosis
47
Anticoagulation has proven to be of benefit in Moyamoya patients. True or False?
False. anticoagulation is not recommended, being usually avoided given the hemorrhagic risk in these patients.
48
What is the angiographic findings in Moyamoya disease?
progressive bilateral stenosis of the distal internal carotid arteries, extending to proximal ACAs and MCAs, and the development of extensive collateral circulation at the base of the brain, with the “puff of smoke” appearance
49
What is the histopathologic finding of Moyamoya disease?
intimal thickening by fibrous tissue of the affected arteries, with no inflammatory cells or atheromas
50
What is the histopathologic finding of Cerebral Amyloid Angiopathhy?
there is deposition of Congo-red positive amyloid material in the media and adventitia of small- and medium-sized vessels.
51
60/M manifested by ipsilateral third nerve palsy, and contralateral ataxia and tremor.. Diagnosis (eponym) and location?
Claude’s syndrome
dorsal red nucleus and the third nerve fascicle, and is in the midbrain tegmentum more dorsally
52
What are the components of CHA2DS2VASc score?
```
CHA2DS2VASc score,
Congestive heart failure (1 point)
Hypertension (1 point)
Age ≥75 years (2 points)
Diabetes mellitus (1 point)
Stroke/TIA/thromboembolism (2 points)
Vascular disease (previous myocardial infarction, peripheral arterial disease or aortic plaque) (1 point)
Age 65 to 74 years (1 point)
Sex category (female) (1 point). The maximum score is 9 points.
```
53
What is HAS-BLED score and its components?
used for the assessment of risk of hemorrhage on patients on anticoagulation.
```
HAS-BLED score,
abnormal renal function
abnormal liver function (1 point each)
history of stroke
bleeding history or predisposition to bleeding
Labile INRs
Elderly (age >65 years)
Drug use (1 point for antiplatelets or NSAIDs
Excessive alcohol intake
```
>2 is high
54
What are emissary veins?
Emissary veins connect scalp veins with the dural venous sinuses.
55
It is a large anastomotic vein that connects the Sylvian vein to the superior sagittal sinus..
superior anastomotic vein of Trolard
56
It is a large vein traveling over the temporal lobe convexity connecting the Sylvian vein to the transverse sinus.
inferior anastomotic vein of Labbe
57
What is the histopathologic finding of CADASIL?
demonstrating a blood vessel with a thick wall, which contains a basophilic granular material.
58
What is the gene involved in CADASIL and chromosome location?
What is the mode of inheritance?
NOTCH3 on chromosome 19
transmembrane receptor expressed mainly in vascular smooth muscle
Autosomal dominant
59
It forms clusters of vascular channels, composed of dilated thin-walled vessels, with no smooth muscle or elastic fibers, and with no intervening brain parenchyma separating the vascular structures.
Cavernous malformation
60
Common carotid artery ascends in the neck and divides into external and internal carotid arteries at what level?
C4, at the angle of the jaw
61
Which clinical trial focuses on Dabigatran 110 mg twice a day was non-inferior to warfarin for prevention of strokes and systemic embolism in nonvalvular atrial fibrillation, with lower rates of major hemorrhage; and Dabigatran 150 mg twice daily was superior to warfarin with similar rates of major hemorrhage?
RE-LY Trial
62
Which clinical trial highlighted that Rivaroxaban was noninferior to warfarin for preventing stroke and systemic embolism in nonvalvular atrial fibrillation, with similar risks of bleeding, but lower risks of intracranial and fatal hemorrhages?
ROCKET-AF Trial
63
Which trial stated that Apixaban 2.5 mg or 5 mg twice daily was superior to warfarin for preventing stroke and systemic embolism in nonvalvular atrial fibrillation. Apixaban also was associated with a lower risk of major bleeding including intracranial hemorrhage, and lower mortality rates?
ARISTOTLE trial
64
What is the reversal agent for Dabigatran and what is its mechanism of action?
Idarucizumab
monoclonal antibody fragment that binds free and thrombin-bound Dabigatran neutralizing its activity
65
What is the reversal agent for Apixaban and Rivaroxaban?
Adnexxanet Alfa
66
What are the cardinal features of histopathology of vasculitis?
Thick vessel wall with inflammation and necrosis
67
What is the histological layer that is absent in cerebral vessels?
no external elastic lamina but with prominent internal elastic lamina
68
The saccular aneurysm has an absence of this layer _____
no internal elastic lamina
69
This is the most readily recognized factor in the genesis of primary intracerebral hemorrhage.
```
A. Age
B. Hypertension
C. Sex
D. Diabetes Mellitus
E. Risk of anticoagulation
```
B. Hypertension
page 801
70
Which is more important factor in considering stroke-producing potential of hypertension?
Systolic or Diastolic Pressure?
Systolic pressure
Page 801 (Adams 11th)
71
This is an important risk actor in embolic stroke. What is this and it increases risk by how much?
Arrhythmia (Atrial Fibrillation)
| Increases risk of stroke by 6x (page 801, Adams 11th ed)
72
Which of the following intramwdullary brainstem syndrome is INCORRECTLY matched?
A. Parinaud Syndrome: Paralysis of upward gaze and accommodation, fixed pupil
B. Benedikt Syndrome: Oculomotor palsy, contralateral cerebellar ataxia and tremor, choreathetosis
C. Claude syndrome: Oculomotor palsy; contralateral cerebellar ataxia and tremor
D. Wallenberg Syndrome: contralateral V, IX, X, XI palsy, Horner syndrome and cerebellar ataxia, contralateral pain and temperature
E. Millard Gubler Syndrome: Ipsilateral Facial and abducens pals and contralateral hemiplegia
D. Wallenberg Syndrome: contralateral (IPSILATERAL) V, IX, X, XI palsy, Horner syndrome and cerebellar ataxia, contralateral pain and temperature
73
Which is correctly paired?
A. Weber Syndrome: Midbrain Tegmentum
B. Claude Syndrome: Tectum of Midbrain
C. Benedikt Syndrome: Tegmentum of Medulla
D. Millard Gubler: Base of pons
E. Wallenberg Syndrome: Medial Tegmentum of Medulla
D. Millard Gubler: Base of pons
Presenting as ipsilateral facial and abducens palsy and contralateral hemiplegia
OTHERS:
A. Weber Syndrome: Midbrain Tegmentum (BASE OF MIDBRAIN)
B. Claude Syndrome: Tectum of Midbrain (TEGMENTUM OF MIDBRAIN)
C. Benedikt Syndrome: Tegmentum of Medulla (TEGMENTUM OF MIDBRAIN)
E. Wallenberg Syndrome: Medial Tegmentum of Medulla (LATERAL TEGMENTUM OF MEDULLA)
```
FOR MIDBRAIN LESION:
Remember:
Nothnagel
Benedikt
Claude
Weber
```
74
Causes of stroke in the young include the following EXCEPT:
```
A. Protein C deficiency
B. Protein S deficiency
C. Excess of Antithrombin III
D. Factor V Leiden Mutation
E. Increased PTT
```
C. Excess of Antithrombin III (Antithrombin III deficiency)
| Page 853, table 33-7
75
Which is correctly paired?
A. MELAS: Autosomal Dominant
B. CADASIL: Autosomal Recessive
C. Protein S Deficiency: Autosomal Recessive
D. Protein C Deficiency: Autosomal Dominant
E. Antithrombin III Deficiency: X-linked Recessive
C. Protein S Deficiency: Autosomal Recessive
ALL stroke in the young causes are inherited via AUTOSOMAL RECESSIVE EXCEPT
:MELAS SYNDROME: Maternal Mitochondrial
:CADASIL: Autosomal Dominant
:Ehlers Danlos Syndrome: Mainly AD
(Table 33-7, page 853)
76
Which is CORRECTLY paired?
```
A. CARASIL: NOTCH 3
B. CADASIL: HART 1
C. Sickle Cell Syndrome: mtDNA
D. MELAS: Globin Genes
E. Marfan Syndrome: Fibrillin 1
```
E. Marfan Syndrome: Fibrillin 1
77
This trial enrolled patients who presented within 6hours after symptom onset of an anterior circulation stroke and compared intraarterial treatment to standard medical care (vs IV thrombolysis)
```
A. MR CLEAN
B. SWIFT PRIME
C. EXTEND-IA
D. ESCAPE
E REVASCAT
```
A. MR CLEAN
78
What is the mechanism of action of Aspirin?
A. Inhibits cyclooxygenase and reduce thromboxane A2
B. inhibits adenosine pyrophosphate dependent platelet aggregation
C. Inhibits adenosine deaminase Phosphodiesterase
D. Factor Xa inhibitor
A. Inhibits cyclooxygenase and reduce thromboxane A2
Explanation
B. inhibits adenosine pyrophosphate dependent platelet aggregation (Clopidogrel)
C. Inhibits adenosine deaminase Phosphodiesterase (Dipyridamole)
D. Factor Xa inhibitor (Rivaroxaban and Apixaban)
79
Which is true of subarachnoid hemorrhage secondary to ruptured aneurysm?
A. Most common location of subarachnoid aneurysm are at the junction of posterior communicating artery and PCA
B. Giant aneurysm is defined as >10mm
C. Aneurysm less than 10mm have annual rupture rate of 0.1%
D. Giant aneurysm have annual rupture rate of 1%
C. Aneurysm less than 10mm have annual rupture rate of 0.1%
EXPLANATION
A. Most common location of subarachnoid aneurysm are at the junction of posterior communicating artery and PCA (ANTERIOR COMMUNICATING ARTERY AND ACA)
B. Giant aneurysm is defined as >10mm (>25mm)
D. Giant aneurysm have annual rupture rate of 1% (6%)
80
Among these patients, who have the highest predictive of recurrent stroke?
A. 50/M DM presenting with slurred speech lasted for 1hr with BP of 180/100
B. 62/F DM presenting with unilateral weakness lasted for 10mins with BP of 130/90
C. 70/M DM smoker, presenting with slurred speech lasting for 20minutes with BP of 200/100.
D. 45/M DM presenting with slurred speech with unilateral weakness, symptoms lasted for 2hrs then improved, BP was 150/100
ANSWER D
D. 45/M (0) DM (1) presenting with slurred speech with unilateral weakness (2) symptoms lasted for 2hrs (2) then improved, BP was 150/100 (1)
Explanation
A. 50/M (0) DM (1) presenting with slurred speech (1) lasted for 1hr (2) with BP of 180/100 (1)
B. 62/F (1) DM (1) presenting with unilateral weakness (2) lasted for 10mins (1) with BP of 130/90 (0)
C. 70/M (1) DM (1) smoker, presenting with slurred speech (1) lasting for 20minutes (1) with BP of 200/100.(1)
A- 5
B- 5
C- 5
D-6
81
In ABCD2, these two factors are most predictive of stroke.
```
A. Age and BP
B. Clinical Presentation and Diabetes
C. Duration of Symptoms and Age
D. Clinical Presentation and BP
E. Clinical Presentation and Duration of Symptoms
```
E. Clinical Presentation and Duration of Symptoms
(Unilateral Weakness and duration lasting. over an hour)-> most predictive of stroke
82
What is the normal CBF level?
A. 55ml/100g/min
B. 23ml/100g/min
C. 10-12ml/100g/min
D. 35ml/100g/min
A. 55ml/100g/min
83
Presence of dense MCA sign during acute infarct can be attributed to...
A. Very high concentrations of protein or globin components brought by clot retraction
B. Due to failure of ion pumps to maintain cellular homeostasis leading to unabated cellular influx of water causing cytotoxic edema
C. Due to severe atherosclerotic plaque brought by clot formation
D. Due to vascular edema surrounding the area of infarcted region
A. Very high concentrations of protein or globin components brought by clot retraction
84
Presence of hypodense lentiform nucleus and hypodense appearance of insular cortex can be attributed to...
A. Very high concentrations of protein or globin components brought by clot retraction
B. Due to failure of ion pumps to maintain cellular homeostasis leading to unabated cellular influx of water causing cytotoxic edema
C. Due to severe atherosclerotic plaque brought by clot formation
D. Due to vasogenic edema surrounding the area of infarct
B. Due to failure of ion pumps to maintain cellular homeostasis leading to unabated cellular influx of water causing cytotoxic edema
(page 143)
85
In CT Perfusion, which parameter is most useful in predicting variable penumbra and penumbra that would convert to infarction.
```
A. Mean Transit Time
B. Cerebral Perfusion Pressure
C. Cerebral Blood Volume
D. Cerebral Blood Flow
E. Mean Arterial Pressure
```
D. Cerebral Blood Flow
This is the most useful parameter in predicting viable penumbra.
It represents the altered area of the brain that is at risk of infarction.
Cerebral Blood Flow (amount of blood passing through a volume of brain in a specified amount of time)
86
In CT Perfusion, which parameter shows the most prominent regional abnormality representing ischemic penumbra, depicted as area of increased ___.
```
A. Mean Transit Time
B. Cerebral Perfusion Pressure
C. Cerebral Blood Volume
D. Cerebral Blood Flow
E. Mean Arterial Pressure
```
A. Mean Transit Time
| MTT is the average time it takes blood to transit through a volume of brain
87
What is the CT perfusion finding that depicts penumbra?
A. Increased MTT, mildly decreased CBF, Normal or elevated CBV
B. Decreased MTT, mildly decreased CBF, normal or decreased CBV
C. Increased MTT, decreased CBF, decreased CBV
D. Decreased MTT, increased CBF, decreased CBV
A. Increased MTT, mildly decreased CBF, Normal or elevated CBV
88
What is the CT perfusion finding that depicts infarction?
A. Increased MTT, mildly decreased CBF, Normal or elevated CBV
B. Decreased MTT, mildly decreased CBF, normal or decreased CBV
C. Increased MTT, decreased CBF, decreased CBV
D. Decreased MTT, increased CBF, decreased CBV
C. Increased MTT, decreased CBF, decreased CBV
89
Which of the following is true regarding SAH and sensitivity of CT scan?
A. 93% sensitive in 24hrs
B. 95% sensitive in 24hrs
C. 100% sensitive in 48hrs
D. 50% sensitive in 5 days
A. 93% sensitive in 24hrs
EXPLANATION
CT Scan sensitivity
12hrs - 98-100%
24hrs- 93%
6 days- 57-85%
90
Determine if MILD, MODERATE or SEVERE stroke:
NIHSS 1-5
A. MILD
B. MODERATE
C. SEVERE
A. MILD
91
Determine if MILD, MODERATE or SEVERE stroke:
NIHSS 7
A. MILD
B. MODERATE
C. SEVERE
B. MODERATE
(NIHSS of 6-21) —> MODERATE
92
Determine if MILD, MODERATE or SEVERE stroke
NIHSS 23
A. MILD
B. MODERATE
C. SEVERE
C. SEVERE
NIHSS >22 is severe
93
Determine if MILD, MODERATE or SEVERE stroke
awake patient with significant motor and sensory deficits
A. MILD
B. MODERATE
C. SEVERE
B. MODERATE
94
Determine if MILD, MODERATE or SEVERE stroke
motor weakness of one side of the body, can still ambulate without assistance
A. MILD
B. MODERATE
C. SEVERE
A. MILD
95
Determine if MILD, MODERATE or SEVERE stroke
disoriented, drowsy or slightly stupor with purposeful response to painful stimuli
A. MILD
B. MODERATE
C. SEVERE
B. MODERATE
96
Determine if MILD, MODERATE or SEVERE stroke
deep stupor with non-purposeful response
A. MILD
B. MODERATE
C. SEVERE
C. SEVERE
97
Determine if MILD, MODERATE or SEVERE stroke
visual field defect alone
A. MILD
B. MODERATE
C. SEVERE
A. MILD
98
```
When is it warranted to request for contrast CT-scan, 4-Vessel Angiogram, MRA or CTA in a patient with hemorrhagic stroke?
A. Age <50 yrs old
B. Known hypertensive patient
C. Lobar/ Cortical hemorrhage
D. Suspected to have AVM
```
C. Lobar/ Cortical hemorrhage
```
EXPLANATION:
Age <45yrs old
Normotensive
Lobar hemorrhage
Uncertain cause of ICH
Suspected to have AVM or vasculitis
```
99
Which is not true in BP monitoring after TPA?
A. every 15 minutes for the first 2 hours after TPA
B. every 30 minutes for 6 hours
C. every 1 hr for 16 hours
D. every 30minutes for first 4 hours after TPA
D. every 30minutes for the first 4 hours after TPA
100
If you suspected symptomatic ICH after thrombolytic therapy which of the following is not part of the protocol?
A. Discontinue rt-PA infusion
B. Do immediate CT scan
C. STAT PTT, PT, Platelet Count, Fibrinogen, Blood Type and Cross Matching
D. Prepare 6-8 units of cryoprecipitate containing Factor VII
E. Prepare 6-8 units of platelets
D. Prepare 6-8 units of cryoprecipitate containing Factor VII (FACTOR VIII)
101
What is the target BP prior to starting rTPA infusion?
A. <180/110 mmHg
B. <185/110 mmHg
C. <180/120 mmHg
D. <185/120 mmH
B. <185/110 mmHg
102
Permissive hypertension is defined as:
A. SBP >220mmHg
B. DBP > 120mmHg
C. MAP >130
D. All of the above
D. All of the above
103
Which is not part of STATE criteria for Immediate Neurosurgical Consultation for Hemicraniectomy for Malignant MCA Infarction?
A. Score (NIHSSS >20 - dominant; NIHSS >15 non-dominant region) or GCS <8
B. Time < 48hrs of acute ischemic stroke
C. Age >60yrs old
D. Territory: Infarct volume > 50% MCA territory infarction
E. Expectations: life expectancy
C. Age >60yrs old
SHOULD BE <60yrs old
