Vascular Neurology

Question 1

Enzyme in Fabry

Answer 1

alpha-galactosidase

accumulation of globotriaosylceramide in vascular SmM and EndoT –> stroke

Question 2

hemorrhage rate unruptured aneurysms

Answer 2

<10 mm = 0.05%/yr
10-25 mm = 1%/yr
>25 mm = 6%

Question 3

TCD cutoff for Exchange Transfusion in SCD>

Answer 3

200 cm/s (in MCA)

target HbS 30%

Question 4

preferred Rx of VOG malformation

Answer 4

embolization

Question 5

goal MAP in ICH w known hypertensive pt

Answer 5

130 mmHg

Question 6

PAN size arteries affected

Answer 6

small and medium sized arteries

Question 7

Recurrent bleeding rates of vascular malformations

Answer 7

DVA: 0.15%/yr
HTN: 2%/yr
Cav mal: 4.5%
AVM: 3-34% (dep. Characteristics)
CAA: 10%

Question 8

Seizure rates w acute cerebrovascular Dz

Answer 8

AIS : 6%
SAH: 5%
ICH: 30% (cortical), 5% subcortical

Question 9

peak SAH periods

Answer 9

re-bleeding = 12-48 hr
vasospasm = 3-?14 (Borsody = 4-7)

Question 10

Basic pathophys of MTHFR mutation

Answer 10

Cannot convert Hcy back to Methionine, both increase in homocystinemia

Question 11

Esoteric condition asoc w marantic endocarditis

Answer 11

AIDS, DIC, SLE

Question 12

Synonym for Factor V Leiden

Answer 12

activated Protein C resistance (Factor V Leiden resists cleavage by Protein C)

Question 13

AVM vs. CavMal vs. DVA

Answer 13

AVM = arterial-venous anastomosis, no parenchyma between vessels
CavMal (aka cavernoma/cavernous hemangioma) = abnormal venous structures, no parenchyma between vessels, +/- adj. cortical dysplasia
DVA = (aka venous angioma) = cluster of normal venous str

Question 14

Arterial layer MC involved in FMD?

Answer 14

Tunica media

Usually results in tunica medica fibroplasia

Question 15

CHADS2 components

Answer 15

CHF at onset of AF, Hypertension, Age >75, Diabetes, Stroke/TIA(+2)
Annualized stroke risks on ASA: 0 (1%), 1 (2%), 2 (4%), 3 (8%), 4 (10%), 5 (12%), 6 (14%)

Question 16

ABCD2 components

Answer 16

Age > 60 +1
BP > 140/90+1
Duration (<10 min+0, 10-59min+1, >60 min+2)
Diabetes+1
Clinical (other symptoms+0, speech disturbance wo weakness+1, unilateral weakness+2)

Question 17

Stroke recurrence rates by TOAST

Answer 17

Extracranial LAA > cardioembolic > intracranial LAA > lacunar

Question 18

size of cerebellar ICH for surgery?

Answer 18

3 cm

Question 19

re-bleeding rate SAH (first week; unsecured)

Answer 19

20%

Question 20

Sturge Weber

Answer 20

Neurocutaneous capillary malformation
leptomeningal angioma + capillary malformation (port wne stain over V1) + eye capillary malformations
MC presentation = seizure in infancy, or stroke-like episodes

Question 21

Sneddon syndrome

Answer 21

positive Lupus AC, livedo reticularis, stroke

Question 22

Blood age on MRI

Answer 22

oxyHg (hyperacute) –> deoxyHg (acute) –> intrac metHg (early subacute) –> extrac metHg (late subacute) –> hemosiderin (chronic, intra)

Question 23

Percent of CT-neg SAH?

Answer 23

5%; 70% CSF is positive for xantho within 6 hours, 90% within 12 of SAH

Question 24

CADASIL vs. MELAS

Answer 24

CADASIL = Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. NOTCH3 mutation; deposition in media of end-arteries that surround SmM cells; subcortical stroke + dementia + migraine +/-mood d;
MELAS  = Mitochondrial Encephalopathy, Lactic acidosis, Stroke-like episodes. mRNA mutations; occipital, multi-territory stroke + dementia + migraine + seizures + SN hearing loss + ret

Question 25

Gene in Pseudoxanthoma Elasticum

Answer 25

ABCC6 gene (encodes MRP6 protein, function unknown)

Question 26

MOA of aspirin?

Answer 26

irreversible inhibitition of COX production of TXA; | also inhibits vasodilatory prostacyclin production

Question 27

MOA of dipyridamole?

Answer 27

inhibition of cAMP-phosphodiesterase --> incr cAMP blocking adenosine reuptake. Also vasodilation (HA) end result = inhibition of platelet aggregation

Question 28

MOA of clopidogrel?

Answer 28

Blocking of adenosine diphosphate (ADP) binding to Adenosine (R)

Question 29

MOA of ticlopidine?

Answer 29

poorly understood, but inhibits platelet aggregation

Question 30

MOA of warfarin

Answer 30

inhibits Factors II, VII, IX, X, C+S | basically acts on both intrinsic + extrinsic systems

Question 31

MOA of heparins?

Answer 31

ALL: activates Antithrombin III, which then: Unfractionated: inhibits Factor X = Factor II Lovenox: X > II

Question 32

MOA of dabigatran?

Answer 32

direct thrombin inhibitor (Factor II)

Question 33

MOA of t-PA?

Answer 33

activates plasminogen, which turns Factor I (fibrin clot) into fibrin degradation products

Question 34

MOA of edoxaban, apixaban, rivaroxaban

Answer 34

Factor Xa inhibitors (Factor Xa activates prothrombin into thrombin)

Question 35

MOA of statins?

Answer 35

HMG-CoA reductase inhibition inhibits enzyme that catalyzes production of mevalonic acid) --> inhibits cell production of cholesterol

Question 36

MOA of thiazide diuretics?

Answer 36

Block reabsorption of NaCl from distal tubule increase Ca2+ decrease K+ decreases Na+ --> hyponatremia

Question 37

MOA of furosemide?

Answer 37

Loop diuretic. Block Na+, Cl-, K+ reabsorption in Loop of Henle. Can also cause hypoK/Na/Mg/Ca2+ Can cause hyperuricemia

Question 38

MOA of nitrates?

Answer 38

venodilation through donation of NO.

Question 39

MOA of different CCBs?

Answer 39

Dihydropyridine (-dipine): vasodilation (vessels>heart) verapamil: cardioselective (AE = neg inotropy) diltiazem: intermediate

Question 40

MOA of cilostazol?

Answer 40

inhibition of phosphodiesterase (platelet inhibition) + vasodilation

Question 41

MOA of abciximab/eptifibatide?

Answer 41

blocking binding of GP2a/3b with fibrinogen (humanized monoclonal ab against glycoprotein IIb/IIIa R).

Question 42

MOA of eptifibatide?

Answer 42

GP2b/3a receptor antagonist

Question 43

most common AE of clopidogrel?

Answer 43

rash

Question 44

cardioselective beta blockers

Answer 44

Eskimos (esmolol) Ate (atenolol) Ace (acebutolol) Butt (??) Meat (metoprolol)

Question 45

MOA of doxazosin

Answer 45

alpha blocker