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Adams Principles of Neurology > Stroke > Flashcards

Flashcards in Stroke Deck (117)
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1
Q

Stands as the most typical sign of cerebrovascular diseases

A

Hemiplegia

2
Q

Miscellaneous conditions taken to be as stroke

A

Migraine, Bell’s palsy, Stokes-Adams syncopal attacks, labyrinthine vertigo, diabetic ophthalmoplegia, temporal arteritis

3
Q

It is the most recognised factor in the genesis of primary intracerebral hemorrhage

A

Hypertension

4
Q

Atrial fibrillation increases the incidence of stroke by how may folds?

A

6x

5
Q

The top three most frequent sites of atheromatous plaques

A

1) in the ICA at its origin from the carotid artery
2) in the cervical part of the VA and at their junction to form the BA
3) in the stem or at the main bifurcation of the MCA

6
Q

This is the most common cause of ischemic strokes and of all types of stroke

A

Cerebral embolism

7
Q

Approximately how many percent of infarcts that follow TIA occur within a year?

A

50%

8
Q

TIA consisting of homonymous hemianopia should suspect stenosis of which vessel?

A

PCA

9
Q

Hemodynamic changes in the cerebral circulation when the lumen of the ICA is reduced to how many mm?

A

2.0 mm

10
Q

Why does the necrotic tissue at the centre of an ischemic stroke swells rapidly?

A

because of excessive intracellular water content

11
Q

The critical level of hypoperfusion that abolishes function and leads to tissue damage?

A

12-23 mL/100g/min

12
Q

After how many minutes can cells withstand complete absence of O2?

A

20 minutes

13
Q

A reduction of 2-3 degrees celsius reduces metabolic requirements of neurons and increases their tolerance to hypoxia by how many %?

A

25-30%

14
Q

Origin of the left common carotid artery

A

Aortic arch

15
Q

Which artery supplies the lower internal capsule, globes pallidus, uncus, amygdala and hippocampus?

A

Anterior choroidal artery

16
Q

Which artery supplies the putamen, upper internal capsule, lower corona radiate and body of caudate?

A

Penetrating branches of MCA

17
Q

Occlusion of this segment of the ACA results in a sensorimotor deficit of the opposite foot and leg, and to a lesser degree, of the shoulder and arm, with sparing of the hand and face

A

A2 segment

18
Q

The anterior choroidal artery springs from what artery?

A

ICA

19
Q

Syndrome characterized with paralysis of soft palate and vocal cord and contralateral hemianesthesia

A

Avellis Syndrome

20
Q

Characterised by transient loss of consciousness, oculomotor disturbances, hemianopia, bilateral ptosis and pupillary enlargement with preserved reaction to light

A

Top of the basilar artery occlusion

21
Q

Lacunes are usually caused by occlusion of small arteries measuring?

A

50-200 microns in diameter

22
Q

81% of lacunar stroke are caused by?

A

hypertension

23
Q

Most common location of lacunes?

A

putamen and caudate nuclei

24
Q

The relative improvement in neurologic state after TPA infusion came at the expense of how many percent risk of symptomatic cerebral haemorrhage?

A

6%

25
Q

Two situations in which the immediate administration of heparin is indicated

A

Basilar Artery Thrombosis with fluctuating deficits

Impending Carotid Artery Occlusion from thrombosis

26
Q

Bleeding into any organ after heparin infusion may occur when the PTT is how many times greater than the pretreatment level?

A

3x

27
Q

Drugs that may alter the anticoagulant effects of warfarin

A

Aspirin, Cholestyramine, Alcohol, Carbamazepine, Cephalosporin, Quinolones, Sulfa drugs, Penicillin

28
Q

This develops several days to a week after carotid endarterectomy presenting with headache, focal deficits, seizures, brain edema or cerebral haemorrhage.

A

Hyperperfusion Syndrome

29
Q

A bruit generally corresponds to the reduction in luminal diameter of the artery to how many mm?

A

2mm

30
Q

Artery most frequently involved in fibromuscular dysplasia

A

Internal carotid artery

31
Q

Treatment for cervical dissection

A

Anticoagulation

32
Q

Refer to an extensive basal cerebral rete mirabile

A

Moyamoya disease

33
Q

Disease characterised by dementia, pseudobulbar state and gait disorder?

A

Binswanger disease

34
Q

Mutation associated with CADASIL?

A

missense change on chromosome 19 of the NOTCH 3 gene

35
Q

small brainstem hemorrhages secondary to temporal lobe herniation and brainstem compression

A

Duret hemorrhages

36
Q

Approximately 50% of the cerebral haemorrhages occur in what area?

A

putamen and adjacent internal capsule

37
Q

Appearance of contrast within the hemorrhage during CTA which is associated with a high rate of hematoma expansion

A

spot sign

38
Q

Why is arteriography necessary in establishing the diagnosis of AVM?

A

1) to define the feeding arteries
2) to look for the presence of an aneurysm
3) to determine the channels of venous drainage

39
Q

Dural Arteriovenous Fistula is usually fed by which vessels?

A

Dural arterial vessels of the internal cranial circulation

40
Q

Vascular malformations composed mainly of clusters of thin-walled veins without important arterial feeders

A

Cavernoma

41
Q

Second most common cause of cerebral haemorrhage next to hypertension

A

Anticoagulant therapy

42
Q

Tumors most commonly associated with cerebral haemorrhage?

A

Choriocarcinoma, melanoma, renal cell and bronchogenic carcinoma

43
Q

T/F: The brain edema in hypertensive encephalopathy is caused by active exocytosis of water rather than simply a passive leak from vessels subjected to high pressures.

A

True

44
Q

Patient presenting with bilateral headache, stiffness in the proximal muscles of the limbs associated with the markedly elevated sedimentation rate

A

Temporal arteritis

45
Q

This is a nonspecific chronic arteritis involving mainly the aorta and the large arteries arising from its arch

A

Takayasu Disease

46
Q

The disease was originally distinguished by the triad of relapsing iridocyclitis and recurrent genital and oral ulcers

A

Behcet disease

47
Q

Least common of the venous syndromes

A

Occlusion of the vein of Galen

48
Q

Most common and most serious disorder of coagulation affecting the nervous system

A

Disseminated Intravascular Coagulation

49
Q

The formal criteria for the diagnosis require that an ischemic event be accompanied by the detection of autoantibodies on two occasions at least 6 weeks apart

A

Antiphospholipid Antibody Syndrome

50
Q

The most frequent neurologic abnormality of APAS

A

Amaurosis fugax

51
Q

Arteriopathy producing deep blue-red skin lesions of livedo reticularis and livedo racemosa in association with multiple ischemic strokes

A

Sneddon Syndrome

52
Q

T/F: Seizures are quite infrequent as the initial manifestation on an ischemic stroke and when they do occur in this fashion, an embolus is usually the causative mechanism

A

True

53
Q

Percent increase in the number of patients with little of no neurologic deficit with the use of IV RTPA

A

30%

54
Q

T/F: Administration of IV heparin prevents early recurrence of stroke

A

True

55
Q

Infarction is caused by a reduction of CBF below this level

A

10-12 ml/100g/min

56
Q

A reduction of 2-3 degrees celsius reduces the metabolic requirement of neurons and increases the tolerance to hypoxia by how many %?

A

25-30%

57
Q

These neurotransmitters, released by ischemic cells, excite neurons and produce an intracellular influx of Na and Ca.

A

Glutamate and aspartate

58
Q

It is a Vitamin K-dependent protease, that in combination with its cofactors protein S and antithrombin III, inhibits coagulation.

A

Protein C

59
Q

A dangerous complication of anticoagulation which is a result of paradoxical microthrombosis of skin vessels and is liable to occur in patients with unsuspected deficiencies of endogenous clotting proteins.

A

Hemorrhagic skin necrosis

60
Q

T/F: the value of surgical decompression has not been limited to patients with right-hemispheric strokes.

A

True

61
Q

It is a segmental nonatheromatous, noninflammatory arterial disease of unkonwn etiology almost exclusively in women characterized by a series of transverse constriction of the arteries.

A

Fibromuscular dysplasia

62
Q

T/F: a unilateral Horner syndrome is often present in internal carotid artery dissection.

A

True

63
Q

Where does vertebral artery dissection commonly originates?

A

C1-C2 segment of the vessel

64
Q

Characterized by a combination of dementia, pseudobulbar state and gait disorder

A

Binswanger disease

65
Q

T/F: the risk of both cerebral infarction and intracerebral hemorrhage appears to be mainly in the 6-week period after delivery rather than during the pregnancy itself.

A

True

66
Q

T/F: As a rule, a cerebellar hematoma less than 2cm in diameter leaves most patients awake and infrequently leads to deterioration, therefore generally not requiring surgery.

A

True

67
Q

The four most common sites of aneurysm

A

1) proximal portion of the ACA 2) origin of the PCA 3) first major bifurcation of the MCA 4) bifurcation of the ICA into MCA and ACA

68
Q

An entity which has been used in an imprecise way to refer to both a headache that precedes SAH and to a small leakage prior to rupture.

A

Sentinel headache

69
Q

T/F: The patient usually does well and a second arteriogram is probably not required in perimesencephalic hemorrhage.

A

True

70
Q

T/F: In almost half of the patients with AVMs, the first clinical manifestation is a cerebral SAH.

A

True

71
Q

Second most common cause of intracerebral hemorrhage next to hypertension

A

Anticoagulant therapy

72
Q

This is perhaps the most common and most serious disorder of coagulation affecting the nervous system.

A

Disseminated intravascular coagulation

73
Q

The most frequent neurologic abnormality of APAS

A

TIA

74
Q

The occurrence of carotid TIA is a predictor not only of cerebral infarction but also of myocardial infarction.

A

True

75
Q

T/F: The frequency of seizures after each type of hemorrhage is lower than for ischemic strokes.

A

True

76
Q

The “hematocrit effect” is particularly prone to occur in cases of what type of hemorrhage.

A

Anticoagulant-induced

77
Q

What is the normal CBF?

A

55 ml/100mg/min

78
Q

The cardinal clinical sign of ICA stenosis near its origin from the common carotid artery

A

Transient ischemic attacks

79
Q

What is the most common stroke subtype in Asians utilizing the oxfordshire classification?

A

Partial Anterior Circulation Infarct (PACI)

80
Q

What is the gold standard for the definitive diagnosis of AVM?

A

Digital subtraction angiography

81
Q

A 63-year old male, hypertensive, diabetic presented with right-sided weakness lasting for 30 minutes. BP 150/100. What is his ABCD2 score?

A

6

82
Q

Cerebral Ischemia accounts for what percentage of stroke cases?

A

80%

83
Q

Most important factor in hematoma expansion during the acute phase of ICH

A

Blood pressure

84
Q

Usual location of hypertensive intracerebral hemorrhage

A

1) basal ganglia
2) lobar
3) thalamus
4) pons
5) cerebellar

85
Q

Most common cause of drug-related strokes

A

Cocaine

86
Q

Most common cause of intracerebral bleed in preadolescent children

A

Vascular malformation

87
Q

T/F: Hydrophilic statin (Atorvastatin) when used in high doses are associated with elevated transaminases but not CPK.

A

True

88
Q

Most common adverse effect related to dipyridamole

A

Headache

89
Q

T/F: in bilateral lesions confined to the occipital poles, there may be a loss of central vision only.

A

True

90
Q

T/F: a solely left-sided infarction of the inferomedial temporal lobe impairs retentive memory.

A

True

91
Q

T/F: doing decompressive hemicraniectomy for malignant MCA infarcts involving the dominant hemisphere will lead to a worse functional outcome.

A

False

92
Q

Size of the bone flap for adequate external decompression

A
12 cm (anterior-posterior)
9 cm (superior-inferior)
93
Q

NOAC that cannot be given per NGT

A

Dabigatran

94
Q

Cardinal clinical sign of ICA stenosis near its origin from the common carotid

A

Transient ischemic attacks

95
Q

Most important cause of drug-related strokes

A

Cocaine

96
Q

Location of more than 90% of unruptured aneurysms

A

Acomm and Pcomm

97
Q

Most common organism associated with infectious aneurysms

A

Streptococcus

98
Q

False aneurysms resulting from intimal tear and intramural hemorrhage

A

Dissecting aneurysms

99
Q

Trauma causing tearing of bridging veins

A

Subdural hematoma

100
Q

A focal neurologic deficit that lasts longer than 24 hours but resolves by 3 weeks.

A

Reversible Ischemic neurologic deficit (RIND)

101
Q

Refers to nonbacterial thrombotic endocarditis (NBTE) in patients with malignancy

A

Marantic endocarditis

102
Q

Autosomal dominant condition characterized by numerous telangiectasias in multiple organs.

A

Osler-Weber-Rendu disease

103
Q

In the Northern American Symptomatic Carotid Endarterectomy Trial (NASCET) among patients with symptomatic internal carotid artery stenosis, the 2-year ipsilateral stroke rate was __ in medically treated vs. __ in carotid endarterectomy group.

A

26% vs. 9%

104
Q

Considered “gold standard” for assessment of degree of internal carotid artery stenosis

A

Arteriography

105
Q

Risk of angioplasty and stenting is highest in this blood vessel because of many perforating vessels

A

Basilar artery

106
Q

Recommended for patients with ischemic stroke related to antiphospholipid antibody syndrome

A

Anticoagulation with warfarin

107
Q

Vascular malformation composed mainly of clusters of thin-walled veins without important arterial feeders and with little or no intervening nervous tissue

A

Cavernoma

108
Q

Earliest histopathological finding in cerebral infarction

A

Shrunken eosinophilic neurons

109
Q

T/F: Patients with SAH and negative angiograms have a good prognosis.

A

True

110
Q

Most common syndrome in lacunar stroke

A

Pure motor hemiplegia

111
Q

The most common cause of subarachnoid hemorrhage

A

Post-traumatic

112
Q

Most common cause of TIA

A

Artery to artery platelet embolism

113
Q

Risk factor for stroke reaches the level of a nonsmoker after how many years?

A

5 years

114
Q

The single best index of outcome of SAH

A

Patient’s state of consciousness at the time of arteriography

115
Q

Mechanism of stroke among alcoholics

A

Head trauma

116
Q

CADASIL is associated with what genetic abnormality?

A

Chromosome 19 Notch 3 gene

117
Q

Most common symptom of hyperperfusion syndrome after carotid endarterectomy

A

Unilateral severe headache