Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
133 Cards in this Set
- Front
- Back
|
___% of stroke is ischemic
the rest is ___ |
80
hemorrhagic |
|
|
___% of hemorrhagic stroke is parenchymal
the rest is ___ |
50
subarachnoid |
|
|
30 day mortality rate for stroke
|
20%
|
|
|
prognosis for MCA branch occlusion
|
20% die
20% significant neuro deficit 40% recover partially 20% recover completely |
|
|
mortality for MCA branch occlusion + obtundation + gaze preference
|
40%
|
|
|
2 causes of death in first 3--5 days after stroke
|
brain swelling
herniation |
|
|
3 causes of death after first week
|
cardiac
PE sepsis |
|
|
4 non modifiable stroke risk factors
|
age
gender (M>F) race (african-american) family hx DM? |
|
|
stroke risk doubles every ___ years after age 55
|
10
|
|
|
stroke incidence is ___% higher for men
|
30
|
|
|
6 modifiable RFs for stroke
|
HTN
cholesterol smoking AF anticardiolipin Abs homocysteine |
|
|
biogenic energetic failure occurs when ___ (2)
this is reflected by fall in ___ (2) and increase in ___ |
CPP < 30 mm Hg
CBF < 20% of normal ATP phosphocreatine ADP |
|
|
normal CBF
|
50 ml/100 g/min
|
|
|
as neuronal injury progresses, ___ release increases
|
Glu
|
|
|
5 causes of cardioembolic stroke
|
AF
AMI ventricular aneurysm prosthetic valve rheumatic disease |
|
|
AF increased risk for stroke in framingham by ___x
|
5.6
|
|
|
given AF is present, 7 RFs for stroke
|
previous TIA/CVA
HTN HF/CAD DM mitral stenosis prosthetic valve thyrotoxicosis |
|
|
5 management scenarios given AF is present
|
age<65 without RFs
age<65 with RFs 65<age<75 without RFs 65<age<75 with RFs age>75 |
|
|
stroke prophylaxis for age<65 without RFs
|
ASA or nothing
|
|
|
stroke prophylaxis for age<65 with RFs
|
warfarin, INR 2--3
|
|
|
stroke prophylaxis for 65<age<75 without RFs
|
ASA or warfarin
|
|
|
stroke prophylaxis for 65<age<75 with RFs
|
warfarin, INR 2--3
|
|
|
stroke prophylaxis for age>75
|
warfarin, INR 2--3
|
|
|
NASCET indications for CEA
|
symptomatic with 70% stenosis
symptomatic with 50% stenosis and male, non-DM, medically stable |
|
|
ACASS indication for CEA
|
asymptomatic with 60% stenosis
|
|
|
3 modalities for measuring stenosis
|
carotid duplex
MRA CTA |
|
|
accepted adverse outcomes from CEA
|
asymptomatic stenosis
symptomatic stenosis small stroke reoperation |
|
|
accepted rates for CEA for:
asymptomatic stenosis symptomatic stenosis small stroke reoperation |
3%
5% 7% 10% |
|
|
accepted M&M rate for CEA
|
2%
|
|
|
2 drugs which block platelet ADPR
|
clopidogrel
ticlodipine |
|
|
1 platelet anti-PDE druge
|
dipyridamole
|
|
|
main side effect of ticlodipene
because of this, do ___ |
neutropenia
fortnightly CBC for 1st 3 months |
|
|
___% of SAH patients die immediately
|
25
|
|
|
of SAH patients reaching hospital,
33% do ___ 33% do ___ 33% do ___ |
die
have permanant deficit recover fully |
|
|
annual risk of aneurysm rupturing
|
1--3%
|
|
|
2 main causes of death for SAH pts reaching hospital
|
rebleeding
vasospasm |
|
|
rebleeding occurs within ___ of initial SAH
|
24h
|
|
|
management of vasospasm
|
hypertension
hypervolemia hemodilution |
|
|
2 kinds of causes of abrupt focal cerebral deficit
|
vascular
nonvascular |
|
|
___% of abrupt focal cerebral deficits have a vascular cause
|
95
|
|
|
4 nonvascular causes of abrupt focal cerebral deficits
|
seizure
tumor demyelination psychogenic |
|
|
2 kinds of vascular AFCD (stroke)
|
hemorrhage
ischemic |
|
|
___% of stroke is hemorrhagic
the rest is ___ |
15
ischemic |
|
|
3 kinds of causes of ischemic stroke
|
cerebrovascular disease
cardiogenic embolism other |
|
|
4 kinds of cerebrovascular disease
|
arteriosclerotic stenosis
thrombosis artery to artery embolism small vessel disease |
|
|
___% of ischemic stroke is due to cerebrovascular disease
___% is due to cardioembolism |
80
15 |
|
|
5 "other" causes of ischemic stroke
|
hyperviscosity
vasospasm vasculitis hypotension hypercoagulability |
|
|
median duration of carotid TIA
90% of carotid TIAs are under ___ |
14 min
6 h |
|
|
median duration of vertebrobasilar TIA
90% of vertebrobasilar TIAs are under ___ |
8 min
2 h |
|
|
prognosis for TIA depends on ___
|
associated RFs
|
|
|
post-TIA risk for stroke, MI or death
|
12%
|
|
|
4 most common sx of carotid TIA
|
monocular blindness
hemiparesis hemianesthesia/paresthesia language disturbance |
|
|
4 most common sx of vertebrobasilar TIA
|
bilateral visual blurring
diplopia ataxia dizziness |
|
|
4 atypical presentation of TIA
|
HA
seizure drop attack transient global amnesia |
|
|
motor sx in vertebrobasilar TIA differ from carotid in ___
|
they can switch from side to side
|
|
|
sensory sx in vertebrobasilar TIA differ from carotid in ___
|
mostly affect face/mouth/tongue
|
|
|
visual sx in vertebrobasilar TIA differ from carotid in ___
|
usually homonymous hemianopia
|
|
|
strokes due to ICA occlusion get worse with increasing ___ of the occlusion
|
proximity to circle of willis
|
|
|
infarction of posterior superior frontal gyrus causes ___
|
forced grasping
|
|
|
bilateral ACA infarction causes ___ with or without ___
|
paraparesis
sensory loss |
|
|
4 non-leg related ACA sx
|
incontinence (mostly urinary)
apraxia agraphia tactile anomia |
|
|
anosognosia occurs for ___ MCA stroke
|
non-dominant hemisphere
|
|
|
aphasia in upper-division MCA stroke
|
Broca
|
|
|
aphasia in lower-division MCA stroke
|
Wernicke's
|
|
|
dense hemiparesis occurs with ___ MCA stroke
|
superior division
|
|
|
eye deviation occurs with ___ MCA stroke
|
superior division
|
|
|
3 kinds of PCA strokes
|
anterior proximal
cortical bilateral cortical |
|
|
3 anterior proximal PCA syndromes
|
thalamic syndrome
central midbrain/subthalamic anteromedial/inferior thalamic |
|
|
thalamic syndrome sx (2)
|
severe sensory loss
tranient hemiparesis |
|
|
central midbrain + subthalamic syndromes are caused by occlusion of ___
|
paramedian a.s
|
|
|
4 central midbrain + subthalamic syndrome sx
|
Weber's syn
upgaze palsy stupor ataxic tremor |
|
|
Weber's syndrome is ___ (2)
|
oculomotor palsy
contralateral hemiplegia |
|
|
anteromedial-inferior thalamic syndrome is caused by occlusion of ___
|
thalamoperforating a.s
|
|
|
cortical blindness is caused by ___
|
bilateral PCA occlusion
|
|
|
in locked-in syndrome, the pt can communicate by ___ing
|
moving eyes up+down
|
|
|
___ (3) may indicate cerebellar stroke
|
ocular skew deviation
miosis abducens palsy |
|
|
5 top of the basilar syn sx
|
ocular skew deviation
pseudo abducens palsy large unreactive pupils temporal lobe amnesia cortical blindness |
|
|
T/F: hemiplegia occurs in top of the basilar syn
|
false
|
|
|
lacunar strokes comprise ___% of all strokes
they are caused by ___ |
10-20
lipohyalinosis |
|
|
lacunar strokes occur in ___ (3)
|
basal ganglia
internal capsule pons |
|
|
3 regions involved in Broca's aphasia
|
Broca's area
anterior rolandic area anterior temporal/parietal area |
|
|
infarction of Wernicke's area only causes ___ Wernicke's aphasia
|
mild transient
|
|
|
infarction of Wernicke's area plus ___ (2) areas causes severe aphasia
|
inferior parietal
supramarginal |
|
|
conduction aphasia is caused by infarction of ___ (3) areas
|
arcuate fasciculus
insula deep parietal |
|
|
transcortical motor aphasia is caused by infarction of ___ (2) areas
speech output is ___ repetition is ___ comprehension is ___ |
SMA
basal ganglia bad good good |
|
|
transcortical sensory aphasia is caused by infarction of ___ (2)
comprehension is ___ repetition is ___ |
temporo-occipital
basal ganglia bad good |
|
|
anomic aphasia is caused by infarction of ___ (4) areas
|
angular gyrus
inferior temporal frontal subcortical |
|
|
7 non-dominant hemisphere syndromes
|
apraxia
neglect motor impersistence anosognosia Gerstmann's prosopagnosia aprosody |
|
|
workup for suspected stroke (6)
|
non-contrast CT
carotid duplex MRA CTA cardiac echo holter |
|
|
infarctions are visible on CT within ___ days
___% are visible within 24h |
3--5
75 |
|
|
infarctions are visible on MRI within ___
hours |
6--12
|
|
|
emboli most often occlude ___
|
MCA
|
|
|
dx of cardioembolism is supported by ___ (3)
|
known cardiac disorder
hemorrhagic infarct multifocal neuro findings |
|
|
hypertensive ICH happens in ___ (5) IDOOF
|
striatum
pons thalamus cerebellum white matter |
|
|
in SAH, focal neuro signs indicate ___
|
ICH
|
|
|
___ commonly co-occur with berry aneurysm
|
AVM
|
|
|
5 infections associated with SAH
|
HSV encephalitis
hemorrhagic encephalitis syphilis tuberculous meningitis brain abscess |
|
|
accuracy of CT in dxing SAH is maximal within ___ of hemorrhage
|
5 days
|
|
|
definitive procedure for dxing SAH
|
cerebral angio
|
|
|
T/F: 1 negative angio is sufficient to exclude aneurysm
|
false: repeat x2
|
|
|
in putaminal ICH,
motor deficit is ___ eye deviation is ___ pupils are ___ (2) |
dense hemiplegia
opposite to hemiplegia dilated fixed |
|
|
in thalamic ICH,
motor deficit is ___ eye deviation is ___ pupils are ___ (2) |
dense hemiplegia
down small unreactive |
|
|
in lobar ICH,
motor deficit is ___ eye deviation is ___ pupils are ___ |
depends on site
none normal |
|
|
in pontine ICH,
motor deficit is ___ eye deviation is ___ pupils are ___ (2) |
dense quadriplegia
neutral or bobbing pinpoint reactive |
|
|
in cerebellar ICH,
motor deficit is ___ eye deviation is ___ pupils are ___ (2) |
quadriparetic but moves all limbs
skew pinpoint reactive |
|
|
cavernous ICA aneurysm compresses ___ (5)
rupture causes ___ |
CN 3, 4, V1, 6
pituitary CCF |
|
|
cavernous ICA aneurysm can cause trigeminal ___
|
neuralgia
|
|
|
supraclinoid ICA aneurysm compresses ___ (2)
|
CN 2, 3
|
|
|
ophthalmic a. aneurysm compresses ___ (2)
|
CN 2
pituitary |
|
|
MCA aneurysm causes ___
|
cortical irritation
|
|
|
ACA aneurysm compresses ___ (2)
|
optic chiasm
olfactory anosmia tract |
|
|
PComm aneurysm compresses ___ (2)
|
CN 3, 6
|
|
|
PCA aneurysm compressses ___
rupture causes ___ (3) |
midbrain
hydrocephalus stupor akinetic mutism |
|
|
basliar a. aneurysm compresses ___ (3)
|
CN 5, 7
midbrain |
|
|
basilar a. aneurysm causes ___ (4)
|
trigeminal neuralgia
atypical facial pain facial palsy hydrocephalus |
|
|
vertebral a. aneurysm compresses ___ (3)
|
CN 9, 10
brainstem |
|
|
vertebral a. aneurysm causes ___ (2)
|
nucleus ambiguus sx
vestibular sx |
|
|
only non-superficial vein which commonly thromboses
|
great vein of galen
|
|
|
3 kinds of presentations of sinus vein thrombosis
|
isolated intracranial HTN
focal cerebral signs cavernous sinus syn |
|
|
isolated intracranial HTN presents with ___ (3)
|
HA
papilledema CN6 palsy |
|
|
septic SVT is most commonly ___ thrombosis
|
cavernous sinus
|
|
|
subcortical arteriosclerotic encephalopathy is aka ___ (2)
|
Binswanger's disease
multi-infarct dementia |
|
|
lesions in Binswanger's are located in ___
|
periventricular white matter
|
|
|
3 behavior changes in Binswanger's
|
apathy/abulia
personality change psychomotor retardation |
|
|
___ ICA is most commonly dissected
|
extracranial
|
|
|
ICA dissection starts at ___ and extends to ___
|
carotid bifurcation
petrous bone |
|
|
2 histological types of ICA dissection
|
subintimal
medial |
|
|
___ dissections occur in pts with no other disease
they are located ___ly |
subintimal
intracranial |
|
|
___ dissections are associated with other diseases such as ___ (4)
|
medial
fibromuscular dysplasia arteriosclerosis syphilis cystic medial degeneration |
|
|
4 syndromes of ICA dissection
|
migraine-like HA
cerebral ischemia pericarotid nerve involvement with sympathetic dysfunction SAH |
|
|
sympathetic dysfunction in ICA dissection
|
Horner's syn
|
|
|
ICA dissection dx is confirmed with ___ (2)
|
carotid duplex
angio |
|
|
6 RFs for vertebral dissection
|
OCP
migraine fibromuscular dysplasia exertion chiropractic EtOH |
