Neurology - Cerebrovascular Disease

Front 1

dysesthesia?

Back 1

- neuropathic pain

Front 2

embolic stroke - work up? tx?

Back 2

- workup: get head CT to r/o intracerebral hemorrhage b/c c/i in TPA treatment
- note: elevated INR also c/i in tpa
- tx: tpa

Front 3

when to do cerebral angiogram?

Back 3

- suspect aneurysm or vascular malformation

Front 4

pure motor stroke - RF, sx, localization?

Back 4

- rf: HTN => small infarction/lacunae
- sx: hemiplegia, not associated with cognitive, sensory or visual deficits
- posterior limb of internal capsule

Front 5

lesion in cerebellum? caudate/putamen? amygdala

Back 5

- impaired coordination, preserved strength
- doesn't cause weakness, may be asympt or more subtle, transiet cog or motor deficits
- memory formation, emotion

Front 6

pure sensory stroke - RF, localization?

Back 6

- HTN causing lacunae (same as pure motor) or secondary to small emboli
- posteroventral nucleus of lateral thalmus => contralateral numbness and tingling => recover causes thalamic pain syndrome = paradoxical pain with decreased pain sensitivity

Front 7

Wallenberg syndrome?

Back 7

- lateral medullary syndrome, infarct all or some structures of lateral medulla => nucleus and descending tract of CN V, nucleus ambiguus, lateral spinothalamic, inferior cerebellar peduncles, descending sympathetic fibers, vagus, glossopharyngeal
- sx: ipsilateral: ataxia, horner, loss of facial pain (trigeminal), temp, cornela reflex
- loss of spinothalamic = contralateral pain, temp
- CN 9, 10: dysphagia, dysphonia

Front 8

nucleus ambiguus

Back 8

- located in ventrolateral medulla
- motor neurons to CN IX, X => innervate striated muscles of larynx, pharynx, preganglionic parasympathetic supply to thoracic organs (esoph, heart, lungs)
- sx: hoarseness, dysphagia

Front 9

Blood supply
- vertebral artery, PICA, basilar artery, superior cerebellar, AICA

Back 9

- vertebral artery: lateral medullary infarction
- PICA: can cause lateral medullary infarction but large so can also cause inferior cerebellum infarction
- basilar artery: entire posterior brain circulation => widespread stroke
- superior cerebellar: superior cerebellum
- AICA: cerebellum and lower CN

Front 10

MCC lobar hemorrhage (e.g. pt with right occipital lobe hemorrhage on CT)

Back 10

- cerebral amyloid angiopathy or congophilic angiopathy
- elderly pt w/out htn, may or may not have dementia
- may need special imaging technique e.g. gradient ECHO MRI
- path: amyloid in blood vessel => disruption of vessel walls => hemorrhage

Front 11

young IVDU with neck stiffness and right sided weakness

Back 11

- mycotic aneurysm => aneurysm will bleed during exertion (e.g. sx after sex) => subarachnoid hemorrhage
- get CSF => bloody

Front 12

hematoma imaging

Back 12

- looks the same in enhanced and unenhanced

Front 13

IVDU with AIDS w/ CT showing many hemorrhagic lesions?

Back 13

- mycotic aneurysm: small aneurysm
- "mycotic" = appearance of aneurysms, tend to be multiple
- path: low virulent G+ or G-; form over cerebral convexities with subacute bacterial endocarditis, disease valve => embolizes => lodges into subarachnoid space
- note: if virulent organism => meningitis, multifocal brain abscess
- may not be visible on CT or arteriography

Front 14

seizures s/p intracerebral or subarachnoid hemorrhage?

Back 14

- very frequent
- repeat CT shows no changes to hemorrhage
- tx with antiepileptic e.g. phenytoin (dilantin) or carbamazepine

Front 15

s/p seizure pt with left lower extremity weakness

Back 15

- Todd's paralysis: weakness after seizure activity = postictal paralysis, can last hours to days
- CT is appropriate to r/o bleed or damage but unlikely
- path: unknown; possible neuronal exhaustion, depletion of glucose in neurons

Front 16

sturge-weber dz

Back 16

- aka encephalofacial angiomatosis
- facial cutaneous angiomas along senosry division of 1st division of trigeminal nerve, leptomeningeal angiomas, MR, seizures
- often have hemiparesis or hemiatrophy contralateral to port-wine nevus, angiom of choroid of eye
- deficits 2/2 focal ischemia in cerebral cortex that underlies leptomeningeal angiomas

Front 17

hemangioblastomas

Back 17

- vascular tumors associated with PCKD and telangectasias of the retina (VHL disease)

Front 18

Charcot-Bouchard aneurysm

Back 18

- small, microscopic, occur in perforate arteries of the brain
- etiology: HTN
- occur in lenticulostriate arteries => hemorrhage => putmane MC site => can go into ventricles => subarachnoid blood
- other sites: dentate nucleus, caudate nuc, thalamus, pons, cerebellum

Front 19

fusiform aneurysm

Back 19

- widened arteries with vaginations along walls
- 2/2 arteriosclerotic damage

Front 20

broca's aphasia

Back 20

- distrubed speech but intact compresion = MCA occlusion

Front 21

Left MCA, PICA, ACA, vertebral/basilar, PCA

Back 21

- left MCA: cortex around sylvian fissure, frontal lobe structures (involved in Broca's speech)
- PICA: brainstem, cerebellar signs
- ACA: lower extremity weakness, no vision changes
- vertebral/basilar: brainstem, cerebellar
- PCA: visual loss, posterior (fluent) aphasia

Front 22

saccular aneurysm

Back 22

- sx of compressing structures around base of brain = diplopia
- if leaks = meningeal signs
- do angiogram; CT/MRI only shows if >5 mm

Front 23

pt <40y.o. with intracerebral or subarachnoid hemorrhage?

Back 23

- most likley AV malformation > aneurysm

Front 24

pt with pupillary activity deficits

Back 24

- aneurysm of PCA compresses CN III => pupilloconstrictors fibers are superficial on nerve so early phenomenon is pupillary constriction issues (vs. ischemic injury in DM where superficial fibers are spared)
= pupillary constriction is decreased with both direct and consensual
- aneurysm grows => affects MR muscle => double vision
- note: do angiogram b/c superior cerebellum and posterior cerebellum may also compress

Front 25

common complication of subarachnoid blood?

Back 25

- vasospams => stroke
- give CCB

Front 26

extracranial internal carotid disease?

Back 26

- ipsilateral transient monoculr blindness (amaurosis fugax) and contralateral TIA with motor weakness
- do doppler U/S carotids or MRI or MRA
- angiography is invasive and risk of stroke

Front 27

transient monocular blindness

Back 27

- embolism, ischemia to central retinal artery or branch

Front 28

retinal vein thrombosis

Back 28

- rapidly progressive loss of vision, hemorrhage in retina
- vs arterial... vein doesn't have TIA like amaurosis fugax

Front 29

carotid stenosis

Back 29

- carotid endarterectomy reduces stroke risk in sx of stenosis >= 70%
- offer to all pts with symptomatic dz of ICA
- give ASA after procedure
- carotid angioplasty with stent is less established

Front 30

difficulty with Kuh, kuh, kuh vs la, la, la, vs mi, mi, mi

Back 30

- kuh: soft palate CN 10
- La: tongue CN 12
- MI: lips CN 7

Front 31

difficulty with Kuh, kuh, kuh vs la, la, la, vs mi, mi, mi

Back 31

- kuh: soft palate CN 10
- La: tongue CN 12
- MI: lips CN 7