Stroke and TIA

Question 1

A stroke in which the focal neurological deficits worsen with time

Also called a stroke in evolution

Answer 1

progressive stroke

Question 2

A stroke in which the focal neurological deficits persist and do not worsen over time.

Answer 2

completed stroke

Question 3

Clinical syndrome of rapid onset of focal deficits of brain function lasting more than 24 hours or leading to death

Answer 3

stroke

Question 4

Clinical syndrome of rapid onset of focal deficits or brain function which resolves within 24 hours

Amaurosis fugax

RIND – 72 hours

Answer 4

TIA Transient Ischemic Attack

Question 5

What is the most important risk factor for stroke?

Answer 5

previous TIA or stroke

Question 6

What is the most prevalent risk factor for stroke?

Answer 6

hypertension

Question 7

____ stroke is when blood leaks into brain tissue

Answer 7

hemorrhagic

Question 8

____ stroke is when a clot stops blood supply to an area of the brain

Answer 8

ischemic

Question 9

85% of strokes are ____

Answer 9

ischemic

Question 10

What type of stroke accounts for 20% of all strokes?

Answer 10

thrombotic

Question 11

5 classical lucunar syndromes:

1. Pure _____ stroke/hemiparesis
2. _____ hemiparesis
3. Dysarthria/_____ hand
4. Pure sensory
5. Mixed sensorimotor

Answer 11

5 classical lucunar syndromes:

1. Pure motor stroke/hemiparesis
2. Ataxic hemiparesis
3. Dysarthria/clumsy hand
4. Pure sensory
5. Mixed sensorimotor

Question 12

Cardioembolic stroke

• Embolus from the heart gets _____ in the intracranial vessels
• ______ is most commonly affected
• ____ ______ is the most common cause
• Others: MI, prosthetic valves, rheumatic heart disease

Answer 12

Cardioembolic stroke

Embolus from the heart gets lodged in the intracranial vessels

MCA is most commonly affected

Atrial fibrillation is the most common cause

Others: MI, prosthetic valves, rheumatic heart disease

Question 13

Artery to artery embolism

• Thrombus formed on atherosclerotic plaques gets embolized to ______ vessels
• Carotid ______ atherosclerosis is the most common source
• Others: aortic arch, vertebral arteries, etc.

Answer 13

Artery to artery embolism

• Thrombus formed on atherosclerotic plaques gets embolized to intracranial vessels
• Carotid bifurcation atherosclerosis is the most common source
• Others: aortic arch, vertebral arteries, etc.

Question 14

Blood flow

If zero leads to death of brain tissue within _____ minutes (time is brain)

<_____ml/100g tissue per minute leads to infarction within and hour

Answer 14

Blood flow

If zero leads to death of brain tissue within 4-10 minutes (time is brain)

<16-18ml/100g tissue per minute leads to infarction within and hour

Question 15

Ischemic Penumbra

Tissue surrounding the core region of the infarction which is ischemic but _____ dysfunctional

Maintained by ______

Can be salvaged if reperfused in time

Primary goal of revascularization therapies

Answer 15

Ischemic Penumbra

Tissue surrounding the core region of the infarction which is ischemic but reversibly dysfunctional

Maintained by collaterals

Can be salvaged if reperfused in time

Primary goal of revascularization therapies

Question 16

Higher mortality rates compared to ischemic stroke

Answer 16

Hemorrhagic stroke

Question 17

Intracerebral Hemorrhage

• Results of chronic ______
• _____arteries are damaged due to hypertension
• In advanced stages vessel wall is disrupted and leads to leakage
• Other causes: amyloid angiopathy, anticoagulant therapy, cavernous hemangioma, cocaine and amphetamines

Answer 17

Intracerebral Hemorrhage

• Results of chronic hypertension
• Small arteries are damaged due to hypertension
• In advanced stages vessel wall is disrupted and leads to leakage
• Other causes: amyloid angiopathy, anticoagulant therapy, cavernous hemangioma, cocaine and amphetamines

Question 18

Subarachnoid Hemorrhage

Most common cause is rupture of ______or Berry aneurysms

Other causes include arteriovenous malformations, angiomas, mycotic aneurysmal rupture

Associate with extremely severe______

Answer 18

Subarachnoid Hemorrhage

Most common cause is rupture of saccular or Berry aneurysms

Other causes include arteriovenous malformations, angiomas, mycotic aneurysmal rupture

Associate with extremely severe headache

Question 19

Pathophysiology of hemorrhagic stroke:

• Explosive entry of blood into the brain ______structurally disrupts neurons
• White matter fiber tracts are split
• Immediate cessation of neuronal function
• ______ hemorrhage can act as a mass lesion and cause further progression
• Large hemorrhages can cause ______ coning and rapid death

Answer 19

Pathophysiology of hemorrhagic stroke:

• Explosive entry of blood into the brain parenchyma structurally disrupts neurons
• White matter fiber tracts are split
• Immediate cessation of neuronal function
• Expanding hemorrhage can act as a mass lesion and cause further progression
• Large hemorrhages can cause transtentorial coning and rapid death

Question 20

Stroke syndromes divided into 3 categories:

• Large-vessel strokes within the ____ circulation
• Large-vessel strokes within the _____ circulation
• _____-vessel disease within either vascular bed

Answer 20

Stroke syndromes divided into 3 categories:

• Large-vessel strokes within the anterior circulation
• Large-vessel strokes within the posterior circulation
• Small-vessel disease within either vascular bed

Question 21

Strokes in anterior circulation:

• _____ carotid artery + branches
  
  • ______cerebral
  • _____ cerebral

Answer 21

Strokes in anterior circulation:

• internal carotid artery + branches
  
  • anterior cerebral
  • middle cerebral

Question 22

Middle cerebral artery stroke in the _____ ______ area causes weakness or paralysis and sensory impairment over contralateral face, arm and leg

Answer 22

somatic motor area

Question 23

Middle cerebral artery stroke in the _____ ______ area in the dominant hemisphere causes motor aphasia

Answer 23

motor speech

Question 24

Middle cerebral artery stroke in ____ area causes expressive aphasia

Answer 24

Broca’s area

Question 25

Middle cerebral artery stroke in ____ area causes ureceptive aphasia

Answer 25

Wernicke's area

Question 26

Middle cerebral artery stroke in ___ \_\_\_\_ causes conduction aphasia

Answer 26

parietal operculum

Question 27

Middle cerebral artery stroke in _____ \_\_\_\_\_\_ causes homonymous hemianopia and paralysis of conjugate gaze to the opposite side

Answer 27

optic radiations

Question 28

\_\_\_\_\_\_\_\_is characterized by the loss of the ability to execute or carry out learned purposeful movements – disorder of motor planning

Answer 28

**_Apraxia_** is characterized by the loss of the ability to execute or carry out learned purposeful movements – disorder of motor planning

Question 29

\_\_\_\_\_ is the loss of the ability to recognize objects, persons, sounds, shapes and smells while senses are not defective and no significant memory loss

Answer 29

**_agnosia_** is the loss of the ability to recognize objects, persons, sounds, shapes and smells while senses are not defective and no significant memory loss

Question 30

If the stroke occurs ______ to the anterior communicating artery it is usually well tolerated secondary to collateral circulation

Answer 30

If the stroke occurs **_prior_** to the anterior communicating artery it is usually well tolerated secondary to collateral circulation