[10.10a] Common Adult Neurological Diseases and Emergencies (Part 1) V2.pdf

Stroke, Intracerebral hemorrhage, and Subarachnoid hemorrhage

What are the three cerebrovascular diseases discussed in the overview?

Occlusion, alteration of blood flow, or vessel rupture

Cerebrovascular disease is an umbrella term for brain abnormalities resulting from what three vascular pathologic processes?

Second

Stroke is the leading cause of death worldwide at what rank?

Fifty percent

What percentage of stroke survivors are chronically disabled?

Ischemic stroke

What type of stroke is caused by the occlusion of a blood vessel?

Thrombosis, embolism, and hypoxia

What are the three types of ischemic stroke?

Large artery atherosclerosis, cardioembolic stroke, and small vessel infarction

What are the three most common etiologies of acute ischemic stroke?

Hypertension

Small vessel infarction in stroke is probably due to what condition?

Atherosclerosis

Which mechanism of stroke typically develops in a step-ladder fashion?

Weakness of arm, then weakness of leg, then slurring of speech

In what three steps does atherosclerosis typically manifest?

Plaque rupture followed by blood clot formation

What event narrows the caliber of a blood vessel in atherosclerosis to cause an occlusion?

Cardioembolism

Which type of stroke should be specifically considered in young patients?

Irregular heart rhythm or infectious process

A thrombus in cardioembolism can travel to the brain due to what two conditions?

Develops rapidly

What is the main difference in development between cardioembolism and atherosclerosis?

Wakeup stroke

Cardioembolism is frequently associated with what clinical phenomenon where patients find symptoms upon rising?

Hemorrhagic stroke

What type of stroke is caused by the rupture of blood vessels causing extravasation of blood?

Hypertension

What is the most common risk factor for stroke?

Atrial fibrillation

Which risk factor is seen on an ECG as an irregular rhythm and commonly causes cardioembolic stroke?

Hypertension, atrial fibrillation, diabetes, smoking, hyperlipidemia, and patent foramen ovale

What are six major risk factors for stroke?

Fat, tumor cells, hydrocartilage, and amniotic fluid

What are four uncommon sources of embolism?

Corticospinal tracts

What is the neuroanatomic correlate for hemiparesis or hemiplegia?

Ascending sensory tracts

What is the neuroanatomic correlate for hemisensory loss?

Dominant hemisphere cortex

What is the neuroanatomic correlate for aphasia?

Non dominant hemisphere cortex

What is the neuroanatomic correlate for neglect?

Retinal artery embolism

What is the neuroanatomic correlate for monocular loss of vision?

Occipital lobe or visual pathways

What is the neuroanatomic correlate for hemianopia or quadrantanopia?

Cerebellum

What is the neuroanatomic correlate for ataxia, dysmetria, and nystagmus?

Brainstem

What is the neuroanatomic correlate for diplopia and dysphagia?

Hemiparesis

What is the term for weakness on one side of the body?

Hemiplegia

What is the term for complete paralysis on one side of the body?

Crossed signs

What type of signs are usually encountered if there is a brainstem lesion?

Dizziness, Diplopia, Dysphagia, and Dysarthria

What are the 4 Ds representing the effect of stroke on the brainstem?

Two percent

The brain accounts for what percentage of total body weight?

Twenty percent

The brain consumes what percentage of the body total energy?

Glucose and oxygen

On which two substances does the brain rely for a constant supply?

Cerebral autoregulation

What mechanism ensures constant cerebral blood flow across a range of blood pressures?

CO2, O2, and vessel shear wall stress

Cerebral vessels constrict or dilate in response to changes in the concentration of which three factors?

Cerebral perfusion pressure

In the cerebral autoregulation curve, cerebral blood flow is plotted against what?

Ischemia

A blood pressure below 50 mmHg can lead to what condition in the brain?

Hyperemia and edema

A blood pressure above 150 mmHg can lead to which two conditions in the brain?

Loss of supply of oxygen and glucose

The pathophysiology of ischemic stroke begins with what loss?

Penumbra

What area contains marginally perfused, at risk but viable neurons?

Physiologically stunted

How are neurons in the penumbra described when subject to moderate ischemia?

Necrotic tissue

If not acted on fast enough, the penumbra is converted into what?

Infarct core

A decrease in cerebral blood flow leads to the failure of the Na-K ATPase pump in which area?

Glutamate

The failure of the Na-K pump leads to the release of which excitatory neurotransmitter?

Cytotoxic edema

The influx of Calcium and Sodium into cells in the infarct core leads to what type of edema?

Brain tumors

Vasogenic edema is commonly present in which condition?

Circle of Willis

What circulatory anastomosis supplies collateral circulation to the brain?

Middle Cerebral Arteries

Which major arteries are NOT part of the Circle of Willis?

55 mL/100g/min

What is the normal cerebral blood flow?

23 mL/100g/min

What is the critical level of cerebral blood flow for infarction?

3 1/2 hours

What is the golden period for stroke treatment?

10 to 12 mL/100g/min

Cerebral blood flow below what level causes infarction regardless of duration?

Hypercoagulation

Pregnancy, birth control pills, and smoking in women can lead to what hematologic state?

Heparin cofactor 2, Antithrombin III, Protein C and S, and Lupus anticoagulant

What are four anticoagulant factors commonly tested in unexplained strokes?

Patent foramen ovale

When a young adult has a stroke, which cardiac etiology must be ruled out?

Transient Ischemic Attacks

What are temporary focal neurologic symptoms that leave no clinical or imaging trace of infarction?

Less than 24 hours

TIAs resolve spontaneously within what time frame?

Hyperintensity

What radiologic finding on an MRI would disqualify a diagnosis of TIA even if symptoms resolve?

Impending vascular occlusion

Repeated TIA episodes are a warning of what?

Age, Blood pressure, Clinical features, Duration, and Diabetes

What do the letters in the ABCD scoring for TIA stand for?

60 years

In the ABCD score, age increases risk if it is greater than or equal to how many years?

140/90 mmHg

In the ABCD score, blood pressure increases risk if it is greater than or equal to what value?

Unilateral weakness

Which clinical feature gives the highest score of 2 in the ABCD score?

60 minutes

A TIA duration of how many minutes or more gives the highest score of 2?

Amaurosis fugax

What is the alternative name for transient monocular blindness?

Internal carotid artery

Amaurosis fugax is due to an occlusion in which artery?

Horizontal shade falling or rising

How is the visual disturbance in Amaurosis fugax often described?

Pain

If blindness is accompanied by what symptom, should you consider other diseases like glaucoma or optic neuritis?

Upper extremity

In a proximal MCA stroke, is the upper or lower extremity weaker?

Dominant hemisphere

Aphasia in an MCA stroke indicates involvement of which hemisphere?

Gaze toward the lesion

In an MCA stroke, how does the preferential gaze present relative to the lesion?

Homonymous hemianopia

The involvement of optic radiation in a proximal MCA stroke leads to what visual deficit?

Superior division of MCA

Which division of the MCA is involved if the patient has Broca motor aphasia?

Parasylvian region of MCA

Gerstmann syndrome is associated with a stroke in which specific region of the MCA?

Agraphia, Acalculia, Finger agnosia, and Right-to-left confusion

What are the four components of Gerstmann syndrome?

Wernicke aphasia

Which type of aphasia is associated with the inferior division of the MCA?

Deep territory of MCA

A stroke in which territory of the MCA usually presents as pure weakness without cortical findings?

Anterior Cerebral Artery

In which stroke syndrome is the leg and foot weaker than the upper extremity?

ACA stroke

Incontinence and abulia are associated with which stroke syndrome?

Occipital lobe

The unilateral PCA supplies which lobe housing the primary visual cortex?

Macular sparing

What visual feature is evident in a PCA stroke because the macula is supplied by the MCA?

Bilateral visual loss, denial of blindness, and confabulations

What is the triad of Anton syndrome?

Weber syndrome

Which syndrome presents with contralateral extremity weakness and ipsilateral CN III palsy?

PCA MCA border zone

Balint syndrome is a watershed infarct located in which border zone?

Optic ataxia, oculomotor apraxia, and simultagnosia

What is the triad of Balint syndrome?

Hearing loss

What unique symptom can occur in an AICA stroke?

Superior Cerebellar Artery

Ipsilateral limb ataxia, nystagmus, and dysarthria characterize a stroke in which artery?

Wallenberg syndrome

What is another name for Lateral Medullary Syndrome caused by a PICA stroke?

Vertigo, nausea, vomiting, ipsilateral facial numbness, and contralateral thermal analgesia

What are five symptoms of Wallenberg syndrome?

Anhidrosis, ptosis, and miosis

What is the triad of Horner syndrome?

Dejerine syndrome

What is the name for Medial Medullary Syndrome caused by a vertebral artery stroke?

Locked-in syndrome

Which syndrome involves quadriplegia where the patient can only move their eyes vertically?

Basilar artery

Locked-in syndrome is a result of a stroke in which artery?

Deep arteries

Lacunar strokes occur when blood flow to which type of arteries becomes occluded?

Fibrohyalinoid arteriolar sclerosis

What is the main mechanism of lacunar infarction?

Putamen, thalamus, pons, and internal capsule

What are four common locations for lacunar strokes?

Pure motor hemiplegia

Which lacunar stroke type involves the internal capsule?

Pure sensory stroke

Which lacunar stroke type involves the thalamus?