Neurology Quiz: Hemorrhagic Strokes

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Questions and Answers

What percentage of cerebrovascular deficits is attributed to ischemia?

  • 95%
  • 90%
  • 70%
  • 85% (correct)

Which of the following conditions can lead to global cerebral ischemia?

  • Chronic hypoxia due to bronchitis
  • Severe dehydration due to heatstroke
  • Pulmonary embolism
  • Atherosclerosis causing low perfusion (correct)

What is the primary energy source required by neurons that makes them vulnerable to ischemia?

  • Amino acids
  • Serum glucose (correct)
  • Oxygen
  • Fatty acids

What can mild global ischemia lead to?

<p>Transient confusion with recovery (C)</p> Signup and view all the answers

What is a significant consequence of neurons undergoing ischemia for 3-5 minutes?

<p>Necrosis (C)</p> Signup and view all the answers

What is the most common site for intracerebral hemorrhage?

<p>Basal ganglia (D)</p> Signup and view all the answers

Which of the following symptoms is most characteristic of subarachnoid hemorrhage?

<p>Sudden severe headache (D)</p> Signup and view all the answers

What complication is commonly associated with intracerebral hemorrhage?

<p>Hypertension (B)</p> Signup and view all the answers

Which condition is most frequently associated with the rupture of a berry aneurysm?

<p>Marfan syndrome (A)</p> Signup and view all the answers

What is the most common cause of subarachnoid hemorrhage?

<p>Rupture of a berry aneurysm (C)</p> Signup and view all the answers

What type of ischemia is characterized by diffuse necrosis and a potential vegetative state upon survival?

<p>Severe global ischemia (D)</p> Signup and view all the answers

Which neuronal locations are primarily affected by moderate global ischemia, causing laminar necrosis?

<p>Pyramidal neurons of the cerebral cortex, hippocampus, and Purkinje layer of the cerebellum (B)</p> Signup and view all the answers

Which subtype of ischemic stroke is most commonly associated with emboli from the heart?

<p>Embolic stroke (B)</p> Signup and view all the answers

Which process primarily follows the early eosinophilic changes observed in ischemic stroke?

<p>Infiltration by neutrophils (D)</p> Signup and view all the answers

In lacunar strokes, which area of the brain is most commonly involved to produce a pure motor stroke?

<p>Internal capsule (B)</p> Signup and view all the answers

What type of necrosis is primarily associated with ischemic strokes?

<p>Liquefactive necrosis (B)</p> Signup and view all the answers

Which of the following accurately describes the infarct formation in a thrombotic stroke?

<p>Occurs at bifurcation points with pale infarcts (D)</p> Signup and view all the answers

Which area of the brain is generally affected in embolic strokes leading to a hemorrhagic infarct?

<p>Middle cerebral artery region (C)</p> Signup and view all the answers

Flashcards

Intracerebral Hemorrhage

Bleeding into the brain tissue, often caused by the rupture of small, weakened blood vessels.

Charcot-Bouchard microaneurysms

A common cause of intracerebral hemorrhage, often due to high blood pressure.

Subarachnoid Hemorrhage

Bleeding into the space between the brain and the thin membrane covering it.

Berry Aneurysm

A bulging, weakened blood vessel in the brain, prone to rupture and causing subarachnoid hemorrhage.

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Anterior Circle of Willis

The most common location for a berry aneurysm, where branches of major arteries connect.

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Cerebrovascular Disease

A condition where the brain's blood supply is disrupted, leading to damage to brain cells.

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Neurologic Deficit

Loss of brain function due to insufficient blood flow.

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Ischemia

A condition where brain cells die due to a lack of oxygen and nutrients, typically caused by a blood clot or blockage.

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Hemorrhage

A condition where blood leaks into the brain tissue, causing damage. Usually caused by a weakened blood vessel.

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Global Cerebral Ischemia

A condition where the entire brain suffers from a lack of blood flow.

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Severe Global Ischemia

Diffuse necrosis throughout the brain, leading to a permanent vegetative state.

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Moderate Global Ischemia

Infarcts specifically in watershed areas and damage to vulnerable brain regions.

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Thrombotic Stroke

Atherosclerosis at branch points, causing a pale infarct at the cortex periphery.

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Embolic Stroke

Embolism, usually from the left heart, leading to a hemorrhagic infarct.

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Lacunar Stroke

Small cystic infarcts in areas supplied by lenticulostriate vessels.

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Ischemic Stroke

A regional brain ischemia that causes focal neurological deficits lasting over 24 hours.

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Transient Ischemic Attack (TIA)

An ischemic stroke with symptoms lasting less than 24 hours.

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Liquefactive Necrosis

A type of cell death characterized by the breakdown of the cell and release of cellular contents.

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Study Notes

Intracerebral Hemorrhage

  • Bleeding into brain parenchyma
  • Classically due to rupture of Charcot-Bouchare microaneurysms of the lenticulostriate vessels
  • Complication of hypertension; treatment of hypertension reduces incidence by half.
  • Basal ganglia is the most common site
  • Presents as severe headache, nausea, vomiting, and eventual coma

Subarachnoid Hemorrhage

  • Bleeding into the subarachnoid space
  • Presents as a sudden headache ("worst headache of my life") with nuchal rigidity
  • Lumbar puncture shows xanthochromia (yellow hue due to bilirubin).
  • Most frequently (85%) due to rupture of a berry aneurysm; other causes include AV malformations and an anticoagulated state.
  • Berry aneurysms are thin-walled saccular outpouchings that lack a media layer (Fig. 17.9), increasing the risk for rupture.
  • Most frequently located in the anterior circle of Willis at branch points of the anterior communicating artery
  • Associated with Marfan syndrome and autosomal dominant polycystic kidney disease.

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