Stroke and Hemorrhage Quiz

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Questions and Answers

What is a common pathophysiological process involved in intracerebral hemorrhage leading to brain injury?

Immediate restoration of blood flow

Increased oxygen supply to the affected area

Rapid formation of neuronal connections

Mechanical destruction of brain tissue by hematoma (correct)

Which of the following is NOT a frequent site of atherosclerosis relevant to large-artery atherosclerosis?

The origin of the internal carotid artery (ICA)

The main stem of the middle cerebral artery (MCA)

The carotid siphon at the base of the brain

The distal portion of the basilar artery (correct)

Which of the following causes contributes to the activation of the coagulation cascade during intracerebral hemorrhage?

Release of VEGF

Degradation of hemoglobin products (correct)

Management of increased vascular permeability

Release of pro-inflammatory cytokines

Cardiogenic embolism is primarily associated with which type of stroke?

Ischemic stroke (C) Signup and view all the answers

What is one common cause of hypertension-related intracerebral hemorrhage?

Arteriovenous malformations (C) Signup and view all the answers

What is the most common cause of subarachnoid hemorrhage?

Rupture of an intracranial aneurysm (C) Signup and view all the answers

Which of the following is considered a potentially modifiable risk factor for ischemic stroke?

Sickle cell disease (A) Signup and view all the answers

In the ABCD2 scoring system, how many points are assigned for diabetes mellitus?

1 point (A) Signup and view all the answers

What visual condition is characterized by the inability to orient or respond to objects in the contralesional space?

Visual neglect (C) Signup and view all the answers

Which of the following tumor grades is classified as low grade according to the WHO classification?

Grade I (A), Grade II (B) Signup and view all the answers

Which of the following is NOT a modifiable risk factor for intracerebral hemorrhage?

Hereditary factors (A) Signup and view all the answers

Which type of stroke is characterized by an acute interruption of cerebral blood flow?

Ischemic stroke (A) Signup and view all the answers

Which assessment techniques are utilized to evaluate visual spatial function?

Line bisection tests (B), Copying and drawing objects (D) Signup and view all the answers

What imaging technique provides information such as tumor localization and vascular permeability?

MRI (A) Signup and view all the answers

What type of brain injury is typically caused by an external physical force?

Traumatic brain injury (D) Signup and view all the answers

Which clinical symptom in the ABCD2 scoring system scores the highest points?

Focal weakness (2 points) (D) Signup and view all the answers

Which of the following is a common imaging modality used in acute stroke evaluation?

Non-contrast CT (NCCT) (A) Signup and view all the answers

Which treatment method is focused on developing and enhancing visual skills through prescribed activities?

Vision therapy (B) Signup and view all the answers

Which type of visual dysfunction refers to the loss of vision in one quadrant of the visual field?

Quadrantanopia (C) Signup and view all the answers

What common condition can result from hypoxia or anoxia affecting brain function?

Non-traumatic brain injury (D) Signup and view all the answers

Which difficulty is most frequently associated with visual information processing dysfunction after TBI?

Longer reaction times (A) Signup and view all the answers

Which of the following microorganisms is NOT commonly responsible for bacterial meningitis in adults?

Escherichia coli (A) Signup and view all the answers

In multiple sclerosis (MS), lesions are most commonly found in which brain region?

Corpus callosum (A) Signup and view all the answers

What is a characteristic finding in the cerebrospinal fluid (CSF) analysis of a patient with bacterial meningitis?

Turbid or purulent fluid color (C) Signup and view all the answers

Which of the following statements about Glioblastoma is correct?

It typically shows disruption of the blood-brain barrier. (B) Signup and view all the answers

Which type of inflammation is primarily observed in Herpes Simplex Encephalitis?

Mononuclear cell infiltration (A) Signup and view all the answers

What best describes secondary injury following traumatic brain injury?

Disruption of the blood-brain barrier and oxidative stress (D) Signup and view all the answers

Which advanced imaging technique is primarily used for assessing changes in brain glucose metabolism?

Positron emission tomography (PET) (D) Signup and view all the answers

Which of the following is NOT a common cerebral swelling type after secondary injury?

Acute intracranial hemorrhage (A) Signup and view all the answers

Which condition is caused by the displacement of brain parenchyma into a different compartment?

Brain herniation (A) Signup and view all the answers

What type of visual dysfunction is characterized by problems with converging the eyes?

Convergence insufficiency (A) Signup and view all the answers

Which of the following symptoms is NOT typically associated with visual dysfunction following traumatic brain injury?

Increased visual acuity (D) Signup and view all the answers

What does the term 'excitotoxicity' refer to in the context of secondary injuries?

Cellular death from prolonged neuronal activation (D) Signup and view all the answers

Which advanced imaging technique is focused on generating images of brain white matter tracts?

Diffusion tensor imaging (DTI) (D) Signup and view all the answers

In traumatic brain injury, which cognitive function is directly assessed by the gap saccade test?

Attention (C) Signup and view all the answers

What is the main goal of treatment for photosensitivity following traumatic brain injury?

Reduce visual disturbances (D) Signup and view all the answers

Study Notes

Secondary Injury

Secondary injury refers to the cascade of events that occur after a primary injury, often mediated by cellular and molecular processes.
These events are triggered by the disruption of the blood-brain barrier, generation of reactive oxygen species, and subsequent oxidative stress.
Secondary injury involves metabolic dysfunction, inflammation, and excitotoxicity.
Macro manifestations can include diffuse cerebral hyperemia, cytotoxic and vasogenic edema, and tissue ischemia.
Causes of secondary injury include microvascular changes, systemic hypotension or hypoxia, and elevated intracranial pressure.

Primary Injury

Primary injury describes the immediate and direct mechanical damage caused by trauma.
This can include fractures, intracranial hemorrhage, contusion, traumatic axonal injury, and vascular injury.
Primary injury is typically apparent acutely and is assessed using conventional CT and MRI.

Traumatic Vascular Injury

Traumatic vascular injury can occur through laceration by fracture fragments, blunt or penetrating trauma, vascular compression from herniation, or arterial strain.
Arterial dissection is a consequence of a tear in the tunica intima or vasa vasorum, leading to blood accumulating within the vessel wall.
Other forms of vascular damage include laceration and arteriovenous fistula.

Imaging Evaluation of Acute Traumatic Brain Injury

Epidural hematoma, subdural hematoma, subarachnoid hemorrhage, intraventricular hemorrhage, brain contusion, and diffuse axonal injury can be identified through imaging.

Secondary Injuries

Cerebral swelling (vasogenic and cytotoxic edema)
Brain herniation (the displacement of brain parenchyma into a different compartment)
Hydrocephalus
Ischemia or infarction
CSF leak
Leptomeningeal cyst
Encephalomalacia

Advanced Imaging Techniques

Diffusion Tensor Imaging (DTI): measures water molecule diffusion in white matter to create structural images and evaluate anisotropy.
fMRI (functional magnetic resonance imaging): detects changes in oxygenation state of hemoglobin, capturing oxygen consumption associated with neuronal activation using BOLD (blood-oxygen-level-dependent) imaging.
PET (positron emission tomography): uses radiolabeled metabolic analogs to measure brain glucose metabolism rates.
MRS (magnetic resonance spectroscopy): measures the concentrations of molecules involved in brain metabolism.

Visual Dysfunction and Visual Symptoms

Visual dysfunction and symptoms are frequent after TBI (traumatic brain injury).
The cortical regions in control of eye movements and visual processing include the frontal, parietal, supplementary eye field (FEF, PEF, SEF); dorsolateral prefrontal cortex (DLPC); superior colliculus (SC); brainstem gaze center (BGC); caudate nucleus (CN); and substantia nigra pars reticulata (SNPR).

Visual Dysfunctions After TBI

Common visual dysfunctions in individuals with TBI:
- Convergence insufficiency
- Accommodative dysfunction
- Photosensitivity
- Pursuit/saccade disorder
- Visual field loss
- Cranial nerve disorder

Cognitive Control Evaluation of Saccadic Movement

Cognitive control evaluation of saccadic movement assesses:
- Attention: visually/symbolically cued saccades and gap saccade tests.
- Memory: memory-guided saccades and memory-guided sequences of saccades.
- Executive function: antisaccades.

Cognitive Control Evaluation of Smooth Pursuit

Smooth pursuit evaluation in TBI:
- Assesses predictive visual tracking and smooth eye movements to maintain gaze.
- Deficits in mild TBI include decreased target prediction, increased eye position error, and variability of eye position.

Photosensitivity

Photosensitivity involves discomfort from various light sources.
Treatment includes tinted lenses to decrease discomfort while preserving sensory information.

Visual Field Loss

Visual field loss can include hemianopia, quadrantanopia, central scotoma, peripheral scotoma, and monocular vision.

Visual Neglect

Visual neglect refers to an inability to orient, report, or respond to objects in the contralesional space.
It is most frequent following right cerebral hemisphere injury.
It reflects visuospatial attention deficits.
Evaluation involves cancellation tests, line bisection tasks, copying, and drawing objects.
Treatment and rehabilitation include scanning therapy and prism adaptation.

Visual Information Processing Dysfunction

Visual information processing dysfunction includes longer reaction times, reduced accuracy, and slowed information processing speed.
Testing for dysfunction includes:
- Visual spatial: line bisection, copying pictures, letter cancellation
- Visual analysis: visual closure, visual memory
- Visual motor integration writing skills, tangrams

Vision Therapy

Vision therapy is a series of neurosensory and neuromuscular activities aimed at developing, rehabilitating, and enhancing visual skills and processing.

Acquired Brain Injury

Acquired brain injury (ABI) encompasses both traumatic brain injury (TBI) and non-traumatic brain injury (NTBI).
TBI refers to disruption of brain function caused by external physical force.
NTBI is caused by internal events, such as stroke, infections, hypoxia or anoxia, brain tumors, drugs, or toxins.

Stroke (Cerebrovascular Accident)

A stroke is an acute interruption of cerebral blood flow.
Key features include sudden onset, involvement of the central nervous system, lack of rapid resolution, and a vascular cause.

Stroke Classification

Ischemic stroke: caused by a blockage of an artery supplying blood to the brain.
Hemorrhagic stroke: caused by bleeding into the brain tissue.

Ischemic Stroke Types

A. Large-artery atherosclerosis (embolus or thrombosis): - Frequent sites of atherosclerosis include the carotid and vertebrobasilar systems. - Imaging of acute ischemic stroke helps diagnose.
B. Cardiogenic embolism
C. Small vessel occlusion (e.g. lacune).
D. Other determined causes.
E. Undetermined causes.

Hemorrhagic Stroke

Caused by bleeding into the brain parenchyma, often due to ruptured small arteries and arterioles.

Intracerebral Hemorrhage

Common causes include hypertension and arteriovenous malformations.
Pathophysiology of brain injury involves mechanical destruction, mass effect, inflammatory response, free radical formation, and activation of the coagulation cascade.

Subarachnoid Hemorrhage (SAH)

The most common cause: rupture of an intracranial aneurysm.
Other causes: vascular malformations.

Terson's Syndrome

Posterior segment hemorrhages occurring as a consequence of subarachnoid or intracranial hemorrhage.

Advantages and Limitations of CT and MR Imaging in Acute Stroke

The text discusses advantages and limitations of CT and MRI in acute stroke, including non-contrast CT (NCCT), gradient-recalled echo (GRE), susceptibility weighted imaging (SWI), and diffusion-weighted imaging (DWI).

Modifiable Risk Factors for Ischemic Stroke

Hypertension
Diabetes
Smoking
Atrial fibrillation
Asymptomatic carotid stenosis
Dyslipidemia
Cardiac disease
Sickle cell disease
Diet
Physical inactivity
Obesity
Alcohol use
Hormone replacement therapy
Hyperhomocysteinemia
Hypercoagulability
Elevated lipoprotein
Inflammation
Infection
Geography

Modifiable Risk Factors for Intracerebral Hemorrhage

Hypertension
Cerebral amyloid angiopathy
Cholesterol
Anticoagulation
Antiplatelets
Alcohol
Smoking
Diabetes
Microbleeds
Dialysis
Drugs

ABCD2 Scoring System for Evaluating Stroke Risk After Transient Ischemic Attack (TIA)

The ABCD2 scoring system evaluates the risk of stroke after a TIA,
Points are awarded based on:
- Age over 60 (1 point)
- Blood pressure greater than or equal to 140/90 (1 point)
- Clinical symptoms: focal weakness (2 points), speech impairment without weakness (1 point)
- Duration: greater than 60 min (2 points), 10-59 min (1 point)
- Diabetes mellitus (1 point)

Brain Tumors

Primary and metastatic tumors.
Over 100 histologic types based on the cell of origin and other histopathologic features.
The World Health Organization (WHO) classification grades tumors from I through IV (I/II: benign or low grade; III/IV: malignant or high grade).
MRI provides information on tumor localization, vascular permeability, cell density, and tumor perfusion.

Meningioma

A tumor arising from the meninges, the membranes that surround the brain and spinal cord.

Glioblastoma

Highly aggressive and malignant brain tumor, often associated with disruption of the blood-brain barrier (BBB) integrity.
Glioblastomas are known for their rapid growth and infiltration into surrounding brain tissue.

Neuroinflammatory Diseases

Multiple sclerosis (MS): the most common chronic disabling immunologic disease of the central nervous system in young populations.
Common MS lesion locations include the periventricular region, juxtacortical region, corpus callosum, brainstem, and cerebellar peduncles.

Common Brain Infections

Bacterial meningitis: Typically, bacteria seed the leptomeninges via the bloodstream or contiguous infection.
Common culprits for meningitis include:
- Adults: Streptococcus pneumoniae, N. meningitidis, L. monocytogenes, H. influenzae.
- Neonates: E. coli, Group B β-hemolytic streptococci.
- Immunocompromised patients: L. monocytogenes.
CSF analysis abnormalities: Increased opening pressure, turbid or purulent fluid, predominantly polymorphonuclear leukocytes, low CSF glucose level, and increased CSF protein levels.
Herpes simplex encephalitis: A viral infection of the brain that can cause severe damage.

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Description

Test your knowledge on the pathophysiological processes related to stroke and intracerebral hemorrhage. This quiz covers common causes, sites of atherosclerosis, and the activation of the coagulation cascade. Challenge yourself and enhance your understanding of these critical medical topics.