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Questions and Answers
What is a common pathophysiological process involved in intracerebral hemorrhage leading to brain injury?
Which of the following is NOT a frequent site of atherosclerosis relevant to large-artery atherosclerosis?
Which of the following causes contributes to the activation of the coagulation cascade during intracerebral hemorrhage?
Cardiogenic embolism is primarily associated with which type of stroke?
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What is one common cause of hypertension-related intracerebral hemorrhage?
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What is the most common cause of subarachnoid hemorrhage?
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Which of the following is considered a potentially modifiable risk factor for ischemic stroke?
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In the ABCD2 scoring system, how many points are assigned for diabetes mellitus?
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What visual condition is characterized by the inability to orient or respond to objects in the contralesional space?
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Which of the following tumor grades is classified as low grade according to the WHO classification?
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Which of the following is NOT a modifiable risk factor for intracerebral hemorrhage?
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Which type of stroke is characterized by an acute interruption of cerebral blood flow?
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Which assessment techniques are utilized to evaluate visual spatial function?
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What imaging technique provides information such as tumor localization and vascular permeability?
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What type of brain injury is typically caused by an external physical force?
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Which clinical symptom in the ABCD2 scoring system scores the highest points?
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Which of the following is a common imaging modality used in acute stroke evaluation?
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Which treatment method is focused on developing and enhancing visual skills through prescribed activities?
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Which type of visual dysfunction refers to the loss of vision in one quadrant of the visual field?
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What common condition can result from hypoxia or anoxia affecting brain function?
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Which difficulty is most frequently associated with visual information processing dysfunction after TBI?
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Which of the following microorganisms is NOT commonly responsible for bacterial meningitis in adults?
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In multiple sclerosis (MS), lesions are most commonly found in which brain region?
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What is a characteristic finding in the cerebrospinal fluid (CSF) analysis of a patient with bacterial meningitis?
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Which of the following statements about Glioblastoma is correct?
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Which type of inflammation is primarily observed in Herpes Simplex Encephalitis?
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What best describes secondary injury following traumatic brain injury?
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Which advanced imaging technique is primarily used for assessing changes in brain glucose metabolism?
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Which of the following is NOT a common cerebral swelling type after secondary injury?
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Which condition is caused by the displacement of brain parenchyma into a different compartment?
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What type of visual dysfunction is characterized by problems with converging the eyes?
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Which of the following symptoms is NOT typically associated with visual dysfunction following traumatic brain injury?
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What does the term 'excitotoxicity' refer to in the context of secondary injuries?
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Which advanced imaging technique is focused on generating images of brain white matter tracts?
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In traumatic brain injury, which cognitive function is directly assessed by the gap saccade test?
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What is the main goal of treatment for photosensitivity following traumatic brain injury?
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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.
