Podcast
Questions and Answers
What is the cause of ipsilateral tongue deviation following a stroke?
What is the cause of ipsilateral tongue deviation following a stroke?
Which syndrome is associated with hemiballismus?
Which syndrome is associated with hemiballismus?
What are the symptoms of Gerstmann syndrome?
What are the symptoms of Gerstmann syndrome?
Which condition results in inability to move the entire body except for the eyes?
Which condition results in inability to move the entire body except for the eyes?
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What is the primary mechanism behind lenticulostriate strokes?
What is the primary mechanism behind lenticulostriate strokes?
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What neurological sign is observed in Weber syndrome?
What neurological sign is observed in Weber syndrome?
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Which syndrome is directly associated with a stroke of the angular gyrus?
Which syndrome is directly associated with a stroke of the angular gyrus?
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What is the defining characteristic of lacunar infarcts?
What is the defining characteristic of lacunar infarcts?
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What is the most important risk factor for stroke in a patient with both hypertension and atrial fibrillation?
What is the most important risk factor for stroke in a patient with both hypertension and atrial fibrillation?
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Which risk factor is most associated with the development of atherosclerotic plaques leading to stroke?
Which risk factor is most associated with the development of atherosclerotic plaques leading to stroke?
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What type of abnormalities are associated with a dominant middle cerebral artery (MCA) stroke?
What type of abnormalities are associated with a dominant middle cerebral artery (MCA) stroke?
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In which type of stroke would a patient most likely experience contralateral homonymous hemianopsia with macular sparing?
In which type of stroke would a patient most likely experience contralateral homonymous hemianopsia with macular sparing?
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What symptoms are indicative of a lateral medullary syndrome (Wallenberg syndrome) stroke?
What symptoms are indicative of a lateral medullary syndrome (Wallenberg syndrome) stroke?
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What is identified as the primary mechanism leading to thrombus formation in patients with atrial fibrillation?
What is identified as the primary mechanism leading to thrombus formation in patients with atrial fibrillation?
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What is the most significant intervention for reducing stroke risk in patients with high blood pressure?
What is the most significant intervention for reducing stroke risk in patients with high blood pressure?
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Which artery is affected during a stroke that would result in motor and sensory abnormalities of the contralateral arm and face?
Which artery is affected during a stroke that would result in motor and sensory abnormalities of the contralateral arm and face?
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What is the primary feature of medial medullary syndrome following a stroke?
What is the primary feature of medial medullary syndrome following a stroke?
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Which stroke is associated with a 'down and out' eye and contralateral spastic hemiparesis?
Which stroke is associated with a 'down and out' eye and contralateral spastic hemiparesis?
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Which clinical presentation is characteristic of Gerstmann syndrome?
Which clinical presentation is characteristic of Gerstmann syndrome?
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What condition results in 'ballistic' movements of an arm and/or leg?
What condition results in 'ballistic' movements of an arm and/or leg?
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What is the main characteristic of lacunar infarcts compared to larger strokes?
What is the main characteristic of lacunar infarcts compared to larger strokes?
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Which syndrome leads to complete paralysis of bodily movements except for eye movement?
Which syndrome leads to complete paralysis of bodily movements except for eye movement?
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What is the defining symptom of lateral pontine syndrome after a stroke?
What is the defining symptom of lateral pontine syndrome after a stroke?
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What vascular condition is associated with Charcot-Bouchard microaneurysms?
What vascular condition is associated with Charcot-Bouchard microaneurysms?
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What is the primary risk factor for stroke in a patient with both hypertension and atrial fibrillation?
What is the primary risk factor for stroke in a patient with both hypertension and atrial fibrillation?
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What mechanism leads to endothelial damage and atherosclerotic plaque development in hypertensive patients?
What mechanism leads to endothelial damage and atherosclerotic plaque development in hypertensive patients?
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Which artery is primarily affected in a lateral medullary syndrome (Wallenberg syndrome) stroke?
Which artery is primarily affected in a lateral medullary syndrome (Wallenberg syndrome) stroke?
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What symptom is associated with a dominant middle cerebral artery (MCA) stroke?
What symptom is associated with a dominant middle cerebral artery (MCA) stroke?
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What is the result of turbulence and stasis caused by atrial fibrillation?
What is the result of turbulence and stasis caused by atrial fibrillation?
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Which symptom indicates an infarct in the posterior cerebral artery (PCA)?
Which symptom indicates an infarct in the posterior cerebral artery (PCA)?
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What is more critical for reducing stroke risk in patients, according to the risk factors presented?
What is more critical for reducing stroke risk in patients, according to the risk factors presented?
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Which of the following complications is most likely after a stroke affecting the posterior inferior cerebellar artery in relation to lateral medullary syndrome?
Which of the following complications is most likely after a stroke affecting the posterior inferior cerebellar artery in relation to lateral medullary syndrome?
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Study Notes
Stroke Risk Factors
- Two key USMLE stroke risk factors are hypertension (HTN) and atrial fibrillation (AF).
- Hypertension damages carotid artery endothelium, leading to atherosclerotic plaque (stenosis), which can then embolize to the brain/eye. A strong systolic impulse pounds the carotid arteries, increasing endothelial damage and plaque formation.
- Atrial fibrillation causes turbulence and stasis, leading to left atrial mural thrombus formation, which can embolize.
- Hypertension is the most common stroke risk factor, but AF is more significant in patients with both conditions.
- Controlling blood pressure is more important than quitting smoking for stroke risk reduction. If a USMLE question presents a patient with both AF and HTN, AF is the more critical factor.
Stroke Etiology by Vessel Affected
- Anterior Cerebral Artery (ACA) stroke: contralateral leg motor/sensory deficits.
- Middle Cerebral Artery (MCA) stroke: contralateral arm and face motor/sensory deficits; dominant MCA stroke can lead to Wernicke or Broca aphasia, while non-dominant MCA stroke can cause hemispatial neglect (inability to draw clockface).
- Posterior Cerebral Artery (PCA) stroke: contralateral homonymous hemianopia with macular sparing, and prosopagnosia (inability to recognize faces).
Other Stroke Syndromes
- Lateral Medullary Syndrome (Wallenberg Syndrome): Dysphagia + ipsilateral Horner syndrome; caused by posterior inferior cerebellar artery (PICA) or vertebral artery stroke. PICA stroke can cause dysphagia. Horner syndrome (ipsilateral miosis, partial ptosis, anhidrosis)- common with Pancoast tumor, also occurs in lateral medullary syndrome.
- Medial Medullary Syndrome: Ipsilateral tongue deviation, due to anterior spinal artery stroke.
- Lateral Pontine Syndrome: Ipsilateral Bell's palsy, due to anterior inferior cerebellar artery (AICA) stroke. "FACIAL" (AICA backwards)- Bells Palsy.
- Weber Syndrome: Midbrain stroke characterized by ipsilateral CN III palsy (down and out eye) and contralateral spastic hemiparesis.
- Locked-in Syndrome: Basilar artery stroke resulting in inability to move entire body except for eyes.
- Gerstmann Syndrome: Stroke of parietal lobe angular gyrus, presenting with agraphia (inability to write), acalculia (cannot do math), finger agnosia (can’t identify fingers), and left-right disorientation.
- Hemiballismus: Subthalamic nucleus stroke leading to ballistic flailing of the contralateral arm/leg. Right subthalamic nucleus stroke causes left arm/leg flailing.
- Lenticulostriate Strokes and Lacunar Infarcts: Hypertension causing microatheroma (lipohyalinosis) of small penetrating lenticulostriate arteries leads to tiny cavities (lacunae) in the brain. These strokes do not typically show cortical deficits (aphasia, neglect, visual field losses). Instead, they present as pure motor hemiparesis, pure sensory stroke, or ataxic hemiparesis. USMLE focuses on the existence and mechanism (HTN causing lipohyalinosis) of these strokes, rather than specific types.
Other Stroke-Related Conditions
- Charcot-Bouchard Microaneurysms: Tiny aneurysms; frequently not mentioned on the USMLE.
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Description
This quiz covers key risk factors for stroke, including hypertension and atrial fibrillation, as well as the etiology linked to different arteries affected. Understand how these conditions contribute to stroke risk and identify the neurological deficits associated with strokes in various cerebral arteries. Test your knowledge on managing these risk factors effectively.
