Podcast
Questions and Answers
What is a characteristic feature of a transient ischemic attack (TIA)?
What is a characteristic feature of a transient ischemic attack (TIA)?
- There is evidence of cerebral infarction.
- Symptoms persist beyond 24 hours.
- Symptoms resolve within a few hours. (correct)
- Symptoms do not resolve completely.
What distinguishes recurrent nonstereotypic TIAs from stereotypic TIAs?
What distinguishes recurrent nonstereotypic TIAs from stereotypic TIAs?
- They differ in character from event to event. (correct)
- They are always caused by large artery occlusion.
- They are caused by the same site of embolism.
- They manifest with identical clinical features.
What percentage of strokes is attributed to ischemia due to occlusion?
What percentage of strokes is attributed to ischemia due to occlusion?
- 90% (correct)
- 10%
- 5%
- 35%
Which structure is supplied by the posterior circulation of the brain?
Which structure is supplied by the posterior circulation of the brain?
Which artery is NOT part of the anterior (carotid) circulation?
Which artery is NOT part of the anterior (carotid) circulation?
What is the primary function of the Circle of Willis?
What is the primary function of the Circle of Willis?
What is a common risk factor for stroke?
What is a common risk factor for stroke?
What technique is crucial for distinguishing between ischemic and hemorrhagic strokes?
What technique is crucial for distinguishing between ischemic and hemorrhagic strokes?
What is a potential role of new neurons generated in response to cerebral ischemia?
What is a potential role of new neurons generated in response to cerebral ischemia?
What is one of the observed effects of angiogenesis following ischemia?
What is one of the observed effects of angiogenesis following ischemia?
Which mechanism describes the ability of mild ischemia to protect against subsequent ischemic events?
Which mechanism describes the ability of mild ischemia to protect against subsequent ischemic events?
What are common pathological findings in a brain affected by large artery occlusion?
What are common pathological findings in a brain affected by large artery occlusion?
During which phase after stroke is cerebral edema usually maximized?
During which phase after stroke is cerebral edema usually maximized?
In the chronic phase of a stroke from large artery occlusion, what typically characterizes the infarct site?
In the chronic phase of a stroke from large artery occlusion, what typically characterizes the infarct site?
Which of the following contributes to spontaneous post-ischemic repair?
Which of the following contributes to spontaneous post-ischemic repair?
Which of the following is NOT a characteristic of acute ischemic changes observed under microscopy?
Which of the following is NOT a characteristic of acute ischemic changes observed under microscopy?
Which structures are primarily supplied by the anterior circulation?
Which structures are primarily supplied by the anterior circulation?
What characterizes pure motor hemiparesis?
What characterizes pure motor hemiparesis?
Where are lacunes typically located in a pure motor hemiparesis condition?
Where are lacunes typically located in a pure motor hemiparesis condition?
Which syndrome involves hemisensory loss associated with paresthesia?
Which syndrome involves hemisensory loss associated with paresthesia?
What type of infarct causes sensorimotor stroke?
What type of infarct causes sensorimotor stroke?
Ataxic hemiparesis primarily affects which part of the body?
Ataxic hemiparesis primarily affects which part of the body?
What does dysarthria-clumsy hand syndrome include?
What does dysarthria-clumsy hand syndrome include?
What is a common cause for lacunar syndromes?
What is a common cause for lacunar syndromes?
What structural features are observed in an atherosclerotic common carotid artery as shown by contrast-enhanced black blood MRI?
What structural features are observed in an atherosclerotic common carotid artery as shown by contrast-enhanced black blood MRI?
Which of the following is NOT a common definition for hypertension?
Which of the following is NOT a common definition for hypertension?
What method is recommended for measuring blood pressure to reduce confounding factors?
What method is recommended for measuring blood pressure to reduce confounding factors?
What is a major risk factor for stroke associated with chronic hypertension?
What is a major risk factor for stroke associated with chronic hypertension?
Which type of diabetes is associated with an increased risk of both ischemic stroke and intracerebral hemorrhage?
Which type of diabetes is associated with an increased risk of both ischemic stroke and intracerebral hemorrhage?
Which aspect of diabetes affects small arteries and arterioles, potentially leading to lacunar infarction?
Which aspect of diabetes affects small arteries and arterioles, potentially leading to lacunar infarction?
What is a characteristic of vasculitis as a cause of stroke?
What is a characteristic of vasculitis as a cause of stroke?
Which treatment approach is indicated to reduce stroke risk in both diabetic and non-diabetic patients?
Which treatment approach is indicated to reduce stroke risk in both diabetic and non-diabetic patients?
What type of strokes do children with moya moya typically present with?
What type of strokes do children with moya moya typically present with?
Which drug is most commonly associated with intracerebral hemorrhage?
Which drug is most commonly associated with intracerebral hemorrhage?
In which demographic is migraine with aura most common?
In which demographic is migraine with aura most common?
What typically occurs in drug users within hours of using certain drugs?
What typically occurs in drug users within hours of using certain drugs?
Which mechanism is NOT proposed as a cause of stroke in drug users?
Which mechanism is NOT proposed as a cause of stroke in drug users?
What percentage of strokes in drug users is thought to be associated with infective endocarditis?
What percentage of strokes in drug users is thought to be associated with infective endocarditis?
What relation does sporadic hemiplegic migraine have with stroke?
What relation does sporadic hemiplegic migraine have with stroke?
What does the middle cerebral artery transformation in moya moya resemble?
What does the middle cerebral artery transformation in moya moya resemble?
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Study Notes
Transient Ischemic Attack (TIA)
- TIA symptoms resolve completely within 1 hour, with no cerebral infarction.
- Recurrent TIAs can be classified into stereotytic (identical features from the same site) and non-stereotypic (varied features from different sites).
Vascular Etiology of Ischemia
- 90% of ischemic strokes result from occlusion:
- 35% due to large artery occlusion
- 25% from small artery occlusion
- 20% caused by cardiac embolism
- 15% are cryptogenic (unknown causes)
- 5% from other processes, like inflammation
- 10% of strokes are hemorrhagic due to rupture.
Diagnostic Techniques
- Distinguishing between ischemia and hemorrhage can be challenging through history and neurologic exam; CT scan or MRI provides definitive diagnosis.
Arterial Circulation in the Brain
- Anterior circulation consists of internal carotid artery and branches, supplying most cerebral cortex and subcortical white matter.
- Major branches include anterior choroidal artery, anterior cerebral artery (ACA), and middle cerebral artery (MCA).
- Posterior circulation involves vertebral arteries and basilar artery, supplying brainstem, cerebellum, thalamus, and parts of occipital and temporal lobes.
Neurogenesis and Angiogenesis
- Cerebral ischemia can stimulate neurogenesis, with new neurons migrating to ischemic areas, promoting survival through growth factor release.
- Angiogenesis results from ischemia prompting capillary sprouting, potentially aiding tissue protection during acute stroke.
Ischemic Tolerance
- Mild ischemia can precondition brain tissue, offering protection against future ischemic events through extensive gene expression changes.
Pathology of Large Artery Occlusion
- Recent infarcts present as swollen brain areas, affecting both gray and white matter.
- Microscopic examination reveals acute ischemic changes, including neuron shrinkage and destruction of glial cells.
- Cerebral edema peaks within the first 2-3 days post-stroke.
Lacunar Syndromes
- Various lacunar syndromes result from small, deep infarcts:
- Pure motor hemiparesis: equal hemiparesis without sensory disturbances.
- Pure sensory stroke: hemisensory loss potentially with paresthesia.
- Sensorimotor stroke: motor and sensory deficits due to thalamus lesions.
- Ataxic hemiparesis: combined pure motor hemiparesis and ataxia, typically affects the leg.
- Dysarthria-clumsy hand syndrome: includes dysarthria and facial weakness with hand clumsiness.
Stroke Risk Factors
- Vascular disorders and cardiac disorders are primary contributing factors.
- Hypertension: defined as BP above 140/90 mmHg, a major risk factor; chronic hypertension leads to small arterial degeneration, increasing stroke risk.
- Diabetes: both type 1 and 2 increase risks for both ischemic stroke and hemorrhage.
- Vasculitis: uncommon but treatable cause of stroke.
Drug Abuse and Migraine
- Cocaine and amphetamines are associated with stroke onset shortly after use, with various proposed mechanisms, including endothelial dysfunction and vasospasm.
- Migraine with aura: a rare ischemic stroke cause, primarily affecting women and younger individuals; links to thrombotic and cardioembolic mechanisms exist.
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