Stroke
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Questions and Answers

What is the main definition of a stroke?

  • A neurological event due to traumatic injury
  • A sudden neurological event of infectious origin
  • A sudden neurological event of vascular origin (correct)
  • A chronic neurodegenerative process

    • What is the recommended door-to-needle time for thrombolysis in acute stroke management?

  • 30 minutes
  • 60 minutes (correct)
  • 90 minutes
  • 120 minutes

    • Which of the following best describes the primary aim of stroke units?

  • To perform a complete workup within 3–4 hours (correct)
  • To initiate neurorehabilitation immediately
  • To provide long-term care for stroke patients
  • To offer palliative care for advanced cases

    • Which imaging technique is crucial for the early recognition of stroke?

    <p>Neuroimaging</p> Signup and view all the answers

    Which of the following is a critical component of stroke prevention?

    <p>Risk factor management</p> Signup and view all the answers

    What is the goal of neurorehabilitation in stroke care?

    <p>Intensive rehabilitation therapy</p> Signup and view all the answers

    Which of the following best defines a stroke?

    <p>A sudden neurological event of vascular origin</p> Signup and view all the answers

    Which of the following is NOT a common cause of an acute ischemic stroke?

    <p>Hypoglycemia</p> Signup and view all the answers

    Intracerebral and subarachnoid types are most commonly associated with which type of stroke?

    <p>Hemorrhagic stroke</p> Signup and view all the answers

    Which of the following conditions could mimic a stroke, causing similar symptoms?

    <p>All of the above</p> Signup and view all the answers

    A stroke that appears atypical and may initially be mistaken for another condition is called a:

    <p>Stroke chameleon</p> Signup and view all the answers

    Which of the following is NOT considered a stroke mimic?

    <p>Movement disorders</p> Signup and view all the answers

    Which of the following symptoms could indicate a 'stroke chameleon,' where the stroke symptoms are disguised?

    <p>All of the above</p> Signup and view all the answers

    Which type of stroke is the most common, accounting for approximately 65% or more of cases?

    <p>Acute ischemic stroke</p> Signup and view all the answers

    What percentage of strokes are caused by intracerebral hemorrhage?

    <p>5.1%</p> Signup and view all the answers

    Which of the following is considered a 'warning stroke' that often precedes a full stroke?

    <p>Transient ischemic attack (TIA)</p> Signup and view all the answers

    Which of the following risk factors is related to vessel wall damage and can increase stroke risk?

    <p>Hypertension</p> Signup and view all the answers

    Atherosclerosis is a risk factor for stroke primarily because it:

    <p>Narrows the vessel lumen</p> Signup and view all the answers

    Which of the following risk factors for stroke is specifically associated with the vessel lumen?

    <p>Embolism</p> Signup and view all the answers

    Atrial fibrillation (AFib) increases the risk of stroke primarily through:

    <p>Formation of emboli</p> Signup and view all the answers

    Which of the following conditions is NOT considered a vessel wall risk factor for stroke?

    <p>Obesity</p> Signup and view all the answers

    Which of the following is NOT a direct vessel lumen-related risk factor for stroke?

    <p>Hyperlipidemia</p> Signup and view all the answers

    Which of the following is a stroke risk factor related to personal and genetic background?

    <p>Family history and race</p> Signup and view all the answers

    Which of the following is a unique vessel wall disease associated with young stroke patients under 50?

    <p>Fibromuscular dysplasia</p> Signup and view all the answers

    Which condition is specifically linked to small vessel disease in young stroke patients?

    <p>Vasculitis</p> Signup and view all the answers

    Which heart condition may increase the risk of stroke in young individuals by allowing clots to bypass the lungs?

    <p>Patent foramen ovale (PFO)</p> Signup and view all the answers

    Which of the following is NOT a risk factor for stroke specifically noted in younger patients?

    <p>Atherosclerosis</p> Signup and view all the answers

    Which of the following could be a drug-induced cause of stroke in younger patients?

    <p>Small vessel disease</p> Signup and view all the answers

    In young stroke patients, which condition is associated with blood clot formation due to an immune system disorder?

    <p>Anti-phospholipid syndrome</p> Signup and view all the answers

    Which type of anemia is a risk factor for stroke, especially in young patients?

    <p>Sickle cell anemia</p> Signup and view all the answers

    Which of the following could be considered a large vessel cause of stroke in young individuals?

    <p>Dissection</p> Signup and view all the answers

    Migraines are a stroke risk factor in young people mainly because they: A) Increase blood pressure B) Contribute to large vessel disease C) Are associated with vasoconstriction and vascular instability D) Cause immune system compromise

    <p>Are associated with vasoconstriction and vascular instability</p> Signup and view all the answers

    Fibromuscular dysplasia is primarily associated with which of the following?

    <p>Large vessels</p> Signup and view all the answers

    Which of the following conditions is associated with small vessel disease?

    <p>Vasculitis</p> Signup and view all the answers

    Dissection is most commonly associated with:

    <p>Large vessels</p> Signup and view all the answers

    Anti-phospholipid syndrome, which increases stroke risk, primarily affects which of the following?

    <p>Small vessels</p> Signup and view all the answers

    Which of the following conditions is linked to both vascular instability and stroke risk, often associated with large vessel involvement?

    <p>Fibromuscular dysplasia</p> Signup and view all the answers

    What is the typical cerebral blood flow (CBF) in mL/100 g/min necessary to maintain normal brain function?

    <p>50 mL/100 g/min</p> Signup and view all the answers

    At what cerebral blood flow rate does electrical failure and ion pump failure begin, leading to potential cell death?

    <p>10 mL/100 g/min</p> Signup and view all the answers

    What is the 'penumbra' in the context of ischemic stroke?

    <p>The area surrounding the infarct with reduced but salvageable function</p> Signup and view all the answers

    Which threshold in cerebral blood flow marks the beginning of affected electrical function but not complete cell death?

    <p>30 mL/100 g/min</p> Signup and view all the answers

    Cerebral autoregulation maintains stable cerebral blood flow despite changes in which of the following?

    <p>Mean arterial blood pressure (MAP)</p> Signup and view all the answers

    What happens to cerebral blood volume (CBV) in areas of metabolically active tissue?

    <p>Increases due to vasodilation</p> Signup and view all the answers

    What is the main outcome when mean arterial pressure (MAP) falls below the lower limit of cerebral autoregulation?

    <p>Hypoperfusion and ischemia</p> Signup and view all the answers

    Which of the following indicates a loss of cerebral autoregulation due to prolonged ischemia?

    <p>Vasodilation and increased CBV in affected areas</p> Signup and view all the answers

    What is the effect of good collateral circulation during a stroke?

    <p>It results in silent occlusion, with no noticeable symptoms.</p> Signup and view all the answers

    What happens when collateral circulation is absent or inadequate during a stroke?

    <p>The infarct becomes massive, leading to a large area of cell death.</p> Signup and view all the answers

    What is the outcome if the collateral circulation is blocked by a propagating thrombus?

    <p>The infarction becomes massive due to complete loss of blood supply.</p> Signup and view all the answers

    When an embolus blocks a bifurcation in the brain's arterial system, what is the likely result?

    <p>A large infarct occurs at the bifurcation site.</p> Signup and view all the answers

    What can happen to a brain infarction if clot lysis occurs?

    <p>The infarction becomes hemorrhagic.</p> Signup and view all the answers

    What happens when the anterior cerebral artery (ACA) collateral circulation is blocked?

    <p>Infarction becomes massive due to lack of blood flow to the ACA territory.</p> Signup and view all the answers

    What is the primary consequence of a sudden occlusion of a large artery like the middle cerebral artery (MCA)? A) No infarction will occur if collateral supply is adequate. B) The infarct will be silent and unnoticed. C) The infarction will typically be massive, with extensive damage. D) The infarction will lead to immediate hemorrhagic transformation.

    <p>The infarction will typically be massive, with extensive damage.</p> Signup and view all the answers

    What is the primary role of multiphase CT angiography in stroke imaging?

    <p>To assess collateral circulation and detect arterial occlusions.</p> Signup and view all the answers

    What is the sensitivity of non-contrast CT (NCCT) for detecting early ischemic changes in the first 3 hours after stroke onset?

    <p>&lt;50%</p> Signup and view all the answers

    What does hypodensity (decreased density) on a non-contrast CT scan indicate in the context of stroke?

    <p>Increased water content (infarction)</p> Signup and view all the answers

    In the Alberta Stroke Program Early CT score (ASPECTS), what score indicates a significant ischemic event in the middle cerebral artery (MCA) territory?

    <p>7</p> Signup and view all the answers

    What is the role of MR imaging in detecting ischemic changes compared to CT scanning?

    <p>MR is slower but more sensitive than CT in detecting ischemic changes.</p> Signup and view all the answers

    What imaging feature on non-contrast CT is indicative of ischemia?

    <p>Loss of lentiform nucleus differentiation</p> Signup and view all the answers

    What does petechial hemorrhage in the brain indicate in the context of stroke imaging?

    <p>Infarction with hemorrhagic transformation</p> Signup and view all the answers

    What does a decrease in cerebral blood flow (CBF) on PET indicate?

    <p>Ischemia and reduced tissue viability</p> Signup and view all the answers

    What does sulcal effacement on NCCT suggest?

    <p>Cerebral edema or ischemia</p> Signup and view all the answers

    What does the loss of the lentiform nucleus on NCCT typically indicate?

    <p>Early ischemic changes or infarction</p> Signup and view all the answers

    Which of the following is a common cause of middle cerebral artery (MCA) occlusion?

    <p>All of the above</p> Signup and view all the answers

    What is the typical sign on imaging for an acute MCA infarct?

    <p>Cytotoxic edema</p> Signup and view all the answers

    Which of the following is most likely to cause large vessel occlusion in the brain? A) Cardioembolism B) Atherothrombosis C) Small vessel disease D) Hypertension

    <p>Atherothrombosis</p> Signup and view all the answers

    Where do most emboli causing ischemic stroke originate?

    <p>Carotid bifurcation</p> Signup and view all the answers

    Which of the following can be seen on a CT scan of a chronic MCA infarct?

    <p>Atrophy</p> Signup and view all the answers

    Where do most emboli causing ischemic stroke originate?

    <p>Carotid bifurcation</p> Signup and view all the answers

    Which of the following is a common cause of large artery occlusion due to thrombus formation?

    <p>Atherothrombosis</p> Signup and view all the answers

    Which of the following conditions is associated with arterial dissection in the carotid or vertebral arteries?

    <p>Fibromuscular dysplasia</p> Signup and view all the answers

    Which of the following heart conditions can result in cardioembolic stroke due to clot formation in the heart?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is associated with fibromuscular dysplasia (FMD)?

    <p>Abnormal growth of the arterial wall</p> Signup and view all the answers

    Which of the following is a common cause of arterial dissection in the neck? A) Trauma or neck injury B) Atherosclerosis C) Hypertension D) Rheumatoid arthritis

    <p>Trauma or neck injury</p> Signup and view all the answers

    Arterial dissection in the neck is most commonly associated with which of the following arteries?

    <p>Carotid artery</p> Signup and view all the answers

    Which of the following conditions is often associated with arterial dissection, especially in young individuals?

    <p>Both A and B</p> Signup and view all the answers

    What is the general principle behind the phrase 'Time is brain' in acute stroke management?

    <p>The longer the time from symptom onset, the more brain tissue is lost</p> Signup and view all the answers

    According to Goyal et al. (2015), what is the expected outcome for 1 in 4 patients if treated with thrombolysis or clot retrieval within the first 1.5 hours?

    <p>They do very well</p> Signup and view all the answers

    Which of the following describes small vessel disease in stroke?

    <p>Involves end arteries, has no collateral supply, and affects critical brain areas</p> Signup and view all the answers

    Charcot-Bouchard aneurysms are associated with which of the following? A) Small vessel disease B) Atherosclerosis C) Embolic stroke D) Large artery occlusion

    <p>Small vessel disease</p> Signup and view all the answers

    Which of the following is most characteristic of small vessel disease in the brain?

    <p>It affects the perforating vessels, leading to lacunar infarcts</p> Signup and view all the answers

    Which of the following interventions is most beneficial for patients with acute ischemic stroke within 3 hours of symptom onset?

    <p>Thrombolysis</p> Signup and view all the answers

    The main limitation of thrombolysis beyond 4.5 hours from symptom onset is: A) Increased risk of hemorrhagic transformation B) Decreased effectiveness in improving outcomes C) Lack of access to appropriate neuroimaging D) High cost and logistical delays in treatment

    <p>Decreased effectiveness in improving outcomes</p> Signup and view all the answers

    Which of the following is the most common cause of intracerebral hemorrhage?

    <p>Hypertension</p> Signup and view all the answers

    Which of the following conditions is a risk factor for intracerebral hemorrhage due to amyloid angiopathy?

    <p>Aging</p> Signup and view all the answers

    Amyloid angiopathy is most commonly associated with which type of protein?

    <p>Beta-amyloid (βA4)</p> Signup and view all the answers

    Which of the following is a common cause of intracerebral hemorrhage in patients with no known vascular risk factors?

    <p>Drugs (therapeutic or recreational)</p> Signup and view all the answers

    In patients with ruptured intracerebral aneurysms, which of the following drugs is most commonly associated with increased risk?

    <p>Cocaine</p> Signup and view all the answers

    What is the most common site for berry aneurysms in the brain?

    <p>Anterior communicating artery</p> Signup and view all the answers

    Which of the following conditions is a known risk factor for cerebral cavernous malformations (CCM) and can cause intracerebral hemorrhage?

    <p>Family history of CCM</p> Signup and view all the answers

    Which of the following is considered a stroke mimic in the context of intracerebral hemorrhage? (Select one)

    <p>Venous sinus thrombosis</p> Signup and view all the answers

    In the case of intracerebral hemorrhage, which of the following is most important to check in the family history?

    <p>Aneurysms</p> Signup and view all the answers

    Which of the following conditions is NOT typically associated with intracerebral hemorrhage?

    <p>Migraine</p> Signup and view all the answers

    Which of the following is an important characteristic of lacunar infarcts caused by small vessel disease?

    <p>Affects deep white matter</p> Signup and view all the answers

    Intracerebral hemorrhage due to amyloid angiopathy is more likely to occur in which area of the brain?

    <p>Deep structures, including basal ganglia</p> Signup and view all the answers

    What is the most common cause of intracerebral hemorrhage (ICH)? A) Cerebral amyloid angiopathy B) Anticoagulants C) Hypertension D) Arteriovenous malformations (AVMs)

    <p>Hypertension</p> Signup and view all the answers

    Cerebral amyloid angiopathy is primarily associated with:

    <p>Alzheimer's disease</p> Signup and view all the answers

    A patient on anticoagulants presents with a sudden onset of a severe headache and altered mental status. What is the most likely diagnosis?

    <p>Intracerebral hemorrhage</p> Signup and view all the answers

    What distinguishes intracerebral hemorrhage from other types of intracranial hemorrhage?

    <p>It occurs within the brain parenchyma</p> Signup and view all the answers

    Which of the following is a risk factor for intracerebral hemorrhage due to small vascular malformations?

    <p>Arteriovenous malformations (AVMs)</p> Signup and view all the answers

    Which of the following is a common risk factor for the development of berry (saccular) aneurysms?

    <p>Cigarette smoking</p> Signup and view all the answers

    Which of the following is a common risk factor for the development of berry (saccular) aneurysms?

    <p>Cigarette smoking</p> Signup and view all the answers

    What is a classic symptom reported by patients with spontaneous subarachnoid hemorrhage (SAH)?

    <p>&quot;The worst headache of my life&quot;</p> Signup and view all the answers

    What is the common cause of spontaneous subarachnoid hemorrhage (SAH)?

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

    Which condition is commonly associated with an increased risk of berry aneurysms?

    <p>Polycystic kidney disease</p> Signup and view all the answers

    After a patient presents with a sudden severe headache and neck stiffness, what would be the next appropriate step if a non-contrast CT scan shows a subarachnoid hemorrhage?

    A) Administer pain relief and observe B) Perform lumbar puncture to look for xanthochromia C) Discharge the patient with instructions for follow-up D) Perform a full neurological examination and send for MRI

    <p>Perform lumbar puncture to look for xanthochromia</p> Signup and view all the answers

    In a patient with subarachnoid hemorrhage (SAH), how soon does rebleeding typically occur after the initial event?

    <p>4-8 days</p> Signup and view all the answers

    What is a typical finding in a lumbar puncture for a patient with subarachnoid hemorrhage (SAH)?

    <p>Presence of red blood cells and xanthochromia</p> Signup and view all the answers

    Which of the following describes a berry aneurysm in terms of its formation and rupture risk?

    <p>A congenital defect that enlarges progressively with age</p> Signup and view all the answers

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