Stroke

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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?

Neuroimaging Signup and view all the answers

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

Risk factor management Signup and view all the answers

What is the goal of neurorehabilitation in stroke care?

Intensive rehabilitation therapy Signup and view all the answers

Which of the following best defines a stroke?

A sudden neurological event of vascular origin Signup and view all the answers

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

Hypoglycemia Signup and view all the answers

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

Hemorrhagic stroke Signup and view all the answers

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

All of the above Signup and view all the answers

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

Stroke chameleon Signup and view all the answers

Which of the following is NOT considered a stroke mimic?

Movement disorders Signup and view all the answers

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

All of the above Signup and view all the answers

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

Acute ischemic stroke Signup and view all the answers

What percentage of strokes are caused by intracerebral hemorrhage?

5.1% Signup and view all the answers

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

Transient ischemic attack (TIA) Signup and view all the answers

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

Hypertension Signup and view all the answers

Atherosclerosis is a risk factor for stroke primarily because it:

Narrows the vessel lumen Signup and view all the answers

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

Embolism Signup and view all the answers

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

Formation of emboli Signup and view all the answers

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

Obesity Signup and view all the answers

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

Hyperlipidemia Signup and view all the answers

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

Family history and race Signup and view all the answers

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

Fibromuscular dysplasia Signup and view all the answers

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

Vasculitis 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?

Patent foramen ovale (PFO) Signup and view all the answers

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

Atherosclerosis Signup and view all the answers

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

Small vessel disease Signup and view all the answers

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

Anti-phospholipid syndrome Signup and view all the answers

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

Sickle cell anemia Signup and view all the answers

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

Dissection 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

Are associated with vasoconstriction and vascular instability Signup and view all the answers

Fibromuscular dysplasia is primarily associated with which of the following?

Large vessels Signup and view all the answers

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

Vasculitis Signup and view all the answers

Dissection is most commonly associated with:

Large vessels Signup and view all the answers

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

Small vessels 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?

Fibromuscular dysplasia 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?

50 mL/100 g/min 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?

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

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

The area surrounding the infarct with reduced but salvageable function Signup and view all the answers

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

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

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

Mean arterial blood pressure (MAP) Signup and view all the answers

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

Increases due to vasodilation Signup and view all the answers

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

Hypoperfusion and ischemia Signup and view all the answers

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

Vasodilation and increased CBV in affected areas Signup and view all the answers

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

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

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

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

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

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

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

A large infarct occurs at the bifurcation site. Signup and view all the answers

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

The infarction becomes hemorrhagic. Signup and view all the answers

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

Infarction becomes massive due to lack of blood flow to the ACA territory. 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.

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

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

To assess collateral circulation and detect arterial occlusions. 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?

<50% Signup and view all the answers

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

Increased water content (infarction) 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?

7 Signup and view all the answers

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

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

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

Loss of lentiform nucleus differentiation Signup and view all the answers

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

Infarction with hemorrhagic transformation Signup and view all the answers

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

Ischemia and reduced tissue viability Signup and view all the answers

What does sulcal effacement on NCCT suggest?

Cerebral edema or ischemia Signup and view all the answers

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

Early ischemic changes or infarction Signup and view all the answers

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

All of the above Signup and view all the answers

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

Cytotoxic edema 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

Atherothrombosis Signup and view all the answers

Where do most emboli causing ischemic stroke originate?

Carotid bifurcation Signup and view all the answers

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

Atrophy Signup and view all the answers

Where do most emboli causing ischemic stroke originate?

Carotid bifurcation Signup and view all the answers

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

Atherothrombosis Signup and view all the answers

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

Fibromuscular dysplasia Signup and view all the answers

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

All of the above Signup and view all the answers

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

Abnormal growth of the arterial wall 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

Trauma or neck injury Signup and view all the answers

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

Carotid artery Signup and view all the answers

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

Both A and B Signup and view all the answers

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

The longer the time from symptom onset, the more brain tissue is lost 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?

They do very well Signup and view all the answers

Which of the following describes small vessel disease in stroke?

Involves end arteries, has no collateral supply, and affects critical brain areas 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

Small vessel disease Signup and view all the answers

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

It affects the perforating vessels, leading to lacunar infarcts 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?

Thrombolysis 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

Decreased effectiveness in improving outcomes Signup and view all the answers

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

Hypertension Signup and view all the answers

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

Aging Signup and view all the answers

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

Beta-amyloid (βA4) 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?

Drugs (therapeutic or recreational) Signup and view all the answers

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

Cocaine Signup and view all the answers

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

Anterior communicating artery 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?

Family history of CCM Signup and view all the answers

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

Venous sinus thrombosis 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?

Aneurysms Signup and view all the answers

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

Migraine Signup and view all the answers

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

Affects deep white matter Signup and view all the answers

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

Deep structures, including basal ganglia 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)

Hypertension Signup and view all the answers

Cerebral amyloid angiopathy is primarily associated with:

Alzheimer's disease 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?

Intracerebral hemorrhage Signup and view all the answers

What distinguishes intracerebral hemorrhage from other types of intracranial hemorrhage?

It occurs within the brain parenchyma Signup and view all the answers

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

Arteriovenous malformations (AVMs) Signup and view all the answers

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

Cigarette smoking Signup and view all the answers

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

Cigarette smoking Signup and view all the answers

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

"The worst headache of my life" Signup and view all the answers

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

Rupture of a berry aneurysm Signup and view all the answers

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

Polycystic kidney disease 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

Perform lumbar puncture to look for xanthochromia Signup and view all the answers

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

4-8 days Signup and view all the answers

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

Presence of red blood cells and xanthochromia Signup and view all the answers

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

A congenital defect that enlarges progressively with age Signup and view all the answers

Stroke

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Questions and Answers

What is the main definition of a stroke?

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

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

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

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

What is the goal of neurorehabilitation in stroke care?

Which of the following best defines a stroke?

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

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

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

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

Which of the following is NOT considered a stroke mimic?

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

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

What percentage of strokes are caused by intracerebral hemorrhage?

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

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

Atherosclerosis is a risk factor for stroke primarily because it:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fibromuscular dysplasia is primarily associated with which of the following?

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

Dissection is most commonly associated with:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What does sulcal effacement on NCCT suggest?

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

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

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

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

Where do most emboli causing ischemic stroke originate?

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

Where do most emboli causing ischemic stroke originate?

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

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

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

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

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

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

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

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

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?