Stroke
Neuroanatomy
It's Not a Tumor
It Is a Tumor
Potpourri
100
a) Of the 2 types of stroke, _____ is less common than _____ in adults and is associated with higher mortality. b) Which is more common in children?
a) Hemorrhagic (~12%); ischemic (~88%). b) Neither, they are about equally common in children. What is the most common cause of hemorrhagic strokes in adults?
100
I have bitemporal hemianopsia - what is a likely cause?
Pituitary tumor.
100
What is a Chiari Malformation?
A (typically) congenital defect in which brain tissue extends into the spinal canal (downward displacement of cerebellar tonsils into the foramen magnum). Can have varying degrees (e.g., Chiari I, Chiari II). If symptomatic, what symptoms would you expect?
100
This is the where brain tumors are most often found in children.
What is posterior fossa
100
What is the most common route for infections to be spread to the CNS? a) through the bloodstream b) along motor and sensory axons c) from infected cranial cavities (e.g., sinuses, middle ear) d) through direct access (e.g., penetrating wound, skull fracture)
a) bloodstream
200
The worst headache of one's life can signify this type of stroke, most often caused by what?
Subarachnoid hemorrhage; ruptured aneurysm. Aneurysm of which artery is the most common cause of SAH?
200
Name the cranial nerves (bonus points if done in under 30 seconds).
1. Olfactory 2. Optic 3. Occular Motor 4. Trochlear 5. Trigeminal 6. Abducens 7. Facial 8. Auditory 9. Glossopharengeal 10. Vagus 11. Spinal Accessory 12. Hypoglossal
200
Which of the following cognitive disorders are LEAST likely to be seen following hypoxic/ischemic damage? a) amnestic syndrome b) visuospatial deficits c) impaired processing speed d) impaired attention/working memory
b) visuospatial deficits
200
The most common type of brain tumor in adults >45 yrs is _____; the second most common type of brain tumor is _____
Meningioma; glioblastoma. Which is more common in females/males?
200
For Multiple Sclerosis, what groups/populations tend to have a more severe disease course?
Men and minorities; later age of onset
300
____ is the most common cause of intracranial hemorrhage in children.
Trauma. Nontraumatic strokes in children are most often associated with what?
300
What are core features of Gerstmann's syndrome? A lesion to which brain region can cause it?
Acalculia Agraphia Finger agnosia Right-left disorientation
300
The most common underlying pathology in pediatric epilepsy is: a) low-grade glioma b) malformation of cortical development c) hippocampal sclerosis d) traumatic brain injury
b) malformation of cortical development. How about for adults?
300
These cancers are most likely to metastasize to the brain (name 3 of 4)
Melanoma, breast cancer, lung cancer, colon cancer
300
Recent studies of adolescents at "ultra-high-risk" for schizophrenia have identified that the best predictor of future illness onset are deficits on tests of: a) declarative memory b) odor identification c) higher level problem-solving d) auditory attention
b) odor identification
400
What cognitive syndrome can be seen after left-hemisphere PCA stroke? a) alexia without agraphia b) agraphia without alexia c) agraphia and alexia d) alexia and anosognosia
a) alexia without agraphia. What visual field deficit is often also associated with this condition?
400
Name the major CNS neurotransmitters and state their most common origin, for those that have one.
Acetylcholine – basal nucleus of meynert. Norepinephrine/noradrenaline – locus coeruleus. Serotonin – raphe nuclei. Dopamine – substantia nigra. GABA & glutamate – widely distributed.
400
What is pseudotumor cerebri?
Increased intracranial pressure whose symptoms mimic those of a brain tumor: headaches, vision problems, nausea, dizziness. Can be a complication following decompression surgery for Chiari malformation.
400
A child with a posterior fossa tumor can often present with what symptoms?
Nausea and ataxia
400
This rare condition is associated with strokes resulting from abnormal tiny tangles of blood vessels and constriction of the internal carotid artery.
MoyaMoya disease
500
Stroke is associated with primary and secondary injuries. Primary injury is a result of intracellular and extracellular damage. Secondary injury occurs directly or indirectly from a series of events that occur after brain tissue is injured. Name at least 3 types of secondary injury.
ICP, herniation, edema, vasospasm, diaschisis. Vasospasm is associated with poorer prognosis following what type of stroke?
500
Damage to the medial frontal cortex is primarily associated with: a) intentional disorders b) disinhibition of emotion/personality c) executive dysfunction d) ADHD
Intentional disorders (e.g., apathy, akinesia, akinetic mutism).
500
A neuropsychologist has been referred a patient who sustained a TBI 12 months ago. Which combination of information would be most helpful in determining injury severity? a) GCS, length of PTA, time to follow commands b) loss of consciousness, length of PTA, brain CT c) GCS, length of PTA, first hospital MMSE score d) brain MRI, length of PTA, mental status exam 1-month postinjury
a) GCS, length of PTA, time to follow commands. CT can be negative, acute mental status can be affected by many non-injury related factors. Which is a better indicator among GCS, length of PTA, and time to follow commands?
500
Cranial radiation therapy is often avoided in this group ____. Why?
Very young children. Due to impaired growth of normal tissue and subsequent brain development.
500
What are 4 criteria for Fetal Alcohol Syndrome?
1. Growth deficiency, 2. Craniofacial features/anomalies, 3. CNS dysfunction, 4. Prenatal etoh exposure
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