6. Carotid artery lesions

G7 p.1144:95mm

a. are considered symptomatic if

     i. there is _____ or _____ ischemic episodes

one or more

     ii. in the _____ of the vessel.

distribution

b. True or False. They are considered asymptomatic if the patient only has

     i. visual complaints

true

     ii. Dizziness

true

     iii. Syncope

true

7. In a patient with carotid plaque categorize the following:

G7 p.1144:95mm

a. blurred vision

asymptomatic

b. aphasia for less than 24 hours

symptomatic

c. weakness of arm for 10 min

symptomatic

d. dizziness

asymptomatic

8. True or False. The stroke rate in a patient with asymptomatic carotid bruit is approximately

G7 p.1144:108mm

a. 0%

false

b. 2%

true

c. 8%

false

d. 22%

false

9. True or False. The central retinal artery is often insufficient in cerebrovascular disease. This artery is a branch of the following:

G7 p.1144:126mm

a. posterior cerebral artery

false

b. orbital artery

false

c. ophthalmic artery

true

d. M2

false

e. anterior communicating artery

false

10. Retinal insufficiency can manifest by

G7 p.1144:126mm

a. temporary loss of vision, aka _____ _____

amaurosis fugax

b. True or False. Such loss of vision is

     i. bilateral

false

     ii. Contralateral

false

     iii. Ipsilateral

true

     iv. Homonymous

false

c. There are four types.

G7 p.1144:136mm

     i. Type I is called “black curtain” due to _____.

emboli

     ii. Type III is called “gray vision” due to _____.

hypoperfusion

     iii. Type III is associated with migraines and the cause is _____.

Vasospastic

     iv. Type IV is associated with anti cardio lipin antibodies, and the cause is _____.

miscellaneous

     v. Blindness may be _____.

permanent

11. What are Hollenhorst plaques?

cholesterol crystal emboli seen on funduscopic examination in patients with carotid artery disease

G7 p.1145:178mm

12. Complete the following about the classification of carotid ulcerations:

G7 p.1145:18mm

a. Type A is s_____ s_____s_____.

small smooth shallow

b. Type B is l_____ d_____.

large deep

c. Type C is c_____ c_____.

complex cavitated

d. Annual stroke rate for type A is _____%.

0.5%

e. Annual stroke rate for type B is _____%.

0.4 to 4.5%

f. Annual stroke rate for type C is _____%.

5 to 7%

13. What is the gold standard for evaluation of carotid artery disease?

angiography

G7 p.1145:63mm

14. In the arteriosclerotic patient what is the risk that angiography will cause a cerebrovascular accident (CVA)?

Less than 1% risk of CVA

G7 p.1145:71mm

15. Complete the following about Nascet study:

G7 p.1145:90mm

a. Nascet stands for _____.

North American Symptomatic Carotid Endarterectomy Trial

b. It measures degree of c_____s_____.

carotid stenosis

c. Formula is _____ =% stenosis

stenosis

d. where N is measured at maximal _____

narrowing

e.

     i. where D is measured _____

distal

     ii. to the _____ _____

carotid bulb

     iii. where the walls become _____

parallel

f. Surgery is not indicated for less than _____%.

40%

16. Complete the following about duplex Doppler ultrasound limitations:

G7 p.1145:165mm

a. It can’t scan above the angle of the _____.

Mandible

b. It performs poorly with the _____ _____.

string sign

c. Depth of penetration is greater with _____ _____.

lower frequencies

d. Signal definition is better with _____ _____.

higher frequencies

17. True or False. Ultrasound of the carotid artery is excellent for evaluating patients with “the string sign.”

false (Ultrasound is very poor for evaluation of such low flow states.)

G7 p.1145:168mm

18. The use of magnetic resonance angiography

G7 p.1145:180mm

a. may demonstrate a flow _____

gap

b. which obviates the need for _____.

angiography

c. It may _____ the degree of carotid stenosis.

underestimate

19. True or False. The following irreversibly inhibits cyclooxygenase:

G7 p.1146:166mm

a. ticlodipine

false

b. aspirin

true (Aspirin irreversibly inhibits cyclooxygenase preventing synthesis of vascular prostacyclin and platelet thromboxane A2. Platelets cannot resynthesize cyclooxygenase, whereas the vascular tissues do so rapidly.)

c. clopidogrel

false

d. prednisone

false

20. Aspirin

G7 p.1147:16mm

a. The optimal dose for cerebrovascular ischemia is _____.

debated

b.

     i. Risk of stroke after TIA can be reduced by _____to _____%

25 to 30%

     ii. by the use of _____ mg PO per day.

325

c. True or False. More mg of ASA is better after TIA.

false

d. Daily doses of 81 or 325 mgm were _____ than higher doses.

better

e. CVA, MI and death were reduced to _____% from _____%.

6.2 from 8.2

21. Complete the following about Plavix:

G7 p.1147:55mm

a. Has a lower incidence of _____

neutropenia

b. Needs to be taken _____ per day

once

c. Requires _____ days off the drug to reverse

5

22. Complete the following about asymptomatic carotid artery stenosis:

G7 p.1147:120mm

a. stroke rate of _____% per year

2%

b. percent that are not disabling is _____%

50%

c. Carotid endarterectomy may be beneficial for stenosis of more than _____%.

60%

23. True or False. The annual stroke rate for patients with symptomatic carotid stenosis is

G7 p.1148:95mm

a. 30%

false

b. 5%

false

c. 1 to 3.4%

true

d. 1%

false

24. True or False. The Asymptomatic Carotid Atherosclerosis Study (ACAS) found that surgery is moderately beneficial for asymptomatic carotid stenosis ≥ 60%.

true

G7 p.1149:20mm

25. True or False. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) found that in patients with a recent TIA and ipsilateral stenosis > 70%, carotid endarterectomy (CEA) reduced the risk of CVA by

G7 p.1150:85mm

a. 17%

true (at 18 months follow-up)

b. 80%

false

c. 60%

false

d. It did not reduce the risk.

false

26. The general trend in carotid endarterectomy surgery is to wait only _____ days after CVA to perform an endarterectomy.

7

G7 p.1151:26mm

27. True or False. Aspirin and dipyridamole have been shown unequivocally to reduce the rate of restenosis after CEA.

false (The use of these medications has not been shown to reduce the rate of restenosis after CEA.)

G7 p.1152:145mm

28. Complete the following about postop check after carotid endarterectomy:

G7 p.1152:165mm

a. Pronator drift to rule out _____ _____ new hemiparesis

b. Dysphasia to rule out _____ _____ _____

dominant hemisphere CVA

c. Pupil size to rule out _____ _____

Horner syndrome

d. STA pulsations to rule out _____ _____ _____

external carotid occlusion

e. Tongue deviation to identify _____ _____ _____

XII nerve injury

f.

     i. Hoarseness consider _____ _____

laryngeal edema

     ii. Or _____ _____ nerve injury

recurrent laryngeal

g. Tracheal deviation to identify postop _____

hematoma

29. List postop complications of carotid endarterectomy.

G7 p.1153:35mm

Hint: c-h4arm2s2

a. c_____

cranial nerve injury

b. h_____

headache

c. h_____

hoarseness

d. h_____

hyperperfusion

e. h_____

hypertension

f. a_____

arteriotomy disruption

g. r_____

restenosis

h. m_____

morbidity

i. m_____

mortality

j. s_____

seizures

k. s_____

stroke

30. Complete the following about carotid endarterectomy:

G7 p.1153:40mm

a. Morbidity: absolute upper limit is _____%.

3%

b. Mortality in hospital is _____%.

1%

31. Complete the following about arteriotomy disruption:

G7 p.1153:41mm

a. Most immediate danger is _____

asphyxiation

b. Symptoms and signs

     i. Swelling of _____

neck

     ii. Swallowing _____

difficulty

     iii. Deviation of _____

trachea

     iv. Air _____

hunger

     v. Late _____ _____

false aneurysm

32. Complete the following about stroke:

G7 p.1153:83mm

a. Infarcation incidence: _____%

5%

b. Hemorrhagic incidence: _____%

0.6%

33. What is the most common cause of

G7 p.1153:102mm

a. minor post-CEA CVA?

emboli

b. major post-CEA CVA?

postoperative ICA occlusion

34. Risk of stroke is related to

G7 p.1153:107mm

a. t_____

technique

b. h_____

state hypercoaguable

c. h_____ reaction

heparin

d. Endarterectomy site is t_____

thrombogenic

35. Complete the following about seizures:

G7 p.1153:139mm

a. Most occur postop day _____ to _____

5 to 13

b. Usually _____

focal

c. Incidence _____%

1%

36. Complete the following about restenosis after CEA surgery:

G7 p.1153:150mm

a. within 2 years is usually due to _____ _____

fibrous hyperplasia

b. after 2 years is usually due to _____

atherosclerosis

37. Complete the following about late restenosis:

G7 p.1153:152mm

a. It occurs within the first year in _____%.

25%

b. If it occurs within 2 years, it is due to f_____ h_____.

fibrous hyperplasia

c. If it occurs after 2 years, it is due to a _____.

atherosclerosis

38. Complete the following about cerebral hyperperfusion syndrome:

G7 p.1153:158mm

a. Due to return of blood to area of lost _____

autoregulation

b. Usually from chronic cerebral _____

ischemia

c. Secondary to high-grade _____

stenosis

d. May result in _____ _____

intracerebral hemorrhage

39. True or false. Hoarseness is most likely caused by

G7 p.1153:175mm

a. superior laryngeal nerve injury

false

b. laryngeal edema

true

c. recurrent laryngeal nerve injury

false

40. Complete the following about hypoglossal nerve injury:

G7 p.1154:16mm

a. Incidence is _____%.

1%

b. Tongue deviates _____ _____ _____ of the injury.

toward the side

c. Unilateral injury causes problem with

     i. sp_____

speaking

     ii. sw_____

swallowing

     iii. c_____

chewing

d. Bilateral injury can cause a_____ o_____.

airway obstruction

e. It may last as long as _____ months.

4 months

f. Palsy is a contraindication to doing endarterectomy.

Contralaterally

41. Complete the following about endarterectomy and vocal cord paralysis:

G7 p.1154:30mm

a. Incidence is _____%.

1%

b. Which side would be affected?

Ipsilateral

c. Due to injury to

     i. v_____ nerve

vagus

     ii. r_____ l_____ nerve

recurrent laryngeal

42. Damage to which nerve could cause postoperative lip asymmetry following CEA? (i.e., not due to stroke)

marginal mandibular branch of facial nerve MMB-VII (usually a retraction injury with the nerve being retracted against the mandible)

G7 p.1154:37mm

43. Complete the following about hypertension:

G7 p.1154:42mm

a. May develop _____ to _____ days after CEA

5 to 7

b. Due to loss of the carotid s_____ b_____ reflex

sinus baroreceptor

44. True or False. Immediately following CEA (i.e., in the post-anesthesia care unit), a patient who developed neurologic deficit in the distribution of the endarterectomized carotid should undergo immediate computed tomography/magnetic resonance imaging (CT/MRI) or angiogram.

false (The patient should be emergently reexplored. There is no deficit if flow is reestablished in 45 minutes.)

G7 p.1154:40mm

45. True or False. When performing CEA, the order of removing clamps after completion of endarterectomy is

G7 p.1154:80mm

a. internal, common, external carotid

false

b. internal, external, common carotid

false

c. external, common, internal carotid

true (This ensures that any embolic material will be flushed to the external carotid circulation.)

d. The order of removal does not matter.

false

46. True or False. When performing reexploration of a CEA occlude in the following order:

G7 p.1154:84mm

a. Internal, common, external

false

b. Internal, external, common

false

c. External, common, internal

false

d. Common, external, internal

true

47. Complete the following about arteriotomy disruption:

G7 p.1154:125mm

a. If you notice difficulty breathing _____ _____

open wound

b. then i_____.

Intubate

c. This may be difficult if the _____ is deviated.

trachea

48. True or False. A patient with disruption of arteriotomy closure following carotid surgery should never be intubated.

false (Intubation is a high priority.)

G7 p.1154:137mm

49. Complete the following about anesthesia and monitoring:

G7 p.1154:165mm

a. Hemodynamic intolerance to clamping occurs in _____%.

1 to 4%

b. If identified, place a vascular _____.

shunt

c. Which is safer: local or general anesthesia?

no difference

d. Add thiopental to general anesthesia until EEG burst suppression lasts for _____ to _____ seconds.

15 to 30

50. True or False. A shunt is commonly used in carotid surgery when the stump pressure is less than

G7 p.1155:48mm

a. 100 mm Hg

false

b. 25 mm Hg

true

c. 1 mm Hg

false

d. Never use a shunt

false

51. Surgical results correlate best with _____ neurologic status.

presenting

G7 p.1157:75mm

52. Totally occluded carotid and patient presents with mild neurologic deficit.

G7 p.1157:165mm

a. Assume _____ occlusion

chronic

b. Have stroke rate of _____ to _____% per year

3 to 5%

53. Complete the following about acute carotid occlusion:

G7 p.1157:165mm

a. Some neurologic deficit in _____ to _____

%40 to 70%

b. Mortality: _____ to _____%

15 to 55%

c. Good recovery in _____ to _____%

2 to 12%

54. Six of the symptoms of vertebrobasilar insufficiency (VBI) begin with the letter “d.” They are

G7 p.1158:110mm

a. dr_____ _____

drop attack

b. di_____

diplopia

c. dy_____

dysarthria

d. de_____ _____ _____

defect in vision

e. diz_____

dizziness

f. de_____ b_____

deficit bilaterally (motor and/or sensory)

55. Answer the following about vertebrobasilar insufficiency (VBI):

G7 p.1158:125mm

a. Clinical diagnosis of VBI requires how many of those criteria?

2 or more

b. Which symptom suggests:

     i. Ischemia to the brain?

diplopia near ocular nuclear

     ii. Ischemia to lower brain stem?

Dysarthria

     iii. Ischemia to occipital cortex?

homonymous hemianopsia

56. Complete the following about vision symptoms:

G7 p.1158:140mm

a.

     i. Carotid artery vision symptoms are _____

unilateral

     ii. For example, a_____ f_____

amaurosis fugax

b.

     i. Vertebral artery symptoms are _____

bilateral

     ii. For example, h_____ h_____

homonymous hemianopsia

57. If a patient has transient episodes of vertigo you may suspect _____.

VBI

G7 p.1158:146mm

58. The most common cause of VBI

G7 p.1158:185mm

a. is s_____ s_____

subclavian steal

b.

     i. which is r_____ f_____ in the VA

reversed flow

     ii. due to p_____ s_____

proximal stenosis

     iii. of the s_____ a_____.

subclavian artery

59. The mainstay treatment of VBI is a_____.

anticoagulation

G7 p.1159:70mm

60. Complete the following regarding bow hunter’s stroke:

G7 p.1159:105mm

a. Bow hunter’s stroke is caused by occlusion of the _____ _____

vertebral artery

b. resulting from _____ _____.

head rotation

c. Can this occur from forceful treatment by a chiropractor?

yes

d. The vessel occluded is _____ to the direction of head rotation.

Contralateral

e. It is more likely in patients with incompetent _____ _____ arteries.

posterior communicating

f. An appropriate test for this condition is _____ _____ _____.

dynamic cerebral angiography (DCA)

g. If condition is proved treatment of choice is _____ _____ _____.

decompression of VA atC1-2

h. If still symptomatic treatment is_____ _____.

C1-2 fusion

a. Hemorrhage into medial layer

true

b. Presentation includes pain, subarachnoid hemorrhage (SAH), TIA, and Horner syndrome.

true

c. Extracranial dissection is treatedsurgically.

false

d. Intracranial dissections with SAH are treated surgically.

false

62. True or False. Regarding arterial dissection:

G7 p.1161:22mm

a. Hemorrhage can occur outside the vascular lumen due to transintimal extravasation of hematoma.

true

b. The hematoma may dissect the internal elastic membrane from the intima.

true

c. Subintimal dissection is more common with extracranial lesions.

false (Subintimal dissection is more common with intracranial dissection—subintimal = intracranial.)

d. Dissection of the internal elastic membrane results in luminal narrowing.

true

63. Matching. Match the dissection with its location.

G7 p.1161:38mm

media; subintima; between media and adventitia

a. intracranial dissection

b. extracranial dissection

,

64. Matching. Rank the following dissection sites in order of frequency of occurrence and give their approximate percentages:

G7 p.1161:103mm

first; second; third

a. ACA/PCA/PICA _____%

10%

b. basilar/ICA/MCA _____%

30%

c. vertebral _____%

60%

65. True or False. Headache usually precedes neurologic deficits by less than 1 hour.

false (Headache usually precedes deficits by days to weeks.)

G7 p.1162:22mm

66. True or False. The most reliable finding on radiographic examination of suspected arterial dissections is

G7 p.1162:90mm

a. direct visualization on CT

false

b. crescent sign on T2-weighted (T2W) axial imaging

false

c. string sign on angiography

false

d. double lumen sign on angiography

true (Double lumen sign on angiography is considered pathognomonic.)

67. True or False. In cerebral arterial dissection the angiographic configuration is expected

G7 p.1162:105mm

a. to remain stable

false

b. to resolve or worsen

true

c. to often change

true

68. Mortality in cerebral arterial dissections is higher in

G7 p.1162:150mm

a. _____ lesions

carotid

b. carotid _____%

49%

c. vertebrobasilar artery (VBA) _____%

22%

d. subarachnoid hemorrhage _____%

24

e. non-SAH patients _____%

29

69. Complete the following regarding carotid dissection:

G7 p.1163:15mm

a. True or False. The most frequent presenting symptom of spontaneous ICA dissection is

     i. neck pain

false (Pain is 9% more common in VBA.)

     ii. neck swelling

false (swelling 2%)

     iii. headache

true (headache 59%)

     iv. oculosympathetic palsy (partial Horner syndrome)

false (30%)

70. Complete the following about vertebral artery dissection:

G7 p.1163:85mm

a. Categories:

     i. s_____

spontaneous

     ii. a_____

aneurysmal

     iii. t_____

traumatic

b. True or False. Frequency:

     i. Carotid dissections are more common.

true

     ii. Vertebral dissections are more common.

false

71. Complete the following regarding cerebral arterial dissections:

G6 p.885:150mm

a. True or False. Posttraumatic ICA dissection injury mechanisms include

     i. chiropractic manipulation

true

     ii. attempted strangulation

true

     iii. postangiography

true

     iv. hyperextension of neck with ICA stretch

true (compress ⇒ stretch ⇒ dissection risk poke ⇒ tweak ⇒)

b. After trauma symptoms manifest within_____ hours _____%.

24 hours; 75%

G6 p.885:180mm

c. The most frequent presenting symptom of posttraumatic ICA dissection is _____ _____.

ischemic symptoms

d. Which is more common: traumatic or spontaneous ICA dissection?

traumatic

72. True or False. Persistent embolic complications of ICA dissection are indications for the following interventions:

G6 p.886:50mm

a. interposition venous grafting

true

b. EC/IC bypass with maintenance of ICA luminal integrity

false (Extracranial/intracranial [EC/IC] bypass is okay, but once you bypass the clot, close the ICA off to reduce further embolic risk.)

c. carotid ligation alone

true

d. heparin-warfarin-based anticoagulation with close angiographic observation

true

73. Complete the following about traumatic dissections:

G7 p.1163:97mm

a. Occur where VA crosses _____ _____

bony prominences

b. Typically the _____ – _____ junction

C1-2

c. Can result from

     i. Manipulation of _____

neck

     ii. Automobile a_____

accidents

     iii. C_____ treatment

chiropractic

     iv. Sudden head _____

turning

     v. Blow to _____ of _____

back of neck

d. Can produce massive _____ hematomas

neck

G7 p.1164:15mm

e.

     i. Angiography demonstrates lesion posterior to the _____

atlas

     ii. Which is the distal extracranial _____ _____

third segment

f. The first and third portions of the VA are _____.

movable

g. The second and fourth portions are immobilized by _____.

bone

h. Most commonly angiography

     i. demonstrates _____ _____

irregular stenosis

     ii. of the horizontal loops as they pass _____.

C1

74. Complete the following about spontaneous dissection:

G7 p.1163:112mm

a. Tends to be _____

intracranial

b. Occur on the _____VA

dominant

c. Associated with

     i. f_____ d_____

fibromuscular dysplasia

     ii. m_____

migraine

     iii. o_____ c_____

oral contraceptives

d. More common in _____ _____

young adults

e. Have other sites of dissection _____%

36%

f. Have bilateral VA dissection _____%

21%

75. True or False. Dissecting aneurysms of the vertebrobasilar arteries commonly present as

G7 p.1163:125mm

a. saccular aneurysms

false

b. fusifom aneurysms

true

c. subarachnoid hemorrhage

true

d. are ameniable to clipping

may be

e. altered consciousness

true

76. Although most spontaneous vertebral artery dissections are intracranial, those that are extracranial present with _____ _____.

occipital pain

G7 p.1163:155mm

77. True or False. Dissecting aneurysms of the vertebrobasilar arteries commonly present as

G7 p.1163:175mm

a. saccular aneurysms

false

b. fusiform dilatation

true

c. subarachnoid hemorrhage

true

78. Matching. Match the treatment with the condition.

G7 p. 1164:70mm

Treatment:

medical-anticoagulation; surgical

Condition:

a. subarachnoid hemorrhage

b. intradural dissection

c. extradural dissections that progress clinically or angiographically despite anticoagulation

d. non-hemorrhagic small infarction

G6 p. 886:116mm

a. oral contraceptives

true

b. ulcerative colitis

true

c. dehydration

true

d. peripheral vascular disease

false

e. infection

true

f. hypercoagulable state

true

g. pregnancy

true

h. trauma

true

80. Hypercoagulable state includes

G7 p.1166:135mm

(Hint: a²p⁴rs)

a. a_____ III deficiency

antithrombin

b. a_____ antibodies

antiphospholipid

c. p_____ C deficiency

protein

d. p_____ S deficiency

protein

e. p_____ _____ hemoglobinuria

paroxysmal nocturnal

f. p_____ deficiency

plasminogen

g. r_____ to activated protein C

resistance

h. s_____ lupus erythematosis

systemic

81. Complete the following about cerebrovascular venous thrombosis:

G7 p.1167:15mm

a. Incidence is 1 in _____ births.

10,000

b. Period of highest risk of cerebrovascular venous thrombosis during the puerperium is within the first _____ _____ after delivery.

2 weeks

82. True or False. Dural sinus thrombosis occurs more often in the superior sagittal sinus and the

G7 p.1167:40mm

a. right transverse sinus

false

b. left transverse sinus

true

c. straight sinus

false

d. inferior sagittal sinus

false

83. Incidence of dural sinus thrombosis (DST)

G7 p.1164:47mm

a. in the superior sagittal sinus is_____%

70%

b. in the left transverse sinus is _____%

70%

c. in multiple sinuses is _____%

71%

84. Complete the following about clinical symptoms from superior sagittal sinus thrombosis (SSS):

G7 p.1167:125mm

a. No symptoms _____ _____

anterior third

b. Spastically, increased muscle tone _____ _____

middle third

c. Cortical blindness or edema, or death_____ _____

posterior third

85. What are the clinical symptoms of thrombosis of SSS?

G7 p.1167:126mm

a. Anterior third: may produce _____ _____

no symptoms

b. Middle third: may produce _____

spasticity

c. Thrombosis of posterior third: may produce _____, _____, _____

blindness, edema, death

86. Thrombosis of the jugular bulb may produce the following syndrome:

G7 p.1167:152mm

a. symptoms (Hint: bash)

     i. b_____

breathlessness

     ii. a_____

aphonia

     iii. s_____

swallowing difficulties

     iv. h_____

hoarseness

b. named _____ _____

Vernet syndrome

also see G6 p.86:140mm

c. nerves involved are _____ _____ _____

9, 10, 11

d. due to compression of the pars _____

nervosa

87. The best way to diagnose thrombosis of a venous sinus is by

G7 p.1167:175mm

a. M_____ or

MRI

b. a_____.

angiography

88. With dural sinus thrombosis and plain CT scan, suspect the diagnosis of DST.

G7 p.1168:20mm

a. May be _____ in 20%

normal

b. Intraparenchymal f_____ hemorrhage _____%

flame; 20%

c. Small v_____ in _____%

ventricles; 50%

d. White matter e_____

edema

e. Above changes occurring b_____

bilaterally

89. Thrombosis of the superior sagittal sinus

G7 p.1168:44mm

a. may produce a configuration on CT scan called a _____ _____,

delta sign

b. which represents _____ _____ in the _____

clotted blood in the sinus

c. or on a CT with contrast it may produce an _____ _____ _____.

empty delta sign

90. Complete the following about delta sign types:

G7 p1168:46mm

a. Delta sign—a triangular-shaped configuration—is seen on

     i. CT _____ contrast

without

     ii. Represents _____ _____

clotted blood

     iii. _____ the sinus

within

b. Pseudo delta sign is

     i. CT _____ contrast

without

     ii. Represents _____ around SSS

SAH

c. Empty delta sign is seen in

     i. CT _____ contrast

with

     ii. Represents enhancement of _____

dura

     iii. More so than the intra sinus _____

clot

91. True or False. The following are benefits of assessing thrombosis of the superior sagittal sinus with MRI:

G7 p.1168:95mm

a. preferred diagnostic procedure

true

b. can demonstrate vascular changes

true

c. can demonstrate parenchymal changes

true

d. can identify congenital absence of sinus

true

e. shows cerebral edema

true

f. can estimate age of thrombosis

true

g. more advantageous than angiography

true

92. Complete the following regarding cerebrovascular venous thrombosis:

G7 p.1169:65mm

a. True or False. Heparin is the treatment of choice for dural venous sinus thrombosis with associated intracranial hemorrhage.

true

b. Must not treat

     i. with _____

steroids

     ii. because they reduce _____ and sthereby increase _____

fibrinolysis; thrombosis

c. Should also correct

     i. _____ _____

underlying abnormality (i.e., use antibiotics)

     ii. and control _____

hypertension

d. continue anticoagulation for _____ to _____ months

3 to 6

G7 p.1169:175mm

93. What is the prognosis of superior sagittal sinus (SSS) thrombosis?

G7 p.1170:65mm

a. Mortality is _____%.

5 to 70% (approximately 30%)

b. Poor prognostic indicators are

     i. e _____ of a_____

extremes of age (infancy or old age)

     ii. c_____

coma

     iii. n_____ d_____

neurological deterioration (rapid)

c. Treatment for visual loss from papilledema is o_____ n_____ s_____ f_____.

optic nerve sheath fenestration

G7 p.1169:170mm

a. Moyamoya means p_____ o_____ s_____.

puff of smoke

b. Skull base arteries are _____

narrowed

c. due to a thickened _____.

intima

d. _____ deposits occur

Lipid

e. without evidence of _____.

inflammation

f. The other vascular abnormality that occurs is _____, which

aneurysms (intracranial)

G7 p.1171:65mm

g. may be due to a _____ defect in the wall.

congenital

h. Aneurysms occur in unusual sites.

     i. Cerebral arteries at their _____

periphery

     ii. Posterior/anterior _____

choroidal

     iii. Recurrent artery of _____

Heubner

     iv. Frequency of VB aneurysms is _____%

62%

i. The country with highest incidence is_____.

Japan

j. If untreated the prognosis of major deficit or death in 2 years is _____%.

73%

k. Treated prognosis is good in _____%.

58%

95. Presentation in

G7 p.1171:150mm

a. children is by _____ attacks

ischemic

b. adults is by _____

hemorrhage

c. Diagnose with

     i. a_____

angiography

     ii. M_____

MRA

d. The best medical treatment is _____.

none known to be beneficial

e. Surgical treatments all involve _____.

revascularization

G7 p.1173:100mm

f. The surgical procedure of choice is _____ _____ _____.

superficial temporal artery—middle cerebral artery (STAMCA) bypass

96. What is the treatment for moyamoya disease?

G7 p.1173:120mm

a. EMS = _____

encephalomyosynangiosis

b. EDAS = _____

encephaloduroarterio-synangiosis

c. OPT = _____

omental pedicle transplantation