SCRN Exam 2023/ 400 Questions and
Answers/ Graded A+
Penumbra - -Salvageable tissue
-oxygen
-blood pressure
-Glucose
-Perfusion - -What oxygen delivers to the brain.
-Above the necklace-Anterior Circulation= - -Unilateral deficits
-Below the necklace-Posterior circulation= - -Bilateral deficits
-Circle of Willis-Collateral circulation= - -Aneurysm
-Cerebrum - -largest part of the brain
-Cerebrum: Frontal Lobe - -Motor function, personality, Brocca speech
-Brocca's aphasia-frontal lobe - -problem with the production and grammar speech
syntax, people know what they want to say but they cant produce the words.
-temporal lobe - -Seizure, Wernicke speech, hearing
-Wernicke's aphasia (receptive aphasia)-temporal lobe - -impaired auditory reception;
speech may be fluent but is often meaningless or nonsensical
-parietal lobe - -sensory input for touch and body position-neglect
-teach patient to scan the room
-occipital lobe - -vision
-basal ganglia - -Hypertensive bleed
-Thalamus - -sensory switchboard, located on top of the brainstem;
-Patient waxing and waning
-Patient asleep/awake
-Thalamic pain syndrome
-thalamic pain syndrome - -a condition caused by damage to the thalamus resulting in
burning or tingling sensations and possibly hypersensitivity to things that would not
normally be painful such as light touch or temperature change
-Cerebellum - -Balance and coordination
, -Left (Dominant) Hemisphere Stroke - --Left gaze preference (looks toward stroke
area)
-Right hononomous hemianopia
-Right hemiparesis
-Right hemisensory loss
-Aphasia
-Right (Nondominant) Hemisphere Stroke - --Right gaze preference
-Left hononomous hemianopia
-Left hemiparesis, plegia
-Left hemisensory loss
*Neglect-left
*Agnosia (failure to recognize objects)
-Posterior circulating stroke syndromes= - -Wallenburg (Medulla)
Horner's Syndrome
-Wallenberg syndrome - -Nystagmus, Vertigo
-Horner's syndrome - -ipsilateral ptosis
miosis
anhidrosis
-Ipsilateral - -on the same side of the body
-Contralateral - -on the opposite side of the body
-Miosis - -constricted pupils
-anhidrosis - -absence of sweating
-Locked-in syndrome - -PONS
-How do you communicate with someone with locked-in syndrome? - -Blinking eye
movement
-Cerebral Venous Thrombosis - -Hypercoagulopathy state
Post-partum/PREGNANCY
-Carotid or Vertebral dissection-TRAUMA - -Trauma most common cause
TX: anticoagulation
-Arterio-venous Fistula - -Ptosis-eyeball pops out
Hears swishing
, -Carotid Cavernous Fistula - -Arterial venous connection between carotid artery and
cavernous sinus---"the bulging red eye"
-can be high-flow or low-flow
-high flow results in patients with atherosclerosis and HTN with carotid aneurysms that
rupture within sinus or secondary to closed head trauma (*basal skull fracture*)
-S&S of high-flow: headache and confusion; *orbital bruit
-Carotid cavernous fistula (CCF) - -Type A-High pressure
Type B-Low pressure
Type C-Low pressure
Type D-Low pressure
-Moyamoya disease - -"Puff of Smoke"
Japanese, young female, genetic
Small, thin walled torturous arteries
Spontaneous stenosis, eventual occlusion
TX: antiplatelet, CCB, surgery
-Moyamoya - -Small, thin walled torturous arteries
TX: surgery-re-establish blood flow to ischemic area
SYNANGIOSIS- creation of new vessels
-Vasculitis- - -Inflammation of blood vessels
Answer: Steriod
-cavernous angioma - -"less common than AVM. Similar to cavernous angioma
elsewhere (liver). Formed by large irregular thin-walled vascular channels. Most are
asymptomatic, may cause bleeding, epilepsy, or focal neuro problems"
CT Scan=PURPLE LESION
-Dural arteriovenous fistula - -Abnormal arteriovenous shunts that occur in the
POSTERIOR DURA
Usually acquired from trauma and associated with obstruction of venous sinus
-Stroke mimics - --Todd's Paralysis (postictal)
-migraine with aura
-Bell's Palsy
-Hypoglycemia
-MS
-Hypertensive encephalopathy
-Wernicke's
-Central venous sinus thrombosus
-ICH - SAH/SDH/EDH
-Brain tumor
-Conversion disorder
-Meningitis/Encephalitis/Abscess
, -TIA - -transient ischemic attack....mini stroke, no dead tissue.
Warning sign of potential or future stroke
Symptoms resolve in minutes to hours
No permanent neurological deficits
Visual difficulties
Carotid stenosis
Carotid endarectomy
-Ischemic stroke - -a type of stroke that occurs when the flow of blood to the brain is
blocked
-Neuroplasticity - -is remodeling process of the brain
-creating new pathways via PT, OT, Speech
-Neuroplasticity of penumbra is continuous repetition of the deficit-ROBOTIC
repetition.
-Neuroplasticity & Stroke Recovery - -Begins 1-3 days post stroke
-Regains lost function after injury
-Success of recovery depends on DESIRE of individual to gain functional ability
-The BE FAST acronym stands for: - -Balance
Eyes
Face
Arms
Speech
Time
-7 D's of stroke care - -Detection-Facial droop, arm weakness
Dispatch-Ambulance gets PT
Delivery-Pt deliver to ER
Door-Pt arrives
Data-CT scan
Decision-Should tPA be given
Drug-what drug
-Door to treatment Times - -Door to ED physician exam=10 min
Door to Stroke expertise=15 min
Door to CT scan= 20 min
Door to CT interpretation= 45 min
Door to lab results= 45 min
Door to Drug (rt-PA)= 60 min (2018: 45 min)
-A CT Scan without contrast can reveal what in the presence of headache? -
-Blood/Hemorrhage
Blood is WHITE
Ischemia/edema does not show up for 12-24 hours
Brain parenchyma is gray
Answers/ Graded A+
Penumbra - -Salvageable tissue
-oxygen
-blood pressure
-Glucose
-Perfusion - -What oxygen delivers to the brain.
-Above the necklace-Anterior Circulation= - -Unilateral deficits
-Below the necklace-Posterior circulation= - -Bilateral deficits
-Circle of Willis-Collateral circulation= - -Aneurysm
-Cerebrum - -largest part of the brain
-Cerebrum: Frontal Lobe - -Motor function, personality, Brocca speech
-Brocca's aphasia-frontal lobe - -problem with the production and grammar speech
syntax, people know what they want to say but they cant produce the words.
-temporal lobe - -Seizure, Wernicke speech, hearing
-Wernicke's aphasia (receptive aphasia)-temporal lobe - -impaired auditory reception;
speech may be fluent but is often meaningless or nonsensical
-parietal lobe - -sensory input for touch and body position-neglect
-teach patient to scan the room
-occipital lobe - -vision
-basal ganglia - -Hypertensive bleed
-Thalamus - -sensory switchboard, located on top of the brainstem;
-Patient waxing and waning
-Patient asleep/awake
-Thalamic pain syndrome
-thalamic pain syndrome - -a condition caused by damage to the thalamus resulting in
burning or tingling sensations and possibly hypersensitivity to things that would not
normally be painful such as light touch or temperature change
-Cerebellum - -Balance and coordination
, -Left (Dominant) Hemisphere Stroke - --Left gaze preference (looks toward stroke
area)
-Right hononomous hemianopia
-Right hemiparesis
-Right hemisensory loss
-Aphasia
-Right (Nondominant) Hemisphere Stroke - --Right gaze preference
-Left hononomous hemianopia
-Left hemiparesis, plegia
-Left hemisensory loss
*Neglect-left
*Agnosia (failure to recognize objects)
-Posterior circulating stroke syndromes= - -Wallenburg (Medulla)
Horner's Syndrome
-Wallenberg syndrome - -Nystagmus, Vertigo
-Horner's syndrome - -ipsilateral ptosis
miosis
anhidrosis
-Ipsilateral - -on the same side of the body
-Contralateral - -on the opposite side of the body
-Miosis - -constricted pupils
-anhidrosis - -absence of sweating
-Locked-in syndrome - -PONS
-How do you communicate with someone with locked-in syndrome? - -Blinking eye
movement
-Cerebral Venous Thrombosis - -Hypercoagulopathy state
Post-partum/PREGNANCY
-Carotid or Vertebral dissection-TRAUMA - -Trauma most common cause
TX: anticoagulation
-Arterio-venous Fistula - -Ptosis-eyeball pops out
Hears swishing
, -Carotid Cavernous Fistula - -Arterial venous connection between carotid artery and
cavernous sinus---"the bulging red eye"
-can be high-flow or low-flow
-high flow results in patients with atherosclerosis and HTN with carotid aneurysms that
rupture within sinus or secondary to closed head trauma (*basal skull fracture*)
-S&S of high-flow: headache and confusion; *orbital bruit
-Carotid cavernous fistula (CCF) - -Type A-High pressure
Type B-Low pressure
Type C-Low pressure
Type D-Low pressure
-Moyamoya disease - -"Puff of Smoke"
Japanese, young female, genetic
Small, thin walled torturous arteries
Spontaneous stenosis, eventual occlusion
TX: antiplatelet, CCB, surgery
-Moyamoya - -Small, thin walled torturous arteries
TX: surgery-re-establish blood flow to ischemic area
SYNANGIOSIS- creation of new vessels
-Vasculitis- - -Inflammation of blood vessels
Answer: Steriod
-cavernous angioma - -"less common than AVM. Similar to cavernous angioma
elsewhere (liver). Formed by large irregular thin-walled vascular channels. Most are
asymptomatic, may cause bleeding, epilepsy, or focal neuro problems"
CT Scan=PURPLE LESION
-Dural arteriovenous fistula - -Abnormal arteriovenous shunts that occur in the
POSTERIOR DURA
Usually acquired from trauma and associated with obstruction of venous sinus
-Stroke mimics - --Todd's Paralysis (postictal)
-migraine with aura
-Bell's Palsy
-Hypoglycemia
-MS
-Hypertensive encephalopathy
-Wernicke's
-Central venous sinus thrombosus
-ICH - SAH/SDH/EDH
-Brain tumor
-Conversion disorder
-Meningitis/Encephalitis/Abscess
, -TIA - -transient ischemic attack....mini stroke, no dead tissue.
Warning sign of potential or future stroke
Symptoms resolve in minutes to hours
No permanent neurological deficits
Visual difficulties
Carotid stenosis
Carotid endarectomy
-Ischemic stroke - -a type of stroke that occurs when the flow of blood to the brain is
blocked
-Neuroplasticity - -is remodeling process of the brain
-creating new pathways via PT, OT, Speech
-Neuroplasticity of penumbra is continuous repetition of the deficit-ROBOTIC
repetition.
-Neuroplasticity & Stroke Recovery - -Begins 1-3 days post stroke
-Regains lost function after injury
-Success of recovery depends on DESIRE of individual to gain functional ability
-The BE FAST acronym stands for: - -Balance
Eyes
Face
Arms
Speech
Time
-7 D's of stroke care - -Detection-Facial droop, arm weakness
Dispatch-Ambulance gets PT
Delivery-Pt deliver to ER
Door-Pt arrives
Data-CT scan
Decision-Should tPA be given
Drug-what drug
-Door to treatment Times - -Door to ED physician exam=10 min
Door to Stroke expertise=15 min
Door to CT scan= 20 min
Door to CT interpretation= 45 min
Door to lab results= 45 min
Door to Drug (rt-PA)= 60 min (2018: 45 min)
-A CT Scan without contrast can reveal what in the presence of headache? -
-Blood/Hemorrhage
Blood is WHITE
Ischemia/edema does not show up for 12-24 hours
Brain parenchyma is gray
