[MCQ] Cerebrovascular Diseases Ischemic stroke- Part 4

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Cerebrovascular Diseases Ischemic stroke- Part 4

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Question 1

The most common pattern of clinical presentations of CVT is ?

A	Focal deficits
B	Isolated intracranial hypertension
C	Subacute diffuse encephalopathy
D	Acute painful ophthalmoplegia

Question 1 Explanation:

The most common pattern of clinical presentations of CVT (~75%) is characterized by the presence of focal signs such as focal deficits or partial seizures. Any neurological symptoms such as aphasia, hemiparesis, hemianopsia, and amnesia can occur with CVT. CVT can be totally asymptomatic.

Question 2

The most frequent but least specific symptom of sinus thrombosis is ?

A	Severe headache
B	Ophthalmoplegia
C	Focal deficits
D	Partial seizures

Question 2 Explanation:

The most frequent but least specific symptom of sinus thrombosis is severe headache, which is present in >90 % of adult patients.

Question 3

Classic picture of deep cerebral venous thrombosis is ?

A	Intracranial hypertension
B	Progressive cerebellar incoordination & cranial N. palsies
C	Acute coma, decerebration & extrapyramidal hypertonia
D	Partial seizures

Question 3 Explanation:

Classic picture of deep cerebral venous thrombosis is that of an acute coma with decerebration and extrapyramidal hypertonia leading to death within a few days, or complicated by akinetic mutism and dementia when resolving. Thrombosis of the deep venous system, the straight sinus and its branches, causes centrally located, often bilateral thalamic lesions, with behavioral symptoms such as delirium, amnesia, and mutism, which can be the only manifestation of sinus thrombosis. Thalamic edema is the imaging hallmark

Question 4

Venous sinus thrombosis pertains to which of the following ?

A	Thrombosis of lateral sinus
B	Thrombosis of sagittal sinus
C	Thrombosis of small cortical veins
D	All of the above

Question 4 Explanation:

Thrombosis of lateral or sagittal sinus or of small cortical veins fall under the category of venous sinus thrombosis.

Question 5

Which of the following mutation carries a high risk of venous sinus thrombosis in women who take oral contraceptives ?

A	Thrombin G20210 mutation
B	Prothrombin G20210 mutation
C	Antiprothrombin G20210 mutation
D	Antithrombin G20210 mutation

Question 5 Explanation:

Women who take oral contraceptives and have the prothrombin G20210 mutation are at a high risk for sinus thrombosis. Also, it occurs as a complication of pregnancy and postpartum period, inflammatory bowel disease, intracranial infections (meningitis), and dehydration. It is also seen with increased incidence in patients with laboratory-confirmed thrombophilia including polycythemia, sickle cell anemia, deficiencies of proteins C and S, factor V Leiden mutation (resistance to activated protein C), antithrombin III deficiency, and homocysteinemia. Some patients with CVT carry more than one congenital thrombophilia factors. Extensive etiologic and complete coagulation work-up should be systematically performed in patients of CVT.

Question 6

Which of the following investigation is normal in patients with venous sinus thrombosis ?

A	CT
B	MR-venography
C	CT-venography
D	Conventional x-ray angiography

Question 6 Explanation:

CT imaging is normal in patients with venous sinus thrombosis unless an intracranial venous hemorrhage has occurred, but the venous sinus occlusion is readily visualized using MR- or CTvenography or conventional x-ray angiography.

Question 7

Which of the following is the brain CT finding in a case of superior sagittal sinus thrombosis ?

A	Dense triangle sign
B	Empty delta sign
C	Cord sign
D	All of the above

Question 7 Explanation:

Brain CT findings in CVT include the “dense triangle sign” (occlusion of SSS by fresh clot on noncontrast CT), the “empty delta sign” (filling of collateral veins in SSS wall after contrast injection, contrasting with the nonenhancement of clot inside the thrombosed sinus), and the “cord sign” (visualization of a thrombosed cortical vein on noncontrast CT). The same radiologic signs have been described on MRI. Normal brain CT scan does not rule out CVT.

Question 8

Use of which of the following has no proven value in intracranial hypertension management in CVT ?

A	Acetazolamide
B	Glycerol
C	Mannitol
D	Corticosteroids

Question 8 Explanation:

Intracranial hypertension is common in CVT and should be treated immediately. Definitive treatment is establishing reperfusion of the venous structures (Heparin, Intravenous thrombolysis, thrombectomy). Elevating head of the bed by 30° improves venous drainage. Good pain control and thermal regulation, acetazolamide, glycerol, or mannitol, surgical ventricular drainage, and surgical decompression are useful. Corticosteroids should be avoided. They increase the risk of systemic infections and are of no proven value in CVT. Moreover, there is concern about their thrombogenic risk.

Question 9

Recurrent sinus thrombosis within one year occurs in what percentage of patients ?

A	2 %
B	4 %
C	6 %
D	8 %

Question 9 Explanation:

Recurrent sinus thrombosis occurs in 2 % of patients and ~4 % of patients have an extracranial thrombotic event within one year.

Question 10

Usually, vitamin K antagonists are given for what length of time after a first episode of sinus thrombosis ?

A	Six months
B	One year
C	Five years
D	Life long

Question 10 Explanation:

Optimal duration of oral anticoagulant treatment after the acute phase is unknown. Usually, vitamin K antagonists are given for six months after a first episode of sinus thrombosis, or longer in the presence of predisposing factors, with a target INR of 2.5.

Question 11

Anticoagulation in patients with venous sinus thrombosis is often continued indefinitely if ?

A	Hypercoagulable state is found
B	Thrombophilia is diagnosed
C	Patient has a h/o coma
D	Patient has a h/o seizure

Question 11 Explanation:

Intravenous heparin reduces morbidity & mortality, regardless of the presence of intracranial hemorrhage. If an underlying hypercoagulable state is not found, vitamin K antagonists (VKAs) are given for 3 - 6 months then switch over to aspirin. Anticoagulation is often continued indefinitely if thrombophilia is diagnosed.

Question 12

Mortality after treatment with anticoagulant drugs in patients of cerebral venous sinus thrombosis (CVST) is ?

A	2 % to 5 %
B	5 % to 10 %
C	10 % to 15 %
D	15 % to 20 %

Question 12 Explanation:

Treatment with anticoagulant drugs leads to a moderate benefit for patients with CVST compared with placebo treatment, but mortality after treatment with anticoagulant drugs is still 5% to 10%.

Question 13

Sickle cell anemia (SS disease) is a common cause of stroke in ?

A	Infants
B	Children
C	Adults
D	Old

Question 13 Explanation:

Sickle cell anemia (SS disease) is a common cause of stroke in children.

Question 14

Which of the following investigation is useful in predicting stroke in childhood in SS disease carriers ?

A	MR-venography
B	CT-venography
C	Conventional x-ray angiography
D	Transcranial Doppler ultrasonography

Question 14 Explanation:

Documenting high-velocity blood flow within MCAs using transcranial Doppler ultrasonography can predict the chances of stroke in childhood in SS disease carriers

Question 15

Which of the following is a common cause of stroke in children ?

A	Temporal (giant cell) arteritis
B	Hypercoagulable disorders
C	Fibromuscular dysplasia
D	Sickle cell anemia

Question 15 Explanation:

Sickle cell anemia (SS disease) is a common cause of stroke in children

Question 16

Which of the following about fibromuscular dysplasia is false ?

A	Affects carotid or vertebral arteries
B	Occurs mainly in women
C	Involvement of renal arteries is common
D	None of the above

Question 16 Explanation:

Systemic lupus erythematosus with Libman-Sacks endocarditis can be a cause of embolic stroke

Question 17

Which of the following is false about Temporal (giant cell) arteritis ?

A	Affects elderly persons
B	Affects internal & external carotid system
C	May cause blindness
D	Rarely causes stroke

Question 17 Explanation:

Temporal (giant cell) arteritis rarely causes stroke as internal carotid artery is usually not inflamed.

Question 18

Which is the most common form of vasculitis that affects the carotid artery ?

A	Temporal arteritis
B	Takayasu’s arteritis
C	Kawasaki disease
D	Polyarteritis nodosa

Question 19

Thalamoperforator branches arise from ?

A	Internal carotid artery
B	Middle cerebral artery
C	Anterior cerebral artery
D	Posterior cerebral artery

Question 20

Out of the following, lacunar infarcts are most frequent in ?

A	Corpus callosum
B	White matter of internal capsule
C	Gray matter of cerebral surface
D	Cerebellum

Question 20 Explanation:

Lacunar infarcts mainly occur in basal ganglia, putamen, thalamus and white matter of internal capsule, pons, & centrum semiovale. They occasionally occur in cerebellum, cerebral gyri & spinal cord & are rare in gray matter of cerebral surface, corpus callosum & visual radiations

Question 21

Which of the following is false about Charcot-Bouchard miliary aneurysm ?

A	Aneurysms of brain blood vessels of <300 μm diameter
B	Located in brainstem
C	Associated with chronic hypertension
D	None of the above

Question 21 Explanation:

Charcot-Bouchard miliary aneurysms (French physicians Jean-Martin Charcot and Charles-Joseph Bouchard) are aneurysms of brain small blood vessels (<300 μm diameter). While, saccular aneurysms (berry aneurysms) occur in larger-sized blood vessels. Charcot-Bouchard aneurysms are most often located in the brainstem and are associated with chronic hypertension

Question 22

Hypothesis of homunculus organization of fibers in internal capsule means ?

A	Sensory & motor fibers have same orientation
B	Sensory & motor fibers have different orientation
C	Adjacent regions on cortex correspond on adjacent areas on body surface
D	None of the above

Question 22 Explanation:

Homunculus means ‘little man’ in Latin. Functional mapping & lesion studies have shown that primary motor & somatosensory cortices are so arranged that adjacent regions on cortex correspond on adjacent areas on body surface. In somatotropic representations, arms are always medial to legs except in primary sensiromotor cortex & in posterior columns

Question 23

Which of the following tracts is not present in the posterior limb of internal capsule ?

A	Cortico-pontine
B	Superior thalamic radiation
C	Anterior thalamic radiation
D	Corticospinal tract

Question 23 Explanation:

Anterior thalamic radiation is part of anterior limb of internal capsule.

Question 24

Genu of the internal capsule is at the level of ?

A	Foremen of Lushka
B	Foramen of Magendie
C	Foramen of Monro
D	Foramen magnum

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See all quizzes of Cerebrovascular Diseases Ischemic stroke at here:

Cerebrovascular Diseases Ischemic stroke- Part 1| Cerebrovascular Diseases Ischemic stroke- Part 2| Cerebrovascular Diseases Ischemic stroke- Part 3|Cerebrovascular Diseases Ischemic stroke- Part 4|Cerebrovascular Diseases Ischemic stroke- Part 5| Cerebrovascular Diseases Ischemic stroke- Part 6| Cerebrovascular Diseases Ischemic stroke- Part 7|Cerebrovascular Diseases Ischemic stroke- Part 8

1 The most common pattern of clinical presentations of CVT is ?
A. Focal deficits
B. Isolated intracranial hypertension
C. Subacute diffuse encephalopathy
680 MCQ’s FOR MEDICAL PROFESSIONALS BY PROF. AJAY MATHUR Neurology
D. Acute painful ophthalmoplegia

2 The most frequent but least specific symptom of sinus thrombosis
is ?
A. Severe headache
B. Ophthalmoplegia
C. Focal deficits
D. Partial seizures

3 Classic picture of deep cerebral venous thrombosis is ?
A. Intracranial hypertension
B. Progressive cerebellar incoordination & cranial N. palsies
C. Acute coma, decerebration & extrapyramidal hypertonia
D. Partial seizures

4 Venous sinus thrombosis pertains to which of the following ?
A. Thrombosis of lateral sinus
B. Thrombosis of sagittal sinus
C. Thrombosis of small cortical veins
D. All of the above

5 Which of the following mutation carries a high risk of venous
sinus thrombosis in women who take oral contraceptives ?
A. Thrombin G20210 mutation
B. Prothrombin G20210 mutation
C. Antiprothrombin G20210 mutation
D. Antithrombin G20210 mutation

6 Which of the following investigation is normal in patients with
venous sinus thrombosis ?
A. CT
B. MR-venography
C. CT-venography
D. Conventional x-ray angiography

7 Which of the following is the brain CT finding in a case of superior
sagittal sinus thrombosis ?
A. Dense triangle sign
B. Empty delta sign
C. Cord sign
D. All of the above

8 Use of which of the following has no proven value in intracranial
hypertension management in CVT ?
A. Acetazolamide
B. Glycerol
C. Mannitol
D. Corticosteroids

9 Recurrent sinus thrombosis within one year occurs in what
percentage of patients ?
A. 2 %
B. 4 %
C. 6 %
D. 8 %

10 Usually, vitamin K antagonists are given for what length of time
after a first episode of sinus thrombosis ?
A. Six months
B. One year
C. Five years
D. Life long

11 Anticoagulation in patients with venous sinus thrombosis is often
continued indefinitely if ?
A. Hypercoagulable state is found
B. Thrombophilia is diagnosed
C. Patient has a h/o coma
D. Patient has a h/o seizure

12 Mortality after treatment with anticoagulant drugs in patients of
cerebral venous sinus thrombosis (CVST) is ?
A. 2 % to 5 %
B. 5 % to 10 %
C. 10 % to 15 %
D. 15 % to 20 %

13 Sickle cell anemia (SS disease) is a common cause of stroke in ?
A. Infants
B. Children
C. Adults
D. Old

14 Which of the following investigation is useful in predicting stroke
in childhood in SS disease carriers ?
A. MR-venography
B. CT-venography
C. Conventional x-ray angiography
D. Transcranial Doppler ultrasonography

15 Which of the following is a common cause of stroke in children ?
A. Temporal (giant cell) arteritis
B. Hypercoagulable disorders
C. Fibromuscular dysplasia
D. Sickle cell anemia

16 Which of the following about fibromuscular dysplasia is false ?
A. Affects carotid or vertebral arteries
B. Occurs mainly in women
C. Involvement of renal arteries is common
D. None of the above
17 Which of the following is false about Temporal (giant cell) arteritis ?
A. Affects elderly persons
B. Affects internal & external carotid system
C. May cause blindness
D. Rarely causes stroke

18 Which is the most common form of vasculitis that affects the
carotid artery ?
A. Temporal arteritis
B. Takayasu’s arteritis
C. Kawasaki disease
D. Polyarteritis nodosa
19 Thalamoperforator branches arise from ?
A. Internal carotid artery
B. Middle cerebral artery
C. Anterior cerebral artery
D. Posterior cerebral artery
20 Out of the following, lacunar infarcts are most frequent in ?
A. Corpus callosum
B. White matter of internal capsule
C. Gray matter of cerebral surface
D. Cerebellum

21 Which of the following is false about Charcot-Bouchard miliary
aneurysm ?
A. Aneurysms of brain blood vessels of <300 μm diameter
B. Located in brainstem
C. Associated with chronic hypertension
D. None of the above

22 Hypothesis of homunculus organization of fibers in internal capsule
means ?
A. Sensory & motor fibers have same orientation
B. Sensory & motor fibers have different orientation
C. Adjacent regions on cortex correspond on adjacent areas on
body surface
D. None of the above

23 Which of the following tracts is not present in the posterior limb
of internal capsule ?
A. Cortico-pontine
B. Superior thalamic radiation
C. Anterior thalamic radiation
D. Corticospinal tract

24 Genu of the internal capsule is at the level of ?
A. Foremen of Lushka
B. Foramen of Magendie
C. Foramen of Monro
D. Foramen magnum

Cerebrovascular Diseases Ischemic stroke

[MCQ] Cerebrovascular Diseases Ischemic stroke- Part 4

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Cerebrovascular Diseases Ischemic stroke- Part 4

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