A 67yo man with a hx of HTN, DM, HLD, and smoking presents to the ED. CC of
persistent dizziness q1week that has become so severe he now has double
vision, N/V. His wife tells you she noticed a L facial droop and slurring. Pt reports
weakness in L arm and leg. He denies HA or SZ. Head CT was negative for
acute bleed. Upon returning to the room he has become increasingly obtunded
and difficult to arouse. You notice he now has a nystagmus and slightly
dysconjugate gaze. His exam appears to be worsening now with R/L extremity
weakness in addition to his L hemiparesis. What type of stroke syndrome are you
concerned he may be having?
a. Wallenberg's stroke
b. Dissection of the R internal carotid artery
c. acute basilar artery occlusion
d. Superior cerebellar artery stroke - answer-c
You are assessing a 35yo M who has been in a motor vehicle crash, and during
the exam you notice he has some abnormal eye exam findings and weakness in
the R arm and leg (arm more than leg). He has droopiness of the L eyelid and his
pupils are unequal. The L pupil is 3mm in diameter and the right is 5MM. Both
pupils are round and reactive to light. Although it is a hot, humid day, he is not
sweating from the heat. What stroke syndrome do you suspect your patient is
experiencing?
a. Weber's syndrome
b. Amaurosis fugax
c. Locked-in syndrome
d. Horner's syndrome - answer-d
What is a possible cause of Horner's syndrome?
a. Occlusion of the MCA
b. Dissection of the L ICA
,c. Dissection of the R ICA
d. ACA stroke - answer-b
a patient presents with central retinal artery occlusion. As you evaluate the
neuroimaging, you recognize that the most likely etiology is artery-to-thrombosis
from which artery?
a. Basilar artery
b. Middle cerebral artery
c. Posterior inferior cerebellar artery
d. Carotid artery - answer-d
A patient is admitted to the emergency department with acute symptoms of
hemiparesis, hemi-sensory loss, gaze preference, and aphasia. Which vessel do
you suspect is involved in the stroke?
a. ACA
b. MCA
c. PCA
d. PICA - answer-b
What cluster of symptoms is consistent with Weber's syndrome?
a. Ipsilateral cranial nerve 3 palsy, contralateral hemiparesis
b. Ipsilateral cranial nerve 4 and 6 palsy, contralateral hemiparesis
c. Contralateral cranial nerve 4 and 6 palsy, ipsilateral hemiparesis
d. ipsilateral cranial nerve 5 paly, ipsilateral ataxia - answer-a
a patient is admitted with symptoms consistent with Weber's syndrome. If the
stroke is ischemic, which arteries would you suspect might have caused the
stroke?
a. Carotid artery
b. Middle cerebral artery
c. Posterior cerebral artery
d. Basilar artery - answer-c
, A patient presents with vertical gaze palsy, pupils mid-dilated with light
dissociation, and convergence-retraction nystagmus. This cluster of symptoms is
consistent with which of the following symptoms?
a. Weber's syndrome
b. Horner's syndrome
c. Parinaud's syndrome
d. Wallenberg's syndrome - answer-c
Parinaud's syndrome results from which part of the brain?
a. Dorsal midbrain
b. Lateral medulla
c. Ventral pons
d. Posterior inferior cerebellum - answer-a
You are caring for a pt who has had multiple small strokes in the watershed
territory between the ACA and MCA. Which of the following is the most likely
etiology for this type of stroke?
a. Embolus of cardiac origin
b. Carotid artery atherosclerosis
c. Vasculitis
d. Severe hypotension - answer-d
Which arteries are occluded in Wallenberg's syndrome?
a. MCA
b. PICA
c. ICA
d. PCA - answer-b
A patient with lacunar ischemic stroke, with a hx of HTN, CAD, and DM is being
discharged from the hospital. What BP goal will you teach them to target?
a. SBP <150
b. SBP <140
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