Neuro 10 Flashcards

A patient becomes hypotensive during surgery and afterward has bilateral proximal arm and leg weakness with relatively spared distal function. This pattern most strongly suggests:
A. Lacunar infarction
B. Watershed infarction
C. Thalamic hemorrhage
D. Brainstem ischemia

A patient with border-zone ischemia has “man-in-the-barrel” syndrome. Which body regions are most characteristically involved?
A. Distal hands and feet
B. Face and distal arm
C. Trunk and proximal limbs
D. One leg only

A patient develops impaired higher-order visual processing after a border-zone stroke. Which watershed territory is most likely involved?
A. ACA-MCA border zone
B. MCA-PCA border zone
C. ACA-PCA border zone
D. Vertebrobasilar border zone

A clot forms in the left atrium, travels distally, and occludes a cerebral artery. This is best classified as a:
A. Thrombotic infarct
B. Lacunar infarct
C. Embolic infarct
D. Venous infarct

A cerebral artery becomes occluded by a clot forming directly on an atherosclerotic plaque in that same vessel. This is a:
A. Embolic infarct
B. Thrombotic infarct
C. Hemorrhagic infarct
D. Watershed infarct

Large-vessel cerebral infarcts are most often caused by:
A. Vasculitis or thrombosis
B. Venous thrombosis
C. Emboli or thrombosis
D. Arteriovenous shunts

A stenotic lesion in which vessel may form thrombi that embolize to the MCA, ACA, and ophthalmic artery territories?
A. External carotid artery
B. Internal carotid artery
C. Basilar artery
D. Vertebral artery

A patient has complete occlusion of one internal carotid artery but remains asymptomatic because of collateral flow. Which vessels most likely provide that collateral circulation?
A. AComm and PComm
B. MCA and PCA
C. Ophthalmic and basilar
D. ACA and vertebral

Sudden posterior neck pain and occipital headache followed by posterior circulation ischemia most strongly suggests:
A. Carotid dissection
B. Cavernous thrombosis
C. Vertebral dissection
D. MCA embolism

TIAs or infarcts in the anterior circulation are most associated with which dissection?
A. Basilar dissection
B. Vertebral dissection
C. Carotid dissection
D. Cavernous dissection

Which veins mainly drain the superficial portions of the cerebral hemispheres?
A. Superficial veins
B. Internal cerebral veins
C. Basal veins
D. Great cerebral vein

Which structure mainly receives drainage from the deep cerebral veins?
A. Cavernous sinus
B. Great vein of Galen
C. Sigmoid sinus
D. Superior sagittal sinus

The superior sagittal sinus drains into the:
A. Straight sinus
B. Cavernous sinus
C. Transverse sinuses
D. Inferior petrosal sinus

A dural venous sinus descends and exits the skull through the jugular foramen, continuing as the internal jugular vein. Which sinus is this?
A. Straight sinus
B. Superior petrosal sinus
C. Sigmoid sinus
D. Inferior sagittal sinus

The cavernous sinus drains into the transverse sinus through the:
A. Inferior petrosal sinus
B. Superior petrosal sinus
C. Straight sinus
D. Sigmoid sinus

The cavernous sinus drains directly into the internal jugular vein through the:
A. Inferior petrosal sinus
B. Superior petrosal sinus
C. Great cerebral vein
D. Occipital sinus

Deep cerebral structures drain through the internal cerebral veins and basal veins of Rosenthal to reach the:
A. Cavernous sinus
B. Straight sinus
C. Great cerebral vein
D. Superior sagittal sinus

The great vein of Galen joins with the inferior sagittal sinus to form the:
A. Straight sinus
B. Confluence
C. Transverse sinus
D. Sigmoid sinus

The superior sagittal, straight, and occipital sinuses meet at the:
A. Jugular bulb
B. Confluence of sinuses
C. Cavernous sinus
D. Carotid siphon

A postpartum woman presents with severe headache and signs of increased intracranial pressure. Which diagnosis should be especially considered?
A. Basilar aneurysm
B. Sagittal sinus thrombosis
C. MCA embolism
D. Carotid stenosis

Imaging of a suspected superior sagittal sinus thrombosis shows a contrast-filling defect within the sinus. This is the:
A. Dense MCA sign
B. Empty delta sign
C. Hyperdense basilar sign
D. Cord sign

In the dominant hemisphere, watershed infarcts may produce which language syndrome?
A. Global aphasia
B. Wernicke aphasia
C. Transcortical aphasia
D. Conduction aphasia

On the sensorimotor homunculus, the face and hand areas are located mainly on the:
A. Medial frontal wall
B. Lateral convexities
C. Calcarine fissure
D. Cingulate gyrus

On the sensorimotor homunculus, the leg area lies mainly within the:
A. Sylvian fissure
B. Lateral occipital cortex
C. Interhemispheric fissure
D. Superior temporal gyrus

Which hemisphere is usually most important for attention to contralateral body and space?
A. Dominant left hemisphere
B. Nondominant right hemisphere
C. Dominant temporal pole
D. Left occipital lobe

A patient has a right parietal lesion and ignores the left side of space. This deficit most directly reflects damage to the:
A. Primary motor cortex
B. Nondominant association cortex
C. Broca area
D. Calcarine cortex

Primary visual cortex representing the contralateral visual hemifield lies along the:
A. Central sulcus
B. Calcarine fissure
C. Sylvian fissure
D. Collateral sulcus

A patient with severe carotid hypoperfusion develops aphasia that is preserved repetition with impaired spontaneous speech. Which mechanism best explains this?
A. Dominant watershed infarction
B. Lenticulostriate hemorrhage
C. PCA branch occlusion
D. Basilar thrombosis

A patient has nonfluent speech with preserved comprehension after a dominant frontal infarct. Which cortical region is most likely involved?
A. Superior frontal gyrus
B. Inferior frontal gyrus
C. Superior parietal lobule
D. Inferior parietal lobule

A stroke adjacent to primary auditory cortex causes fluent but nonsensical speech and impaired comprehension. Which region is affected?
A. Inferior frontal gyrus
B. Superior frontal gyrus
C. Inferior temporal gyrus
D. Superior temporal gyrus

The vertebral arteries arise directly from which vessels?
A. Subclavian arteries
B. Common carotid arteries
C. External carotid arteries
D. Internal carotid arteries

The ACA and MCA are terminal branches of the:
A. Basilar artery
B. Common carotid artery
C. Internal carotid artery
D. Posterior communicating artery

The two anterior cerebral arteries connect anteriorly through the:
A. Posterior communicating artery
B. Anterior communicating artery
C. Basilar artery
D. Ophthalmic artery

Which vessel links anterior and posterior circulations?
A. Anterior choroidal artery
B. Anterior communicating artery
C. Pericallosal artery
D. Posterior communicating artery

A vessel courses forward in the interhemispheric fissure, then sweeps back over the corpus callosum. Which artery is this?
A. Posterior cerebral artery
B. Anterior choroidal artery
C. Anterior cerebral artery
D. Superior division MCA

Which pair represents the two main cortical branches of the Anterior cerebral artery (ACA)?
A. Angular and temporal
B. Lenticulostriate and Heubner
C. Calcarine and parieto-occipital
D. Pericallosal and callosomarginal

Contralateral leg-predominant weakness with medial cortical sensory loss most strongly suggests infarction of the:
A. Inferior division MCA
B. Anterior cerebral artery
C. Posterior cerebral artery
D. Anterior choroidal artery

Within the Sylvian fissure, which artery divides into superior and inferior divisions?
A. Middle cerebral artery
B. Anterior cerebral artery
C. Posterior cerebral artery
D. Anterior choroidal artery

A patient has ischemia of cortex above the Sylvian fissure involving lateral frontal regions near the central sulcus. Which branch is most likely occluded?
A. Inferior division MCA
B. Callosomarginal artery
C. Superior division MCA
D. Posterior communicating artery

Infarction of cortex below the Sylvian fissure involving lateral temporal and parietal regions most likely involves the:
A. Superior division MCA
B. Pericallosal artery
C. Calcarine artery
D. Inferior division MCA

Most of the dorsolateral convexity of the brain is supplied by the:
A. Posterior cerebral artery
B. Anterior cerebral artery
C. Basilar artery
D. Middle cerebral artery

A patient with infarction of the medial occipital cortex and inferior temporal lobe most likely has occlusion of the:
A. Posterior cerebral artery
B. Superior division MCA
C. Anterior cerebral artery
D. Recurrent artery of Heubner

Chronic hypertension affecting lenticulostriate vessels most classically leads to:
A. SAH and venous infarct
B. Embolic and cortical stroke
C. Lacunar infarct and ICH
D. TIA and aneurysm

The anterior choroidal artery most commonly arises from the:
A. Middle cerebral artery
B. Anterior cerebral artery
C. Posterior cerebral artery
D. Internal carotid artery

A patient develops pure motor hemiparesis from a lacune involving the posterior limb of the internal capsule. Which vascular territory best fits?
A. PCA cortical branch or posterior choroidal
B. Lenticulostriate or anterior choroidal
C. Inferior division MCA or anterior choroidal
D. Recurrent Heubner or posterior choroidal

The recurrent artery of Heubner usually arises from the:
A. Proximal anterior cerebral artery
B. Proximal middle cerebral artery
C. Posterior communicating artery
D. Distal posterior cerebral artery

In the acute phase of a large MCA territory infarct, the eyes typically show:
A. Contralesional gaze preference
B. Vertical gaze palsy
C. Internuclear ophthalmoplegia
D. Ipsilesional gaze preference

A typical ACA syndrome becomes much larger. Which additional motor deficit may then occur?
A. Ipsilateral facial weakness
B. Flaccid monoplegia
C. Contralateral hemiplegia
D. Bilateral ptosis

A dominant ACA infarct is most associated with:
A. Wernicke aphasia
B. Transcortical motor aphasia
C. Global aphasia
D. Conduction aphasia

A nondominant ACA infarct is most likely to cause:
A. Contralateral neglect
B. Alexia without agraphia
C. Broca aphasia
D. Homonymous hemianopia

A right PCA infarct most classically produces:
A. Left neglect
B. Right gaze preference
C. Left homonymous hemianopia
D. Right arm weakness

A patient can write normally but cannot read after infarction of the left occipital cortex and splenium. This syndrome is:
A. Pure word deafness
B. Transcortical sensory aphasia
C. Gerstmann syndrome
D. Alexia without agraphia

Sudden internal carotid occlusion or hypotension in severe carotid stenosis most predisposes to which watershed infarct?
A. MCA-PCA watershed
B. MCA-ACA watershed
C. ACA-PCA watershed
D. Basilar-vertebral watershed

Which structure is classically supplied by the anterior choroidal artery?
A. Superior temporal gyrus
B. Medial occipital cortex
C. Posterior limb internal capsule
D. Inferior frontal gyrus

Which structure is classically supplied by the recurrent artery of Heubner?
A. Visual cortex
B. Head of caudate
C. Medial temporal cortex
D. Splenium of corpus callosum

Which paired arteries chiefly supply the anterior circulation?
A. Vertebral arteries
B. Basilar artery
C. Internal carotid arteries
D. Posterior cerebral arteries

Before entering the foramen magnum, the vertebral arteries ascend through the cervical:
A. Optic canals
B. Carotid canals
C. Jugular foramina
D. Transverse foramina

After entering the skull, the paired vertebral arteries join to form the:
A. Internal carotid artery
B. Basilar artery
C. Posterior cerebral artery
D. Anterior communicating artery

In the neck, the first internal carotid segment is relatively:
A. Horizontal
B. Vertical
C. Tortuous
D. Intradural

As the internal carotid enters the temporal bone, it becomes the:
A. Petrous segment
B. Cervical segment
C. Cavernous segment
D. Supraclinoid segment

The carotid siphon is located within the internal carotid:
A. Ophthalmic segment
B. Cervical segment
C. Cavernous segment
D. Petrous segment

Just after the ICA enters the dura, a branch arises from the bend, passes with the optic nerve through the optic foramen, and supplies the retina. Which vessel is this?
A. Ophthalmic artery
B. Anterior choroidal artery
C. Posterior communicating artery
D. Callosomarginal artery

After arising from the top of the basilar, which artery curves back to supply medial occipital cortex and inferior-medial temporal lobes?
A. Middle cerebral artery
B. Anterior cerebral artery
C. Posterior cerebral artery
D. Anterior choroidal artery

Infarction of the recurrent artery of Heubner would most likely involve the:
A. Calcarine cortex
B. Optic nerve
C. Precentral gyrus
D. Head of caudate

Thalamoperforator territories primarily involve the thalamus and may extend into the:
A. Genu of corpus callosum
B. Anterior limb capsule
C. Posterior limb capsule
D. Internal auditory canal

A patient with a large acute MCA infarct has a conjugate gaze preference:
A. Toward the lesion
B. Away from the lesion
C. Upward from midline
D. Downward from midline

An ACA infarct most classically causes UMN weakness and cortical sensory loss affecting the:
A. Ipsilateral arm
B. Contralateral face
C. Ipsilateral leg
D. Contralateral leg

When adjacent arterial territories are both underperfused, the border zone between them is most vulnerable to:
A. Lacunar infarction
B. Venous infarction
C. Watershed infarction
D. Subarachnoid hemorrhage

The typical duration of a TIA is closest to:
A. 10 minutes
B. 2 hours
C. 24 hours
D. Several days

Transient loss of consciousness without focal deficits is most commonly caused by cardiogenic:
A. Seizure
B. Syncope
C. TIA
D. Migraine

Headache is more common in:
A. Anterior circulation infarcts
B. Border-zone infarcts
C. Hemorrhagic conversion
D. Posterior circulation infarcts

On examination, carotid stenosis may produce a whooshing sound that continues into diastole and is best described as a:
A. Rub
B. Murmur
C. Bruit
D. Click

A patient with carotid stenosis and ipsilateral transient monocular blindness is classified as having:
A. Incidental carotid disease
B. Symptomatic carotid stenosis
C. Asymptomatic carotid occlusion
D. Vertebrobasilar insufficiency

The mainstay of treatment for symptomatic carotid stenosis is carotid:
A. Stenting
B. Bypass
C. Ligation
D. Endarterectomy

Complete carotid occlusion may remain asymptomatic if collateral flow is adequate through the anterior or posterior:
A. Communicating arteries
B. Choroidal arteries
C. Cerebellar arteries
D. Meningeal arteries

Minor trauma, coughing, or sneezing may cause an intimal tear that allows blood to track into the vessel wall, producing a:
A. Pseudoaneurysm
B. Vasospasm
C. Dissection
D. Plaque rupture

A patient with carotid dissection develops an ipsilateral partial ptosis and miosis. Which syndrome is most likely present?
A. Wallenberg syndrome
B. Horner syndrome
C. Brown-Séquard syndrome
D. Weber syndrome

Which symptom is especially characteristic of vertebral dissection?
A. Retro-orbital pain
B. Bitemporal headache
C. Facial numbness
D. Posterior neck pain

Superficial cerebral veins drain mainly into the superior sagittal sinus and the:
A. Cavernous sinus
B. Straight sinus
C. Sigmoid sinus
D. Inferior sagittal sinus

Ultimately, nearly all cerebral venous drainage reaches the:
A. Vertebral veins
B. Internal jugular veins
C. External jugular veins
D. Subclavian veins

The internal carotid artery and cranial nerves III, IV, V1, V2, and VI pass through the:
A. Sigmoid sinus
B. Straight sinus
C. Cavernous sinus
D. Superior sagittal sinus

The cavernous sinus drains into the transverse sinus through the:
A. Superior petrosal sinus
B. Inferior petrosal sinus
C. Great cerebral vein
D. Occipital sinus

The cavernous sinus drains directly toward the internal jugular vein through the:
A. Straight sinus
B. Transverse sinus
C. Superior petrosal sinus
D. Inferior petrosal sinus

The superior sagittal, straight, and occipital sinuses join at the:
A. Jugular bulb
B. Cavernous sinus
C. Confluence of sinuses
D. Carotid siphon

A dominant frontal lesion causes nonfluent aphasia. Relative to the articulatory area of primary motor cortex, Broca area lies:
A. Posterior
B. Anterior
C. Medial
D. Inferior

The posterior communicating artery directly links the internal carotid artery to the:
A. Anterior cerebral artery
B. Basilar artery
C. Middle cerebral artery
D. Posterior cerebral artery

Which artery supplies most of the anterior medial frontal and anterior parietal cortex, including the medial sensorimotor region?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Anterior choroidal artery

Hypertensive lipohyalinosis affects small vessels arising from the initial MCA before it enters the Sylvian fissure. Which vessels are these?
A. Thalamoperforators
B. Recurrent Heubner branches
C. Lenticulostriate arteries
D. Posterior choroidal arteries

When thrombosis causes a large-vessel cerebral infarct, it most often involves which proximal arteries?
A. ACA, MCA, PCA
B. Ophthalmic, ACA, MCA
C. PICA, AICA, SCA
D. Vertebral, basilar, carotid

Deep cerebral drainage reaches the great vein of Galen through the internal cerebral veins and the basal veins of:
A. Rosenthal
B. Labbé
C. Trolard
D. Sylvius

Superior sagittal sinus thrombosis is especially associated with which patient group?
A. Elderly men
B. Children with migraine
C. Pregnant or postpartum women
D. Patients with Bell palsy

A carotid bruit from stenosis is best detected by:
A. Diaphragm over mastoid
B. Bell below jaw angle
C. Bell over vertex
D. Diaphragm over orbit

A patient with carotid stenosis has contralateral arm weakness from a TIA. This carotid disease is classified as:
A. Incidental stenosis
B. Border-zone disease
C. Vertebrobasilar insufficiency
D. Symptomatic stenosis

After the cervical segment, the internal carotid enters the temporal bone as the:
A. Petrous segment
B. Cavernous segment
C. Supraclinoid segment
D. Ophthalmic segment

The ophthalmic artery usually arises from the internal carotid:
A. Before the carotid canal
B. At MCA bifurcation
C. After dural entry bend
D. Within the basilar trunk

Besides thalamoperforators, which vessels also help supply the thalamus and may reach the posterior limb of the internal capsule?
A. Lenticulostriate and posterior choroidal
B. Thalamogeniculate and posterior choroidal
C. Callosomarginal and anterior choroidal
D. Superior and anterior choroidal

The recurrent artery of Heubner supplies not only the head of the caudate but also parts of the anterior putamen, globus pallidus, and:
A. Optic tract
B. Internal capsule
C. Medial occipital cortex
D. Superior temporal gyrus

A patient has right face and arm weakness, right cortical sensory loss, and nonfluent aphasia. Which artery is most likely occluded?
A. Left ACA
B. Left MCA
C. Left PCA
D. Left AChA

A patient can write but cannot read after infarction of the left occipital cortex and splenium. Which artery is most likely involved?
A. Left ACA
B. Left MCA
C. Left AChA
D. Left PCA

A patient has contralateral leg-predominant weakness, abulia, and urinary incontinence after a frontal stroke. Which artery is most likely involved?
A. ACA
B. MCA
C. PCA
D. Basilar

A small deep infarct causes pure motor hemiparesis from posterior limb internal capsule injury. Which vessels are most classically involved?
A. PCA cortical branches
B. ACA cortical branches
C. Lenticulostriates
D. Superior cerebellar

A patient has left neglect, left face-arm weakness, and eyes deviated to the right. Which artery is most likely occluded?
A. Right MCA
B. Right ACA
C. Right PCA
D. Right PICA

A ventral pontine infarct leaves a patient conscious but quadriplegic with preserved vertical eye movements. Which artery is most likely involved?
A. Vertebral artery
B. PICA
C. AICA
D. Basilar artery

A patient has hoarseness, dysphagia, vertigo, ipsilateral facial pain loss, and contralateral body pain loss. Which artery is most likely involved?
A. AICA
B. PICA
C. SCA
D. ACA

A patient has facial paralysis, loss of lacrimation, decreased taste, vertigo, and ipsilateral hearing loss. Which artery is most likely involved?
A. PICA
B. SCA
C. AICA
D. PCA

A patient develops sudden painless monocular blindness from retinal ischemia. Which artery supplies the affected structure?
A. Anterior choroidal
B. Posterior cerebral
C. Middle cerebral
D. Ophthalmic artery

After profound hypotension, a patient develops bilateral proximal arm and leg weakness with relatively spared distal strength. Which infarct pattern is most likely?
A. ACA-MCA watershed
B. MCA-PCA watershed
C. Lenticulostriate lacune
D. Basilar thrombosis

A patient with border-zone ischemia has impaired higher-order visual processing rather than pure field loss. Which territory is most likely involved?
A. ACA-MCA watershed
B. ACA-PCA watershed
C. MCA-PCA watershed
D. PICA territory

A patient has transient monocular blindness and later contralateral hemispheric TIAs from the same neck lesion. Which artery is the most likely source?
A. Vertebral artery
B. Internal carotid
C. Middle cerebral
D. Basilar artery

A patient has a right homonymous hemianopia with relatively preserved motor strength after a cortical stroke. Which artery is most likely involved?
A. Left PCA
B. Left MCA
C. Left ACA
D. Left AICA

A patient has dysmetria, nausea, dysarthria, and gait ataxia without facial paralysis or hearing loss. Which artery is most likely involved?
A. AICA
B. PICA
C. Basilar artery
D. SCA

A patient has pure sensory stroke localizing to the thalamus. Which arterial territory is most likely involved?
A. MCA superior division
B. ACA pericallosal
C. PCA perforators
D. AICA territory

A patient has fluent but nonsensical speech, poor comprehension, and a right superior quadrantanopia. Which artery is most likely involved?
A. Left ACA
B. Left MCA
C. Left PCA
D. Left PICA

A dominant frontal medial infarct causes leg weakness and transcortical motor aphasia. Which artery is most likely involved?
A. Dominant MCA
B. Dominant PCA
C. Anterior choroidal
D. Dominant ACA

Severe carotid hypoperfusion causes border-zone ischemia with proximal limb weakness. Which upstream vessel is most likely diseased?
A. Vertebral artery
B. Internal carotid
C. Posterior cerebral
D. Basilar artery

A patient has contralateral hemiparesis from a deep infarct involving the posterior limb of the internal capsule and globus pallidus. Which artery is most likely involved?
A. Recurrent Heubner
B. MCA inferior division
C. Anterior choroidal
D. Pericallosal artery

A patient has vertigo, dysphagia, hoarseness, ipsilateral Horner syndrome, and ipsilateral limb ataxia. Which artery is most likely involved?
A. PICA
B. AICA
C. SCA
D. ACA

A patient has contralateral hemiparesis, contralateral vibration loss, and ipsilateral tongue weakness from a medial medullary infarct. Which artery is most likely involved?
A. PICA
B. Vertebral artery
C. Basilar artery
D. Anterior spinal artery

A patient has just ipsilateral limb ataxia and dysarthria. Which artery is most likely involved?
A. AICA
B. PICA
C. SCA
D. MCA

A patient with amaurosis fugax is found to have a stenotic neck vessel that can also embolize to ACA and MCA territories. Which artery is most likely involved?
A. Vertebral artery
B. Internal carotid
C. External carotid
D. Basilar artery