Neurologists Exam Cerebrovascular Disease & Stroke 1 — Questions and Answers
Question 1: What percentage of all strokes are classified as ischemic strokes?
- Approximately 50%
- Approximately 70%
- Approximately 87% (Correct answer)
- Approximately 95%
Correct answer: Approximately 87%
Ischemic strokes account for approximately 87% of all strokes, making them by far the most common type.
Question 2: Which small penetrating arteries are most commonly involved in lacunar infarcts affecting the basal ganglia and internal capsule?
- Middle cerebral artery branches
- Posterior cerebral artery branches
- Lenticulostriate arteries (Correct answer)
- Anterior choroidal artery
Correct answer: Lenticulostriate arteries
Lenticulostriate arteries are small penetrating branches of the MCA that supply the basal ganglia and internal capsule, making them the primary vessels involved in lacunar infarcts at these sites.
Question 3: A patient presents with sudden right-sided face and arm weakness, expressive aphasia, and left gaze preference. Which arterial territory is most likely occluded?
- Right posterior cerebral artery
- Right anterior cerebral artery
- Left middle cerebral artery (Correct answer)
- Left vertebrobasilar artery
Correct answer: Left middle cerebral artery
Left MCA territory strokes cause contralateral (right-sided) hemiparesis, Broca's or global aphasia, and ipsilateral gaze preference (eyes deviate toward the lesion side).
Question 4: What is the approved time window for IV alteplase (tPA) administration in eligible acute ischemic stroke patients per current guidelines?
- Within 1 hour of symptom onset
- Within 3 to 4.5 hours of symptom onset (Correct answer)
- Within 6 hours of symptom onset
- Within 12 hours of symptom onset
Correct answer: Within 3 to 4.5 hours of symptom onset
IV alteplase is approved for use within 3 to 4.5 hours of symptom onset in eligible patients, with the extended window supported by the ECASS-3 trial.
Question 5: Wallenberg (lateral medullary) syndrome, caused by PICA occlusion, classically presents with which combination of findings?
- Contralateral hemiplegia and ipsilateral CN VII palsy
- Ipsilateral facial pain/temperature loss, contralateral body pain/temperature loss, vertigo, and dysphagia (Correct answer)
- Bilateral leg weakness and urinary retention
- Homonymous hemianopia and visual agnosia
Correct answer: Ipsilateral facial pain/temperature loss, contralateral body pain/temperature loss, vertigo, and dysphagia
PICA occlusion causes lateral medullary syndrome with ipsilateral facial sensory loss, contralateral body hemianesthesia (crossed pattern), vertigo, dysphagia, hoarseness, Horner syndrome, and ipsilateral limb ataxia.
Question 6: Which of the following is the single most important modifiable risk factor for ischemic stroke?
- Diabetes mellitus
- Hypertension (Correct answer)
- Hyperlipidemia
- Atrial fibrillation
Correct answer: Hypertension
Hypertension is the most prevalent and impactful modifiable risk factor for both ischemic and hemorrhagic stroke, contributing to endothelial damage, atherosclerosis, and small vessel disease.
Question 7: The NIH Stroke Scale (NIHSS) is used in acute stroke care primarily to:
- Determine the patient's long-term functional prognosis
- Estimate the risk of stroke recurrence within 90 days
- Quantify neurological deficit severity and guide treatment decisions (Correct answer)
- Classify stroke etiology by TOAST criteria
Correct answer: Quantify neurological deficit severity and guide treatment decisions
The NIHSS is an 11-item validated scale (scores 0–42) used to objectively quantify neurological deficit severity, guide thrombolysis eligibility, and monitor clinical progression.
Neurologists Exam Cerebrovascular Disease & Stroke 1
What percentage of all strokes are classified as ischemic strokes?