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Vendor Name : Certification-Board
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Number of questions: 200 questions Percent

01. Basic science aspects of vascular neurology 4-6%

02. Risk factors and epidemiology 8-12%

03. Clinical features of cerebrovascular diseases 8-12%

04. Evaluation of the patient with cerebrovascular disease 13-17%

05. Causes of stroke 18-22%

06. Complications of stroke 4-6%

07. Treatment of patients with stroke 28-32%

08. Recovery, regenerative approaches, and rehabilitation 4-6%

TOTAL 100%



Content Areas

01. Basic science aspects of vascular neurology

A. Vascular neuroanatomy

1. Extracranial arterial anatomy

2. Intracranial arterial anatomy

3. Collaterals

4. Alterations of vascular anatomy

5. Venous anatomy

6. Spinal cord vascular anatomy

7. Specific vascular-brain anatomic correlations

8. End vessel syndromes

B. Stroke pathophysiology

1. Cerebral blood flow

a. Vascular smooth muscle control

b. Vasodilation and vasoconstriction

c. Autoregulation

d. Vasospasm

e. Rheology

f. Blood flow in stroke

2. Blood-brain barrier in stroke

3. Coagulation cascade

a. Clotting factors

b. Platelet function

c. Endothelium function

d. Biochemical factors

4. Metabolic and cellular consequences of ischemia

a. Ischemic cascade

b. Reperfusion changes

c. Electrophysiology

d. Gene regulation

5. Inflammation and stroke

6. Brain edema and increased ICP

a. Secondary effects

7. Restoration and recovery following stroke

8. Secondary consequences from intracranial bleeding

C. Neuropathology of stroke

1. Vascular neuropathology

2. Atherosclerosis and atherosclerotic plaque

3. Brain and meningeal biopsy

a. Indications

4. Pathological/imaging/clinical correlations

02. Prevention, risk factors, and epidemiology

A. Populations at risk for stroke

1. Non-modifiable risk factors

2. Age, gender, ethnicity, geography, family history

B. Modifiable risk factors for stroke

1. Hypertension

2. Diabetes mellitus

3. Cholesterol

4. Homocysteine

5. Obesity

6. Alcohol abuse

7. Tobacco use

8. Drug abuse

9. Practice and other lifestyle factors

C. Infections predisposing to stroke

D. Genetic factors predicting stroke

E. Stroke as a complication of other medical illness

F. Special populations at risk for stroke

1. Children and adolescents

2. Young adults

3. Pregnancy

G. Stroke education programs and regional health services

1. Screening

2. Medical economics

3. Primary versus high risk prevention

4. National stroke programs

H. Concepts of clinical research

1. Use and interpretation of statistics

2. Clinical trial design and methodology

3. Understanding the medical literature

4. Rules of evidence and guidelines

5. Rating instruments and stroke scales

I. Outcomes

1. Prognosis

2. Mortality and morbidity of stroke subtypes

03. Clinical features of cerebrovascular diseases

A. Neuro-otology

1. Head and neck pathology

2. Vertigo and hearing loss in stroke

B. Neuro-ophthalmology

1. Retinal changes of vascular disease, including arterial hypertension

and retinal embolism

2. Other ocular manifestations of vascular disease

a. Ischemic oculopathy

b. Horner syndrome

c. Cavernous sinus syndrome

3. Disorders of ocular motility

4. Visual field defects

C. Transient ischemic attack (TIA)

1. General features of TIA

2. Carotid circulation TIA including amaurosis fugax

3. Vertebrobasilar circulation TIA

4. Asymptomatic carotid bruit or stenosis

5. Differential diagnosis of TIA

D. Ischemic stroke syndromes—cerebral hemispheres

1. Cortical stroke syndromes

a. Branch cortical artery syndromes

b. Watershed syndromes

2. Subcortical stroke syndromes

a. Lacunar strokes

b. Striatocapsular infarctions

c. Multiple lacunar infarcts

3. Major hemispheric syndromes

a. Internal carotid artery occlusion

b. Middle cerebral, anterior cerebral, or posterior cerebral artery

4. Behavioral and cognitive impairments following stroke

5. Bi-hemispheric stroke, including hypotensive events

6. Multifocal or diffuse disease

E. Ischemic stroke syndromes—brainstem and cerebellum

1. Basilar artery occlusion

a. Locked-in syndrome

b. Major brainstem strokes

2. Vertebral artery occlusion

3. Branch brainstem stroke syndromes

4. Syndromes from cerebellar arteries (brainstem/cerebellum)

5. Top-of-the-basilar syndromes

6. Thalamic syndromes

F. Ischemic stroke syndromes of the spinal cord

G. Vascular dementia (vascular cognitive impairment) and vascular cognitive

syndromes

1. Multi-infarction (multiple subcortical infarctions)

2. White matter disease (leukoaraiosis, Binswanger subcortical

leukoencephalopathy)

H. Features differentiating hemorrhagic or ischemic stroke

I. Intracerebral hemorrhage

1. Hypertension

2. Cerebral amyloid angiopathy

3. Coagulopathy/bleeding diatheses

4. Locations

a. Putamen

b. Thalamus

c. Lobar and white matter

d. Brainstem

e. Cerebellum

J. Subarachnoid hemorrhage

1. Saccular aneurysms

2. Other aneurysms

3. Unruptured aneurysm

4. Trauma

K. Vascular malformations

1. Hemorrhage

2. Other presentations

L. Primary intraventricular hemorrhage

M. Subdural or epidural hematoma

N. Venous thrombosis

1. Cavernous sinus

2. Superior sagittal sinus

3. Other sinus

4. Cortical thrombophlebitis

5. Deep cerebral veins

O. Carotid cavernous or dural fistulas

P. Pituitary apoplexy

Q. Hypertensive encephalopathy and eclampsia

R. Clinical presentations of primary and multisystem vasculitides

S. Hypoxia-ischemia

1. Cardiac arrest

2. Carbon monoxide poisoning

3. Cortical laminar necrosis

4. Other

T. Brain death

U. MELAS and metabolic disorders causing neurologic symptoms

V. Nonstroke presentations of vascular disease

W. Cardiovascular diseases

1. Heart disease, including coronary artery disease

2. Cardiac complications of stroke

3. Peripheral arterial disease

4. Aortic disease

5. Venous disease

X. Vascular presentations of other diseases of the central nervous system

Y. Infectious diseases and stroke

Z. Migraine

04. Evaluation of the patient with cerebrovascular disease

A. Evaluation of the brain and spinal cord

1. Computed tomography of brain

a. Acute changes of ischemic stroke

b. Acute changes of hemorrhagic stroke

c. Chronic changes of stroke

d. Complications of stroke

e. Vascular imaging by CT

f. Differential diagnosis by CT

g. CT perfusion

h. MR perfusion

2. Computed tomography of spine and spinal cord

3. Magnetic resonance imaging of brain

a. MRI sequences—T1, T2, FLAIR, DWI, PWI, gradient echo

b. MR spectroscopy

c. Acute changes of ischemic stroke

d. Acute changes of hemorrhagic stroke

i. Changes affected by time

e. Functional MRI

f. Vascular imaging by CT

g. Vascular imaging by MRI

4. PET and SPECT

5. EEG and evoked potentials—stroke

a. Changes in stroke

b. Complications of stroke

c. Monitoring

6. test of the CSF

7. ICP monitoring

B. Evaluation of the vasculature—occlusive or non-occlusive

1. Arteriography and venography

a. Cerebral

b. Spinal cord

2. Extracranial ultrasonography

a. Duplex and other imaging

b. Collateral flow challenges

c. Monitoring

3. Intracranial ultrasonography

a. Collateral flow changes

b. Contrast enhancement

c. Monitoring

4. CT angiography and CT venography

5. MR angiography and MR venography

C. Evaluation of the heart and great vessels

1. Electrocardiography

a. Monitoring

b. Holter and event monitors

2. TTE and TEE

a. Contrast-enhanced studies

3. Other chest imaging studies

a. Chest x-ray

b. Chest CT

c. Chest MRI

4. Other studies

a. Blood pressure monitoring

b. Blood cultures

c. Testing for ischemic heart disease

d. Peripheral artery disease

D. Other diagnostic studies

1. Hematologic studies

a. Blood count

b. Platelet count

c. Special coagulation studies

d. Antiplatelet (aspirin, clopidogrel) resistance studies

2. Immunological studies

a. Inflammatory markers

b. Other autoimmune studies (multisystem)

c. Serologic studies

3. Biochemical studies

a. Glucose

b. Cholesterol

c. Blood gases

d. Hepatic and renal tests

4. Urine tests

5. Biopsies

6. Evaluation for the complications of stroke

7. Evaluation for the consequences of stroke

a. Swallowing

b. Orthopedic

c. Other

8. Genetic testing

05. Causes of stroke

A. Atherosclerosis—ischemic stroke

1. Evaluation of patients prior to non-cerebrovascular operations

2. Asymptomatic bruit or stenosis

3. Aortic atherosclerosis

B. Non-atherosclerotic vasculopathies—ischemic stroke

1. Non-inflammatory

a. Dissection

b. Moyamoya disease

c. Fibromuscular dysplasia

d. Trauma

e. Radiation-induced vasculopathy

f. Saccular aneurysm

g. Other

2. Infectious

a. Syphilis

b. Herpes zoster

c. AIDS

d. Cysticercosis

e. Bacterial meningitis

f. Aspergillosis

g. Mucormycosis

h. Cat-scratch disease

i. Behçet syndrome

j. Other

3. Inflammatory, non-infectious (angiitis)

a. Isolated CNS vasculitis

b. Multisystem vasculitis

c. Cogan syndrome

d. Eales disease

e. Polyarteritis nodosa

f. Wegener granulomatosis with polyangiitis

g. Eosinophilic granulomatosis with polyangiitis (Churg-Strauss

syndrome)

h. Takayasu disease

i. Systemic lupus erythematosus

j. Scleroderma

k. Rheumatoid arthritis

l. Mixed connective tissue disease

m. Ulcerative colitis and regional enteritis

n. Sarcoidosis

o. Other

C. Migraine

D. Other causes of ischemic stroke

1. Kawasaki disease

2. Lyme disease

3. Susac syndrome

E. Genetic and metabolic causes of stroke

1. CADASIL

2. MELAS

3. Fabry-Anderson disease

4. Homocystinuria

5. Kearns-Sayre syndrome

6. Myoclonus epilepsy with ragged red fibers

7. Ehlers-Danlos syndrome, type IV

8. Marfan syndrome

9. CARASIL

10. Other monogenetic small vessel brain diseases

11. Other

F. Drugs that cause stroke, including drugs of abuse

G. Cerebral amyloid angiopathy—infarction or hemorrhage

H. Cardioembolic causes of stroke

1. Atrial fibrillation

2. Cardiovascular procedures and operations

3. Acute myocardial infarction

4. Dilated cardiomyopathy

5. Rheumatic mitral or aortic stenosis

6. Infective endocarditis

7. Libman-Sacks endocarditis

8. Non-bacterial thrombotic endocarditis

9. Mechanical or bioprosthetic valves

10. Atrial myxoma

11. Sick sinus syndrome

12. Mitral valve prolapse

13. Patent foramen ovale, including atrial septal aneurysm

14. Congenital heart diseases, including cyanotic heart disease

15. Other

I. Prothrombotic causes of stroke

1. Inherited

a. Sickle cell disease

b. Factor V Leiden—activated protein C resistance

c. Prothrombin gene mutation

d. Protein S, C, antithrombin

e. Thalassemia

f. Iron deficiency anemia

g. Others

2. Acquired

a. Pregnancy

b. Cancer

c. Dehydration

d. Thrombocytosis

e. Thrombotic thrombocytopenic purpura

f. Heparin-induced thrombocytopenia and thrombosis (HITT)

g. Leukemia

h. Disseminated intravascular coagulation

i. Nephrotic syndrome

j. Hemolytic uremic syndrome

k. Sepsis and inflammation

l. Other

3. Autoimmune causes of thrombosis

a. Lupus and lupus anticoagulant, Sneddon syndrome and

antiphospholipid antibodies

b. Others

4. Iatrogenic/drugs/toxins

a. Antineoplastic

b. Prothrombotic agents

c. Others

J. Bleeding diatheses

1. Inherited

a. Hemophilia

b. Sickle cell disease

c. Thalassemia

d. von Willebrands disease

e. Others

2. Acquired

a. Leukemia

b. Thrombocytopenia

c. Disseminated intravascular coagulation

d. Others

3. Systemic diseases

4. Iatrogenic/drugs/toxins

a. Anticoagulants

b. Antiplatelet aggregating agents

c. Thrombolytic agents

d. Drugs of abuse

e. Others

K. Aneurysms

1. Saccular

2. Infected

3. Traumatic

4. Neoplastic

5. Dolichoectatic

6. Dissecting

L. Vascular malformations

1. Arteriovenous

2. Developmental venous anomaly

3. Cavernous

4. Telangiectasia

5. Dural arteriovenous fistula

M. Trauma and intracranial bleeding

N. Moyamoya disease and syndrome

O. Hypertensive hemorrhage

P. Other causes of hemorrhage

1. Vasculitis

2. Tumors

a. Primary

b. Metastatic

3. Iatrogenic

Q. Genetic diseases causing hemorrhagic stroke

06. Complications of stroke

A. Early neurologic complications

1. Brain edema, increased ICP, and herniation

2. Hydrocephalus

3. Seizures

4. Hemorrhagic transformation

5. Recurrent infarction

6. Recurrent hemorrhage

7. Other

B. Early medical complications

1. Cardiac

2. Gastrointestinal

3. Pulmonary

4. Electrolyte

5. Other

C. Chronic neurologic sequelae

D. Chronic medical sequelae

07. Treatment of patients with stroke

A. Outpatient management

1. Patient educational materials

B. Medical therapies to prevent stroke

1. Antiplatelet agents

a. Aspirin

b. Clopidogrel

c. Ticlodipine

d. Dipyridamole

e. Cilostazol

f. Prasugrel

g. Ticagrelor

h. Others

2. Anticoagulant agents

a. Warfarin

b. Heparin

c. LMW heparins

d. Direct thrombin inhibitors

e. Factor X inhibitors

3. Thrombolytic agents

4. Neuroprotective agents and other acute treatments

5. Cardioactive agents

6. Medications to prevent stroke by treating risk factors

a. Hyperlipidemia

b. Diabetes mellitus

c. Hypertension

d. Smoking

e. Hyperhomocysteinemia

f. Antiinflammatory

g. Alcohol dependence and detoxification

7. Medications to treat autoimmune diseases and vasculitis

8. Medications to treat complications of stroke

a. Anticonvulsants

b. Antidepressants

c. Brain edema and increased ICP

i. Hypertonic saline

ii. Mannitol

9. Medications to Excellerate or restore neurologic function or to

augment rehabilitation

10. Medications to prevent rebleeding or vasospasm following a

hemorrhage

a. Aminocaproic acid

b. Tranexamic acid

c. Nimodipine

11. Antimigraine medications

12. Vitamins

13. Interactions between medications

C. Hyperacute treatment of ischemic stroke

1. Emergency department

a. Intravenous thrombolytics

b. Intra-arterial thrombolytics

c. Mechanical thrombectomy

d. Anticoagulants and antiplatelet agents

e. Antihypertensives

f. Anticonvulsants

g. Other

2. Hospitalization – general management

a. Prevention of recurrent stroke

b. Prevention of deep vein thrombosis and pulmonary

embolism

c. Blood pressure management

d. Treatment of complications

e. Treatment of comorbid diseases

f. Treatment of risk factors for stroke

g. Other

3. Intensive care unit

a. Osmotic agents

b. Steroids

c. Sedation

d. Blood products

e. Anti-vasospasm therapy

f. Management of ventriculostomy

g. Temperature control

h. Antiarrhythmics

i. Ventilator management

j. Pressors

k. Antibiotics

l. Other

4. Neurosurgical management

a. Hemorrhage

i. Evacuation

ii. Ventriculostomy

b. Ruptured aneurysms

i. Management of vasospasm

c. Vascular malformations

d. Surgical treatment of brain edema – decompressive

craniectomy

e. Other

D. Chronic care

1. Antidepressants

2. Sedatives

3. Stimulants

E. Treatment of venous thrombosis

F. Treatment of spinal cord vascular disease

G. Treatment of pituitary apoplexy

H. Professionalism, ethics, systems-based practice

1. Palliative care

2. End-of-life decisions

3. Advanced directives, informed consent, regulations

4. Other

08. Recovery, regenerative approaches, and rehabilitation

A. Functional test

B. Regeneration and plasticity

C. Predicting outcomes

D. Pharmacologic effects on recovery

E. Rehabilitation principles

F. Emerging approaches



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Warum sind Cyberrisiken so schwer greifbar?

Als mehr oder weniger neuartiges Phänomen stellen Cyberrisiken Unternehmen und Versicherer vor besondere Herausforderungen. Nicht nur die neuen Schadenszenarien sind abstrakter oder noch nicht bekannt. Häufig sind immaterielle Werte durch Cyberrisiken in Gefahr. Diese wertvollen Vermögensgegenstände sind schwer bewertbar.

Obwohl die Gefahr durchaus wahrgenommen wird, unterschätzen viele Firmen ihr eigenes Risiko. Dies liegt unter anderem auch an den Veröffentlichungen zu Cyberrisiken. In der Presse finden sich unzählige Berichte von Cyberattacken auf namhafte und große Unternehmen. Den Weg in die Presse finden eben nur die spektakulären Fälle. Die dort genannten Schadenszenarien werden dann für das eigene Unternehmen als unrealistisch eingestuft. Die für die KMU nicht minder gefährlichen Cyber­attacken werden nur selten publiziert.

Aufgrund der fehlenden öffentlichen Meldungen von Sicherheitsvorfällen an Sicherheitsbehörden und wegen der fehlenden Presseberichte fällt es schwer, Fakten und Zahlen zur Risikolage zu erheben. Aber ohne diese Grundlage fällt es schwer, in entsprechende Sicherheitsmaßnahmen zu investieren.

Erklärungsleitfaden anhand eines Ursache-Wirkungs-Modells

Häufig nähert man sich dem Thema Cyberrisiko anlass- oder eventbezogen, also wenn sich neue Schaden­szenarien wie die weltweite WannaCry-Attacke entwickeln. Häufig wird auch akteursgebunden beleuchtet, wer Angreifer oder Opfer sein kann. Dadurch begrenzt man sich bei dem Thema häufig zu sehr nur auf die Cyberkriminalität. Um dem Thema Cyberrisiko jedoch gerecht zu werden, müssen auch weitere Ursachen hinzugezogen werden.

Mit einer Kategorisierung kann das Thema ganzheitlich und nachvollziehbar strukturiert werden. Ebenso hilft eine solche Kategorisierung dabei, eine Abgrenzung vorzunehmen, für welche Gefahren Versicherungsschutz über eine etwaige Cyberversicherung besteht und für welche nicht.

Die Ursachen sind dabei die Risiken, während finanzielle bzw. nicht finanzielle Verluste die Wirkungen sind. Cyberrisiken werden demnach in zwei Hauptursachen eingeteilt. Auf der einen Seite sind die nicht kriminellen Ursachen und auf der anderen Seite die kriminellen Ursachen zu nennen. Beide Ursachen können dabei in drei Untergruppen unterteilt werden.

Nicht kriminelle Ursachen

Höhere Gewalt

Häufig hat man bei dem Thema Cyberrisiko nur die kriminellen Ursachen vor Augen. Aber auch höhere Gewalt kann zu einem empfindlichen Datenverlust führen oder zumindest die Verfügbarkeit von Daten einschränken, indem Rechenzentren durch Naturkatastrophen wie beispielsweise Überschwemmungen oder Erdbeben zerstört werden. Ebenso sind Stromausfälle denkbar.

Menschliches Versagen/Fehlverhalten

Als Cyberrisiken sind auch unbeabsichtigtes und menschliches Fehlverhalten denkbar. Hierunter könnte das versehentliche Veröffentlichen von sensiblen Informationen fallen. Möglich sind eine falsche Adressierung, Wahl einer falschen Faxnummer oder das Hochladen sensibler Daten auf einen öffentlichen Bereich der Homepage.

Technisches Versagen

Auch Hardwaredefekte können zu einem herben Datenverlust führen. Neben einem Überhitzen von Rechnern sind Kurzschlüsse in Systemtechnik oder sogenannte Headcrashes von Festplatten denkbare Szenarien.

Kriminelle Ursachen

Hackerangriffe

Hackerangriffe oder Cyberattacken sind in der Regel die Szenarien, die die Presse dominieren. Häufig wird von spektakulären Datendiebstählen auf große Firmen oder von weltweiten Angriffen mit sogenannten Kryptotrojanern berichtet. Opfer kann am Ende aber jeder werden. Ziele, Methoden und auch das Interesse sind vielfältig. Neben dem finanziellen Interesse können Hackerangriffe auch zur Spionage oder Sabotage eingesetzt werden. Mögliche Hackermethoden sind unter anderem: Social Engineering, Trojaner, DoS-Attacken oder Viren.

Physischer Angriff

Die Zielsetzung eines physischen Angriffs ist ähnlich dem eines Hacker­angriffs. Dabei wird nicht auf die Tools eines Hackerangriffs zurückgegriffen, sondern durch das physische Eindringen in Unternehmensgebäude das Ziel erreicht. Häufig sind es Mitarbeiter, die vertrauliche Informationen stehlen, da sie bereits den notwendigen Zugang zu den Daten besitzen.

Erpressung

Obwohl die Erpressung aufgrund der eingesetzten Methoden auch als Hacker­angriff gewertet werden könnte, ergibt eine Differenzierung Sinn. Erpressungsfälle durch Kryptotrojaner sind eines der häufigsten Schadenszenarien für kleinere und mittelständische Unternehmen. Außerdem sind auch Erpressungsfälle denkbar, bei denen sensible Daten gestohlen wurden und ein Lösegeld gefordert wird, damit sie nicht veröffentlicht oder weiterverkauft werden.

Ihre Cyberversicherung sollte zumindet folgende Schäden abdecken:

Cyber-Kosten:

  • Soforthilfe und Forensik-Kosten (Kosten der Ursachenermittlung, Benachrichtigungskosten und Callcenter-Leistung)
  • Krisenkommunikation / PR-Maßnahmen
  • Systemverbesserungen nach einer Cyber-Attacke
  • Aufwendungen vor Eintritt des Versicherungsfalls

Cyber-Drittschäden (Haftpflicht):

  • Befriedigung oder Abwehr von Ansprüchen Dritter
  • Rechtswidrige elektronische Kommunikation
  • Ansprüche der E-Payment-Serviceprovider
  • Vertragsstrafe wegen der Verletzung von Geheimhaltungspflichten und Datenschutzvereinbarungen
  • Vertragliche Schadenersatzansprüche
  • Vertragliche Haftpflicht bei Datenverarbeitung durch Dritte
  • Rechtsverteidigungskosten

Cyber-Eigenschäden:

  • Betriebsunterbrechung
  • Betriebsunterbrechung durch Ausfall von Dienstleister (optional)
  • Mehrkosten
  • Wiederherstellung von Daten (auch Entfernen der Schadsoftware)
  • Cyber-Diebstahl: elektronischer Zahlungsverkehr, fehlerhafter Versand von Waren, Telefon-Mehrkosten/erhöhte Nutzungsentgelte
  • Cyber-Erpressung
  • Entschädigung mit Strafcharakter/Bußgeld
  • Ersatz-IT-Hardware
  • Cyber-Betrug