100+ Free ABPN Vascular Neurology Practice Questions

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A 68-year-old right-handed woman presents with acute onset right face and arm weakness greater than leg, global aphasia, and right-sided neglect. Which vascular territory is most likely affected?

Right middle cerebral artery (MCA) territory

Left anterior cerebral artery (ACA) territory

Left posterior cerebral artery (PCA) territory

Left middle cerebral artery (MCA) territory

to track

2026 Statistics

Key Facts: ABPN Vascular Neurology Exam

~200

Total MCQ Items

ABPN Vascular Neurology subspecialty exam

4.5 h

IV Alteplase Window

From last known well (AHA/ASA 2019)

24 h

Thrombectomy Window

Extended via DAWN with clinical-core mismatch

$2,200

2026 Exam Fee

ABPN Vascular Neurology subspecialty

1 yr

Fellowship Training

ACGME-accredited Vascular Neurology fellowship

Pearson VUE

Test Delivery

Computer-based testing at authorized centers

The ABPN Vascular Neurology subspecialty exam is a 1-day computer-based test at Pearson VUE with ~200 single-best-answer MCQs. The 2026 content outline emphasizes acute ischemic stroke syndromes and NIHSS (~15%), IV thrombolysis (~8%), endovascular thrombectomy (~8%), hemorrhagic stroke — ICH and SAH (~10%), stroke mechanism and TOAST/ESUS (~5%), dissection and CVST (~7%), secondary prevention (~10%), specific etiologies and young stroke (~8%), stroke in pregnancy and pediatrics (~5%), neuroimaging (~10%), and vasculopathies/systems of care/post-stroke (~14%). Exam fee is ~$2,200; requires primary ABPN Neurology certification plus 1-year ACGME Vascular Neurology fellowship.

Sample ABPN Vascular Neurology Practice Questions

Try these sample questions to test your ABPN Vascular Neurology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 68-year-old right-handed woman presents with acute onset right face and arm weakness greater than leg, global aphasia, and right-sided neglect. Which vascular territory is most likely affected?

A.Right middle cerebral artery (MCA) territory

B.Left anterior cerebral artery (ACA) territory

C.Left posterior cerebral artery (PCA) territory

D.Left middle cerebral artery (MCA) territory

Explanation: MCA territory infarcts cause contralateral face and arm weakness greater than leg (motor cortex somatotopy), aphasia if the dominant (usually left) hemisphere is involved, and hemineglect if the non-dominant hemisphere is involved. ACA causes leg > arm weakness. PCA produces homonymous hemianopsia with relative sparing of motor function.

2A patient presents with isolated pure motor hemiparesis involving the face, arm, and leg equally, without sensory, visual, or cortical findings. Which lesion location is most likely?

A.Cortical MCA branch infarct

B.Posterior limb of the internal capsule (lacunar infarct)

C.Thalamic infarct

D.Pontine basis

Explanation: Pure motor hemiparesis is the classic lacunar syndrome localizing to the posterior limb of the internal capsule (or pontine basis). The hallmark is proportional weakness of face, arm, and leg with NO cortical signs (no aphasia, neglect, or hemianopsia) and NO sensory involvement.

3A 72-year-old man develops sudden vertigo, ipsilateral facial numbness, Horner syndrome, ataxia, dysphagia, and contralateral body pain/temperature loss. Which syndrome is this?

A.Millard-Gubler syndrome

B.Weber syndrome

C.Locked-in syndrome

D.Wallenberg (lateral medullary) syndrome

Explanation: Wallenberg syndrome (lateral medullary, PICA/vertebral artery) features ipsilateral facial pain/temperature loss (spinal trigeminal), Horner syndrome (descending sympathetics), ataxia (inferior cerebellar peduncle), dysphagia/dysarthria (nucleus ambiguus), vertigo/nystagmus (vestibular), and contralateral body pain/temperature loss (spinothalamic).

4A 65-year-old presents with right homonymous hemianopsia and inability to read, but preserved writing ability. Which stroke syndrome is this?

A.Bilateral occipital infarct — cortical blindness

B.Left MCA infarct with Wernicke aphasia

C.Left PCA infarct — alexia without agraphia

D.Anton syndrome

Explanation: Alexia without agraphia occurs with a left PCA infarct involving the left occipital cortex AND the splenium of the corpus callosum. Writing is preserved because language areas are intact; reading fails because visual input from the intact right occipital cortex cannot cross the destroyed splenium to reach left-hemisphere language areas.

5A patient with acute stroke has complete paralysis except for vertical eye movements and blinking, with preserved consciousness. Which occlusion is responsible?

A.Anterior spinal artery occlusion

B.Bilateral MCA occlusion

C.Basilar artery occlusion (ventral pontine infarct) — locked-in syndrome

D.Cerebellar hemorrhage

Explanation: Locked-in syndrome results from ventral pontine infarction, typically due to basilar artery occlusion. Corticospinal and corticobulbar tracts are disrupted bilaterally (quadriplegia, anarthria) while the reticular formation and tegmentum (consciousness) and the oculomotor nuclei (vertical gaze) are spared. Vertical eye movements and blinking provide the only communication channel.

6A stroke patient has contralateral leg weakness greater than arm, urinary incontinence, and abulia. Which vascular territory is involved?

A.Anterior choroidal artery

B.Middle cerebral artery (MCA)

C.Posterior cerebral artery (PCA)

D.Anterior cerebral artery (ACA)

Explanation: ACA infarcts cause contralateral leg > arm weakness (medial motor cortex), urinary incontinence (paracentral lobule), and abulia, apathy, or akinetic mutism (bilateral or dominant medial frontal involvement).

7What is the maximum total NIHSS score possible?

A.50

B.30

C.15

D.42

Explanation: The NIHSS consists of 15 items scored from 0 to a maximum total of 42. Items assess level of consciousness, orientation, commands, gaze, visual fields, facial palsy, motor arm and leg, limb ataxia, sensory, language, dysarthria, and extinction/inattention.

8On the NIHSS, a patient who is unresponsive and requires painful stimuli to make non-stereotyped movements receives what score on Item 1a (Level of Consciousness)?

A.3 (reflex response or unresponsive)

B.0 (alert)

C.1 (drowsy but arousable)

D.2 (responds only to repeated or painful stimuli)

Explanation: NIHSS Item 1a LOC: 0 = alert/keenly responsive; 1 = drowsy but arousable to minor stimulation; 2 = obtunded/stuporous, requires repeated or painful stimuli; 3 = coma with only reflex motor/autonomic responses or totally unresponsive.

9A patient has pure hemisensory loss of the face, arm, and leg contralateral to the lesion without motor, visual, or cortical findings. Where is the most likely lacunar lesion?

A.Corona radiata

B.Posterior limb of the internal capsule

C.Ventral posterolateral (VPL) nucleus of the thalamus

D.Pontine tegmentum

Explanation: Pure sensory stroke is the lacunar syndrome of the VPL thalamus. Hemisensory loss involves face, arm, and leg equally and is not accompanied by motor, language, or visual findings, distinguishing it from cortical lesions.

10A patient develops dysarthria with clumsy hand on the contralateral side. Which lacunar syndrome and typical location is this?

A.Ataxic hemiparesis — posterior limb of internal capsule

B.Wallenberg syndrome — lateral medulla

C.Pure motor hemiparesis — internal capsule

D.Dysarthria-clumsy hand — basis pontis or genu of internal capsule

Explanation: Dysarthria-clumsy hand syndrome typically localizes to the basis pontis or the genu of the internal capsule and is one of the classic lacunar syndromes. Ataxic hemiparesis (another lacunar syndrome) usually involves the posterior limb of the internal capsule or pons.

About the ABPN Vascular Neurology Exam

The ABPN Vascular Neurology Subspecialty Certification Examination is a 1-day computer-based test for neurologists who have completed a 1-year ACGME-accredited vascular neurology (stroke) fellowship after primary ABPN Neurology or Child Neurology certification. The exam contains approximately 200 single-best-answer MCQs covering acute ischemic stroke syndromes and NIHSS, IV thrombolysis (alteplase and tenecteplase), endovascular thrombectomy for large vessel occlusion (DAWN, DEFUSE-3, SELECT2, BAOCHE), hemorrhagic stroke (ICH, SAH, CAA) with anticoagulant reversal, cervical artery dissection, cerebral venous sinus thrombosis, TOAST classification and ESUS, secondary prevention (CHANCE/POINT/THALES, NASCET CEA, SAMMPRIS, PFO closure), young stroke and hypercoagulable states, stroke in pregnancy, pediatric stroke, CADASIL/MELAS/Fabry/moyamoya/sickle cell, neuroimaging (CT perfusion, DWI/FLAIR mismatch, ASPECTS), RCVS and PACNS, stroke systems of care and door-to-needle metrics, and post-stroke rehabilitation.

Questions

200 scored questions

Time Limit

1-day CBT

Passing Score

Criterion-referenced scaled score set by ABPN

Exam Fee

~$2,200 ABPN Vascular Neurology subspecialty exam fee (2026) (American Board of Psychiatry and Neurology (ABPN) / Pearson VUE)

ABPN Vascular Neurology Exam Content Outline

~15%

Acute Ischemic Stroke & Syndromes

MCA (contralateral face/arm > leg weakness, aphasia if left dominant, neglect if right non-dominant), ACA (leg > arm, abulia), PCA (homonymous hemianopsia, alexia without agraphia), lacunar syndromes (pure motor internal capsule, pure sensory thalamus, ataxic hemiparesis, clumsy hand-dysarthria), brainstem (locked-in basilar, Wallenberg lateral medullary, Weber midbrain). NIHSS 15 items 0-42, localization, recrudescence with metabolic stress.

~8%

IV Thrombolysis

Alteplase 0-4.5 h from last known well at 0.9 mg/kg (max 90 mg; 10% bolus, 90% over 60 min). Exclusions — BP >185/110 after antihypertensives, platelets <100K, INR >1.7, therapeutic anticoagulation, recent major surgery/bleeding, prior ICH, hypoglycemia <50. Tenecteplase 0.25 mg/kg bolus (NOR-TEST, EXTEND-IA TNK, AcT 2022). Extended window imaging selection (WAKE-UP, EXTEND). Antiplatelets deferred 24 h. sICH and angioedema complications.

~8%

Endovascular Thrombectomy

Large vessel occlusion (ICA, M1, proximal M2, basilar, vertebral). Anterior circulation 0-24 h — DAWN (6-24 h clinical-core mismatch), DEFUSE-3 (6-16 h perfusion mismatch). ASPECTS ≥6 standard; SELECT2, RESCUE-Japan LIMIT, ANGEL-ASPECT 2023 extended to large cores (ASPECTS 3-5). Bridging IV tPA vs direct thrombectomy — SKIP, DIRECT-MT, MR-CLEAN-NoIV, SWIFT-DIRECT, DIRECT-SAFE. Basilar occlusion positive (ATTENTION 2023, BAOCHE 2023).

~10%

Hemorrhagic Stroke (ICH & SAH)

ICH — hypertensive (basal ganglia, thalamus, pons, cerebellum) vs CAA (lobar). Anticoagulant reversal — warfarin (4-factor PCC + vitamin K), dabigatran (idarucizumab), Xa inhibitors (andexanet alfa). INTERACT-2 SBP <140 within 6 h. ICH Score. SAH — aneurysmal thunderclap HA, Hunt-Hess 1-5, modified Fisher 1-4, xanthochromia on LP, CTA/DSA, coiling vs clipping (ISAT 2002), nimodipine 60 mg PO q4h × 21 d, vasospasm days 4-14, TCD monitoring, DCI, EVD for acute hydrocephalus.

~10%

Secondary Prevention

Antiplatelets — ASA, clopidogrel; DAPT ASA+clopidogrel 21-90 days after minor stroke/high-risk TIA (CHANCE, POINT, SAMMPRIS). Ticagrelor (THALES); CHANCE-2 for CYP2C19 LOF alleles. AF anticoagulation — CHA2DS2-VASc ≥2 men/≥3 women, DOACs first-line (apixaban, rivaroxaban, dabigatran, edoxaban) except mechanical valve/mod-severe MS. Symptomatic carotid 70-99% → CEA within 2 weeks (NASCET). Intracranial stenosis — aggressive medical > Wingspan (SAMMPRIS). PFO closure <60 y (RESPECT, CLOSE, REDUCE, DEFENSE-PFO). Statin (SPARCL), BP <130/80.

~10%

Neuroimaging & Diagnostics

Non-contrast CT — hyperdense MCA sign, early loss of gray-white differentiation, ASPECTS 10-point MCA scale. CT perfusion — CBF, CBV, Tmax, MTT; core (CBF <30%) vs penumbra (Tmax >6 s). CTA head/neck. MRI — DWI/ADC hyperacute infarct; FLAIR positive after ~4.5 h (DWI/FLAIR mismatch for wake-up stroke per WAKE-UP). MRA, vessel wall imaging for vasculitis/dissection. Carotid Doppler, TCD, TEE (PFO, LAA thrombus), cardiac MRI, Holter/implantable loop recorder (CRYSTAL-AF, STROKE-AF).

~8%

Specific Etiologies & Young Stroke

Cardioembolic (AF, LV thrombus post-MI, endocarditis, PFO/ASD, myxoma). CADASIL (NOTCH3 — subcortical infarcts, dementia, migraine). MELAS (mtDNA, lactic acidosis). Sickle cell (TCD ≥200 cm/s → chronic transfusion). Fabry (X-linked alpha-galactosidase A; skin angiokeratomas + renal + cardiac; agalsidase ERT). Moyamoya (Asian populations, EC-IC bypass). APS — lupus anticoagulant, anti-cardiolipin, anti-β2GP1 (Sydney criteria, 2 of 3 positive 12 wks apart + clinical event); warfarin INR 2-3; rivaroxaban inferior in triple-positive (TRAPS). Protein C/S/AT, factor V Leiden, prothrombin G20210A.

~7%

Dissection & Cerebral Venous Thrombosis

Cervical artery dissection — traumatic (hyperextension, chiropractic) vs spontaneous (Ehlers-Danlos IV, Marfan, FMD). Antithrombotic choice — CADISS showed no difference between antiplatelet and anticoagulation; TREAT-CAD supports aspirin. CVST — dural sinus thrombosis from pregnancy, OCP, dehydration, thrombophilia, mastoiditis; presents with HA, papilledema, seizures, focal deficits; MRV/CTV; anticoagulation LMWH/UFH then warfarin or DOAC for 3-6 months.

~5%

Stroke Mechanism (TOAST & ESUS)

TOAST — large artery atherosclerosis, cardioembolism, small-vessel occlusion (lacunar), other determined etiology (dissection, coagulopathy, vasculopathy), cryptogenic/undetermined. ESUS — embolic stroke of undetermined source; RESPECT-ESUS (dabigatran) and NAVIGATE-ESUS (rivaroxaban) negative vs aspirin. Extended monitoring with implantable loop recorder doubles AF detection (CRYSTAL-AF, STROKE-AF).

~5%

Stroke in Pregnancy & Pediatric Stroke

Pregnancy — elevated risk in 3rd trimester and postpartum; eclampsia (MgSO4, delivery), CVST, AVM rupture, PRES. Pediatric — sickle cell disease (TCD >200 → chronic transfusion per STOP trial), moyamoya, congenital heart disease, dissection, post-varicella (focal cerebral arteriopathy). Management typically aspirin; anticoagulation in select cases.

~14%

Vasculopathies, Systems of Care & Post-Stroke

RCVS (recurrent thunderclap HA, postpartum or vasoactive drug-induced, usually benign), PACNS (progressive encephalopathy + multifocal deficits, LP pleocytosis, angiographic narrowing, biopsy for diagnosis, immunosuppression), FMD (string of beads). Stroke centers — Acute Stroke Ready, Primary, Thrombectomy-capable, Comprehensive; telestroke; Mobile Stroke Units. Door-to-needle <60 min (<45 target). GWTG-Stroke registry. Post-stroke — aspiration screening, VTE prophylaxis with IPC ± LMWH if non-hemorrhagic, dysphagia, post-stroke depression (FOCUS/AFFINITY/EFFECTS fluoxetine negative), spasticity (BTX, baclofen, tizanidine), post-stroke seizures, rehab.

How to Pass the ABPN Vascular Neurology Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABPN
Exam length: 200 questions
Time limit: 1-day CBT
Exam fee: ~$2,200 ABPN Vascular Neurology subspecialty exam fee (2026)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABPN Vascular Neurology Study Tips from Top Performers

1IV alteplase dosing: 0.9 mg/kg with a maximum dose of 90 mg. Give 10% as an IV bolus over 1 minute, then the remaining 90% as an infusion over 60 minutes. The time window is 0-4.5 h from last known well (LKW), not from symptom discovery. For wake-up strokes, use DWI/FLAIR mismatch on MRI (DWI-positive, FLAIR-negative) per WAKE-UP to identify patients within the 4.5 h metabolic window even when LKW is unknown.

2DAWN vs DEFUSE-3 thrombectomy windows: DAWN (6-24 h) uses clinical-core mismatch — high NIHSS with small infarct core on CTP or DWI. DEFUSE-3 (6-16 h) uses perfusion-core mismatch — mismatch ratio ≥1.8, mismatch volume ≥15 mL, core <70 mL on CT perfusion. Standard ASPECTS cutoff is ≥6 for thrombectomy; SELECT2, RESCUE-Japan LIMIT, and ANGEL-ASPECT (2023) extended benefit to large cores (ASPECTS 3-5). Basilar occlusion thrombectomy is supported by ATTENTION and BAOCHE (2023).

3Anticoagulant reversal in ICH: Warfarin → 4-factor prothrombin complex concentrate (4F-PCC, e.g., Kcentra) 25-50 units/kg IV + vitamin K 10 mg IV (faster and less volume than FFP). Dabigatran → idarucizumab 5 g IV. Factor Xa inhibitors (apixaban, rivaroxaban, edoxaban) → andexanet alfa (FDA-approved 2018) or 4F-PCC. Target SBP <140 within 6 h per INTERACT-2 (no benefit <120 per ATACH-2).

4SAH management pearls: Nimodipine 60 mg PO q4h for 21 days improves outcome by preventing delayed cerebral ischemia (DCI) — it does NOT prevent angiographic vasospasm but works via neuroprotection. Vasospasm peaks days 4-14. Monitor with TCD (mean MCA velocity >120 cm/s suspicious, >200 cm/s severe; Lindegaard ratio >3 MCA/ICA). Treatment of symptomatic vasospasm: induced hypertension (permissive HTN now; old 'triple-H' abandoned), intra-arterial vasodilators, angioplasty. Secure aneurysm within 72 h by coiling (ISAT 2002: better outcomes than clipping for amenable lesions) or clipping.

5Short-term DAPT after minor stroke/high-risk TIA: CHANCE (Chinese, 21 days) and POINT (global, 90 days) showed ASA+clopidogrel reduces early recurrent stroke vs ASA alone in NIHSS ≤3 or ABCD2 ≥4 TIA. POINT found bleeding risk rises after day 21 → current guideline is DAPT for 21 days then ASA monotherapy. THALES added ticagrelor+ASA as alternative. CHANCE-2 showed ticagrelor+ASA > clopidogrel+ASA in CYP2C19 loss-of-function allele carriers. SAMMPRIS used 90-day DAPT for symptomatic intracranial stenosis and also showed aggressive medical management beats Wingspan stenting.

Frequently Asked Questions

What is the ABPN Vascular Neurology Subspecialty Examination?

The ABPN Vascular Neurology Subspecialty Certification Examination is a 1-day computer-based test administered by the American Board of Psychiatry and Neurology (ABPN) at Pearson VUE test centers. It certifies expertise in the evaluation and management of patients with cerebrovascular disease, including acute ischemic and hemorrhagic stroke, transient ischemic attack, cerebral venous thrombosis, cervical and intracranial vasculopathies, and stroke prevention. The exam is taken after primary ABPN Neurology or Child Neurology certification and a 1-year ACGME-accredited Vascular Neurology fellowship.

Who is eligible to sit for the Vascular Neurology subspecialty exam?

Candidates must hold primary ABPN certification in Neurology or Child Neurology, have completed a 1-year ACGME-accredited Vascular Neurology fellowship with fellowship director attestation of satisfactory completion, and hold a valid unrestricted medical license at the time of examination. Application is submitted through the ABPN website during the designated eligibility window.

What is the format of the exam?

The exam is a 1-day computer-based test delivered at Pearson VUE test centers. It consists of approximately 200 single-best-answer multiple-choice items covering the full 2026 ABPN Vascular Neurology content outline. Questions frequently include clinical vignettes with neuroimaging (non-contrast CT, CTA, CT perfusion, DWI/FLAIR MRI, MRA, DSA), vascular territory diagrams, and decision trees for IV thrombolysis and endovascular thrombectomy eligibility.

How much does the 2026 ABPN Vascular Neurology exam cost?

The 2026 exam fee is approximately $2,200. Cancellation and refund policies follow the ABPN schedule with decreasing refunds as the exam date approaches. Retakes within the eligibility window require full re-registration and fee payment. Enrollment in the ABPN Continuing Certification program includes annual activities and associated fees.

What are the highest-yield topics?

Highest-yield topics include: IV alteplase eligibility (0-4.5 h, 0.9 mg/kg, exclusions including BP >185/110, INR >1.7, platelets <100K) and tenecteplase 0.25 mg/kg; endovascular thrombectomy for LVO using DAWN (6-24 h clinical-core mismatch) and DEFUSE-3 (6-16 h perfusion mismatch) with extension to larger cores via SELECT2/RESCUE-Japan LIMIT/ANGEL-ASPECT; basilar occlusion (ATTENTION, BAOCHE); INTERACT-2 BP target <140 in ICH; anticoagulant reversal (PCC for warfarin, idarucizumab for dabigatran, andexanet alfa for Xa inhibitors); SAH management with nimodipine 60 mg q4h × 21 days; CHANCE/POINT/THALES short-term DAPT; NASCET for symptomatic carotid; SAMMPRIS (medical > stent for intracranial); PFO closure trials (RESPECT, CLOSE, REDUCE, DEFENSE-PFO); and CADASIL/MELAS/Fabry/moyamoya/sickle cell young stroke etiologies.

How should I study for the Vascular Neurology boards?

Plan 200-400 hours over 6-12 months during and after fellowship. Core resources include Caplan's Stroke: A Clinical Approach, Stroke: Pathophysiology, Diagnosis, and Management (Grotta/Albers), Continuum Lifelong Learning in Neurology — Cerebrovascular Disease issues, the AHA/ASA 2019 acute ischemic stroke guideline and 2022 guideline for spontaneous ICH and aneurysmal SAH, and the ABPN Vascular Neurology Core Curriculum. Drill high-volume MCQs with timed sets, master trial acronyms (DAWN, DEFUSE-3, SELECT2, ATTENTION, BAOCHE, CHANCE, POINT, THALES, NASCET, SAMMPRIS, RESPECT, INTERACT-2), and complete 2-3 full-length timed mock exams.

When is the 2026 exam administered?

ABPN subspecialty exams are typically offered annually. Applications open months before the exam with a submission deadline prior to the testing window, after which candidates schedule specific Pearson VUE appointments. Exact 2026 dates should be confirmed on the ABPN Vascular Neurology page.

How is the exam scored?

ABPN uses a criterion-referenced scaled scoring system with a passing standard set by subject-matter experts. A candidate's pass/fail result depends on performance relative to the fixed cut-score rather than on other test-takers. Score reports include subdomain performance to guide future learning. Results are typically released several weeks after the testing window closes.