stroke

Question 1

features

Answer 1

motor weakness
speech problems - dysphasia
swallowing problems - dysphagia
homonoymous hemianopia
balance problems

Question 2

features of cerebral hemisphere infarcts

Answer 2

contralateral hemiplegia
contralaterol sensory loss
homonymous hemianopia
dysphagia

Question 3

features of brainstem infarction

Answer 3

quadriplegia

locked in syndrome

Question 4

lacunar infarcs

Answer 4

small infarcts around basal ganglia, internal capsule, thalamus and pons

Question 5

lacunar infarct features

Answer 5

pure motor, pure sensoyr, mixed motor + sensory or ataxia

Question 6

total anterior circulation infarct - what vessel

Answer 6

involves middle and anterior cerebral arteries

Question 7

total anterior circulation infarct - criteria

Answer 7

3/3 of

• unilateral hemiparesis and/or hemisensory loss
• homonymous hemianopia
• higher cognitive dysfunctio ne.g. dysphasia

Question 8

partial anterior circulation infarct - which vessels

Answer 8

involves smaller arteries of anterior circulation

e.g. upper or lower divisions middle cerebral artery

Question 9

partial anterior circulation infarct - criteria

Answer 9

2/3 of

• unilateral hemiparesis and/or hemisensory loss
• homonymous hemianopia
• higher cogntive funciton decline e.g. dysphasia

Question 10

Lacunar Infarcts - which vessels

Answer 10

perforating arteries around internal capsule, thalamus and basal ganglia

Question 11

lacunar infarcts - criteria

Answer 11

1 of

• unilateral weakness (and/or sensory deficit)
• pure sensory stroke
• ataxic hemiparesis

Question 12

posterior circulation infarcts - which vessel

Answer 12

involves vertebrobasilar arteries

Question 13

posterior circulation infarcts - criteria

Answer 13

1 of

• cerebellar or brainstem syndromes
• loss consciousness
• isolated homonymous hemianopia

Question 14

haemorrhagic stroke - more likely to have

Answer 14

decrease level of consciousness
headache
N&V
seizure

Question 15

Ix

Answer 15

need emergency neuroimaging
CT
MRI

Question 16

Mx ischamic strokes

Answer 16

thrombolysis

aspirin 300mg

Question 17

Mx TIA

Answer 17

aspirin 300mg unless contraindicated

Question 18

what is given as thombolysus

Answer 18

alteplase

Question 19

thrombolysis should only be given if

Answer 19

• administered within 4.5hrs of onset stroke symptoms

- haemorrhage definitevly excluded i.e imaging

Question 20

absolute contraindication to thrombolysis

Answer 20

• prev intracranial haemorrhage
• seizure at stroke onset
• intracranial neoplasm
• suspected SAH
• stroke/traumatic brain injury last 3mo
• LP in last 7 days
• GI bleed last 3wks
• active bleeding
• pregnant
• uncontrolled htn 200/120

Question 21

relative contraindications to thrombolysis

Answer 21

• concurrent anticoagulation INR >1.7
• haemorrhagic diathesis
• active diabetic haemorrhagic retinopathy
• suspectedintracardiac thrombus
• major surgery/trauma last 2wks

Question 22

when to offer thombectomy within 6hrs + IV thrombolysis

Answer 22

acute ischaemic stroke

confirmed occlusion of proximal anterior circulation by CTA or MRA

Question 23

offer thrombectomy ASAP to people …

Answer 23

last known to be well between 6-24hrs ago
confirmded occlusoin proximal anterior circulation
potential to salvage brain tisssue

Question 24

2ry prevention

Answer 24

clopedigrol