Stroke

Question 1

What defines a stroke?

Answer 1

Sudden focal neurological deficit lasting >24 hours from a vascular cause.

Question 2

What defines a transient ischaemic attack (TIA)?

Answer 2

Identical pathophysiology to stroke but symptoms resolve <24 hours (usually <1 hour) and no infarct on imaging.

Question 3

What percentage of strokes are ischaemic?

Answer 3

Approximately 85 percent.

Question 4

What percentage of strokes are haemorrhagic?

Answer 4

Approximately 15 percent.

Question 5

What artery supplies the medial frontal and parietal lobes?

Answer 5

Anterior cerebral artery (ACA).

Question 6

What clinical pattern suggests ACA stroke?

Answer 6

Contralateral leg > arm weakness, abulia, urinary incontinence.

Question 7

What artery supplies the lateral frontal, parietal, and temporal lobes?

Answer 7

Middle cerebral artery (MCA).

Question 8

What pattern suggests MCA stroke?

Answer 8

Contralateral face and arm > leg weakness; aphasia if dominant; neglect if non-dominant.

Question 9

What artery supplies the occipital cortex and thalamus?

Answer 9

Posterior cerebral artery (PCA).

Question 10

What visual deficit is typical of PCA stroke?

Answer 10

Contralateral homonymous hemianopia with macular sparing.

Question 11

What are the hallmark signs of a brainstem stroke?

Answer 11

‘Crossed’ cranial nerve palsy with contralateral limb weakness or sensory loss.

Question 12

What causes pure motor hemiparesis without cortical signs?

Answer 12

Lacunar stroke of the internal capsule (posterior limb).

Question 13

What causes pure sensory stroke?

Answer 13

Lacunar infarct in the thalamic ventral posterolateral (VPL) nucleus.

Question 14

What syndrome causes bilateral arm weakness with leg sparing?

Answer 14

Watershed (ACA–MCA) ‘man-in-a-barrel’ syndrome.

Question 15

What are key features of lateral medullary (Wallenberg) syndrome?

Answer 15

Ipsilateral facial pain/temp loss, contralateral body pain/temp loss, dysphagia, hoarseness, vertigo, Horner’s, ataxia.

Question 16

What are key features of medial medullary syndrome?

Answer 16

Contralateral hemiparesis and proprioception loss with ipsilateral tongue weakness (hypoglossal palsy).

Question 17

What vessel causes Wallenberg syndrome?

Answer 17

Posterior inferior cerebellar artery (PICA).

Question 18

What vessel causes Weber syndrome?

Answer 18

Midbrain infarct from posterior cerebral artery branches.

Question 19

What are features of basilar artery occlusion?

Answer 19

Quadriplegia, anarthria, preserved consciousness (‘locked-in syndrome’).

Question 20

What immediate investigation must every stroke patient have?

Answer 20

Non-contrast CT brain to exclude haemorrhage.

Question 21

When must CT be done in suspected stroke?

Answer 21

Within 20 minutes of arrival.

Question 22

What are early CT signs of ischaemic stroke?

Answer 22

Loss of insular ribbon, obscured lentiform nucleus, sulcal effacement.

Question 23

What is the thrombolysis window for ischaemic stroke?

Answer 23

Up to 4.5 hours from symptom onset.

Question 24

What is the dose of alteplase for stroke thrombolysis?

Answer 24

0.9 mg/kg (max 90 mg): 10 percent bolus, 90 percent infusion over 1 hour.

Question 25

What is the dose of tenecteplase for stroke thrombolysis?

Answer 25

0.25 mg/kg (max 25 mg) single IV bolus.

Question 26

What is the pre-lysis blood pressure requirement?

Answer 26

Less than 185/110 mmHg.

Question 27

What is the post-lysis BP target?

Answer 27

Maintain <180/105 mmHg for 24 hours.

Question 28

What should be avoided for 24 hours after thrombolysis?

Answer 28

Antiplatelet or anticoagulant therapy until repeat imaging excludes haemorrhage.

Question 29

What is the time window for mechanical thrombectomy?

Answer 29

Up to 24 hours from onset if perfusion-core mismatch (DAWN/DEFUSE 3 criteria).

Question 30

What is the main contraindication to thrombolysis?

Answer 30

Intracranial haemorrhage or large established infarct on CT.

Question 31

When should aspirin be started after ischaemic stroke without thrombolysis?

Answer 31

Immediately after CT excludes haemorrhage.

Question 32

When should aspirin be started after thrombolysis?

Answer 32

After 24 hours and repeat scan confirms no bleed.

Question 33

What is the DAPT rule for minor stroke or high-risk TIA?

Answer 33

Aspirin + clopidogrel for 21 days started within 24 hours, then single antiplatelet.

Question 34

What defines a minor stroke?

Answer 34

NIH Stroke Scale ≤ 3.

Question 35

What defines a high-risk TIA?

Answer 35

ABCD2 score ≥ 4.

Question 36

What anticoagulant is preferred for atrial fibrillation-related stroke?

Answer 36

Direct oral anticoagulant (DOAC) unless mechanical valve.

Question 37

What is the updated anticoagulation timing (ELAN 2023)?

Answer 37

Small infarct: day 0–2; moderate: day 3–4; large: day 6–7, individualised.

Question 38

What is the LDL target for secondary stroke prevention?

Answer 38

<1.8 mmol/L or ≥50 percent reduction.

Question 39

What statin regimen has proven benefit?

Answer 39

High-intensity atorvastatin 40–80 mg daily (SPARCL trial).

Question 40

What BP target reduces recurrence (PROGRESS trial)?

Answer 40

<130/80 mmHg using ACE inhibitor ± thiazide.

Question 41

When is carotid endarterectomy recommended?

Answer 41

Symptomatic carotid stenosis ≥70 percent within 2 weeks.

Question 42

When is carotid stenting preferred?

Answer 42

If CEA contraindicated (hostile neck, high surgical risk).

Question 43

What are features of a putaminal haemorrhage?

Answer 43

Contralateral hemiparesis, sensory loss, eyes deviate toward lesion.

Question 44

What BP target is used for intracerebral haemorrhage?

Answer 44

Systolic ≈140 mmHg (INTERACT-2).

Question 45

What drug reverses dabigatran?

Answer 45

Idarucizumab.

Question 46

What drug reverses factor Xa inhibitors?

Answer 46

Andexanet alfa.

Question 47

What drug reverses warfarin?

Answer 47

Prothrombin complex concentrate plus vitamin K.

Question 48

What dose of nimodipine prevents vasospasm in subarachnoid haemorrhage?

Answer 48

60 mg every 4 hours for 21 days (or 30 mg q2h if hypotensive).

Question 49

When should lumbar puncture be done after suspected SAH with normal CT?

Answer 49

≥12 hours post-onset to detect xanthochromia.

Question 50

What syndrome causes central post-stroke pain weeks later?

Answer 50

Dejerine–Roussy syndrome after thalamic PCA infarct.

Question 51

What is the hallmark of cerebellar stroke needing surgery?

Answer 51

Vomiting, ataxia, 4th ventricle compression → urgent decompression.

Question 52

What is the most common cause of lobar haemorrhage in elderly non-hypertensives?

Answer 52

Cerebral amyloid angiopathy.

Question 53

What are main causes of cardioembolic stroke?

Answer 53

Atrial fibrillation, LV thrombus, endocarditis, prosthetic valve, PFO.

Question 54

What condition causes ‘dangerous dizziness’ in posterior stroke?

Answer 54

Basilar or vertebral artery occlusion.

Question 55

What complication occurs 3–5 days post large MCA stroke?

Answer 55

Cytotoxic oedema and herniation → consider decompressive craniectomy.

Question 56

What trial supports decompressive craniectomy for malignant MCA infarct?

Answer 56

DESTINY II trial.

Question 57

What systemic cause must be excluded first in suspected stroke?

Answer 57

Hypoglycaemia.

Question 58

What is the key feature distinguishing embolic from lacunar stroke?

Answer 58

Embolic = cortical signs; lacunar = small deep perforator infarct with no cortical signs.

Question 59

What syndrome results from ACA–MCA watershed ischaemia?

Answer 59

Man-in-a-barrel syndrome.

Question 60

What vascular lesion causes alexia without agraphia?

Answer 60

Dominant occipital cortex involving the splenium of corpus callosum (PCA territory).