Stroke

Question 1

6 risk factors for stroke

Answer 1

Age
Obesity
Fhx
HTN
MI
Atrial fibrillation
T2DM
Hyperlipidemia
Smoking
OCP
Cocaine

Question 2

Name three causes of ischemic stroke

Answer 2

Cardioembolic (Afib)
Atheroemboli (atherosclerotic disease)
Arterial dissection
Vasospasm
Vasculitis
Hypercoagulable state

Question 3

Name 2 signs and symptoms of R-hemisphere stroke and 2 of L-hemisphere stroke.

Answer 3

Right hemisphere
Hemispatial neglect
Left visual field neglect
Right gaze preference
Impulsive

Left hemisphere
Aphasia
Alexia
Agraphia
Cautious behaviour
Left gaze preference
Deficit in the right visual field

Question 4

Name 3 S+S of posterior-circulation stroke

Answer 4

N/V
Ataxia
Vertigo
Sensory loss
Dysarthria

Question 5

Name 5 ddx of stroke

Answer 5

Vascular
Hypertensive encephalopathy
Subdural hematoma
SAH

Infectious/inflammatory
Abscess
Encephalitis
Vasculitis

Anatomic
Neoplasm
Demyelinating disease
Bell’s palsy

Other
Atypical migraine
Seizure
Somatization

Question 6

Name 5 prevention strategies of non-pharmacological stroke prevention

Answer 6

Healthy diet
Moderate intensity exercise 150 min/w
Smoking cessation
Healthy BMI
EtOH - limit intake to ≤ 2/w
Discontinue recreational drugs
Discontinue estrogen contraceptives

Question 7

What is the risk score system for TIA?

Answer 7

The ABCD2 score

Question 8

Name the components of the ABCD2 score

Answer 8

A – Age ≥60 years → 1 point

B – Blood pressure ≥140 systolic or ≥90 diastolic → 1 point

C – Clinical features

Unilateral weakness → 2 points

Speech disturbance without weakness → 1 point

D – Duration of symptoms

≥60 minutes → 2 points

10–59 minutes → 1 point

D² – Diabetes mellitus → 1 point

Question 9

Na

A 68-year-old man presents after a 45-minute episode of right arm weakness and slurred speech that fully resolved. His BP in clinic is 152/96 mmHg. He has type 2 diabetes.

Question:
Calculate the ABCD² score.

Answer 9

ABCD² = 6

Age ≥60 → 1

BP ≥140/90 → 1

Clinical: unilateral weakness → 2

Duration 10–59 min → 1

Diabetes → 1

Total = 6 (high risk)

Question 10

Name the 7 first steps of acute management of stroke

Answer 10

Code stroke
ABCs
Vital signs + glucose test
Neuro exam
NIHSS
Neuro vitals q4h
Non-contrast CT head within 20 min

Question 11

Name 7 additional investigations of acute stroke

Answer 11

ECG
Bloodwork
Hb
Platelets
INR
PTT
Creatinine
Na + K
Troponin

Question 12

If a patient does not meet the inclusion criteria for stroke thrombolysis, what is an alternative? (2)

Answer 12

ASA 160 - 325 mg + Clopidogrel 300 - 600 mg

Question 13

Name the two inclusion criteria of stroke thrombolysis

Answer 13

Ischemic stroke causing disability in an adult patient with life expectancy ≥ 3 mo
Onset of symptoms ≤ 4.5 h

Question 14

What is the only absolute exclusion criteria for stroke thrombolysis

Answer 14

Active hemorrhage (hemorrhagic stroke)

Question 15

Name 5 relative exclusion criteria for stroke thrombolysis

Answer 15

Hx of intracranial hemorrhage
Previous ischemic stroke or head/spine injury in the past 3mo
Refractory HTN
Patient on DOAC/LMWH

Labs
BG < 2.7 or > 22.2
↑ aPTT
INR > 1.7
Platelets < 100

Question 16

Which patients benefit from endovascular thrombectomy? (2)

Answer 16

• Time to treat: 6 - 12h after onset

Disabling stroke

Imaging
Small -moderate ischemic stroke
Intracranial artery affected in the anterior circulation

Question 16

Name 4 members of the MDT for a stroke patient

Answer 16

Speech therapy
Physiotherapy
Dietitian
OT/PT
Neurology
Social work
Psychotherapy

Question 17

Name the targets for secondary prevention for HTN, lipids, diabetes, afib and carotid stenosis in a patient following a stroke

Answer 17

HTN → BP < 130/80
Lipids → LDL < 1.8
Diabetes → A1C < 7.0%
Non-valvular Afib → DOAC
Carotid stenosis
Endarterectomy if > 50% stenosis of the ipsilateral symptomatic hemisphere

Question 18

How long should a patient stay on DAPT following a cardioembolic stroke?

Answer 18

21 - 30d (for cardioembolic origin)

Question 19

Name 4 post-stroke complications

Answer 19

Depression
Vascular cognitive impairment
Post-stroke fatigue
Dysphagia - aspiration pneumonia
Motor deficits
Speech difficulties
Urinary/bowel incontinence

Question 20

Name three resources to be offered to a patient with motor deficits from a stroke

Answer 20

Cane, walker, home care, physiotherapy

Question 21

What blood pressure threshold must be achieved before initiating thrombolysis in acute ischemic stroke?

Answer 21

• BP must be < 185/110 mmHg
• If above → lower BP before giving tPA
• Use IV agents (e.g., labetalol, nicardipine)

This threshold is critical to ensure patient safety during thrombolysis.

Question 22

What is the target blood pressure after thrombolysis in acute ischemic stroke?

Answer 22

• Maintain BP < 180/105 mmHg
• Monitor closely for first 24 hours
• Avoid aggressive drops to prevent hypoperfusion

Proper management of blood pressure post-thrombolysis is essential to prevent complications.