Stroke/TIA

Question 1

which type of stroke is more likley to loose conciousness

Answer 1

haemorrhagic (50%)

Question 2

what are the types of ischaemic stroke

Answer 2

thrombotic - clot in artery of brain
embolic - clot that travels to brain

Question 3

management of haemorrhagic stroke with no co-morbidities

Answer 3

1. stabalize - blood pressure control if above 150 and reversal of anticoagulant medication
2. refer to stoke unit

Question 4

quadriplegia and locked in syndrome suggest infarct wheer?

Answer 4

brainstem

• paralysis of limbs and voluntary movement
• LIS includes preserved cognition, vertical eye movement, blinking, and hearing

Question 5

subtypes of haemorrhagic stroke

Answer 5

intercerebral haemorrhage (ICH) and subarachnoid (SAH)

Question 6

what ethnicities are at higher risk of stroke

Answer 6

African, Hispanic, Asian, Native American

Question 7

key difference between ischaemic and haemorrhagic stroke on CT

Answer 7

I = darkness (hypoattenuation), loss of white matter differenation

H = brightness with surrounding darkness due to odema

Question 8

what acryonm is used to aid stroke diagnosis

Answer 8

FAST (face,arms,speech,time)

Question 9

contraindications for thrombolysis

Answer 9

previous ICH
pregnanacy
uncontrolled HTN
active bleeding

Question 10

What is the secondary prevention for ischaemic stroke?

Answer 10

clopidogrel 75 mg OD - can be higher (unless contraindicated in which case Asprin)

and Statin (atorvastatin 80 mg daily)

antihypertensives for HTN and anticoagulants for AF

Question 11

what is TIA

Answer 11

subtype of an ischaemic stroke but doesnt cause peremenant damage

Question 12

Initial medical managment of all ischaemic strokes

Answer 12

Alteplase or tenecteplase

if severe give Aspirin 300mg

Question 13

what would warrant consideration for carotid end-arterectomy

Answer 13

70% stenosis and performed within 2 weeks of the stroke

Question 14

CT: convex white mass on right side

Answer 14

extradural hematoma

Question 15

which cortical areas are supplied by MCA

Answer 15

frontal. temporal, parietal lobes
basal ganglia
internal capsule

Question 16

what artery is affected: right side of face weakness and nonfluent aphasia or fluent aphasia

Answer 16

left middle cerebral artery - superficial division

damage to motor cortex and brocas (nonfluent) or wernickes (fluent) areas

Question 17

what artery is affected: left face and upper arm weakness and left hemineglect

Answer 17

right MCA - superficial

damage to motor cortex and non-dominant assocaition areas

Question 18

what artery is affected: Right homonymous hemianopia, right hemi-sensory loss and right hemiparesis

Answer 18

left posterior cerebral

damage to left visual cortex in occipital lobe,
internal capsule and thalamus effected through disruption of ascending and descending info passing through these structures

Question 19

what artery is affected: Left homonymous hemianopia, left hemi-sensory loss and left hemiparesis

Answer 19

right posterior cerebral

same as left PCA but on left side

Question 20

what artery is affected: Right leg upper-motor neuron weakness, Grasp reflex, frontal lobe behavioral abnormalities, and transcortical aphasia

Answer 20

left anterior cerebral

damage to motor cortex
prefrontal cortex and supplement motor areas involved

Question 21

Left leg upper-motor neuron weakness, Grasp reflex, frontal lobe behavioural abnormalities and left hemineglect

Answer 21

right anterior cerebral artery

damage to motor cortex
prefrontal cortex and non- dominant association cortex involved

Question 22

what is initial management for patient presenting with GCS of <8

Answer 22

airway control vis intubation

Question 23

cerebellar strokes cause what common symptom

Answer 23

impair balance and coordination (ataxia) and posture

Question 24

what can you use to assess cerebellar stroke

Answer 24

finger nose test and leg down shin
assess gait if possible

Question 25

what symptoms would suggest a haemorrhagic stroke

Answer 25

more pronounced headaches, neck pain, light intolerance, nausea and vomiting, impaired conciousness level - more migraine like

Question 26

how would you differentiate stroke from other conditions

Answer 26

sudden onset - new symptoms still occurring? assess for non-stroke conditions that can cause neurologic effects

Question 27

typical presentation of MCA stroke

Answer 27

hemiplegia of contralateral side affecting lower face, arm, hand but not leg contralateral sensory loss contralateral homonymous hemianopia

Question 28

Ipsilateral CN VII palsy - Contralateral loss of pain & temperature loss in limb/torso - Vertigo, nystagmus, ataxia

Answer 28

lateral pontine syndrome

Question 29

which lobes control the lower limbs

Answer 29

medial surface of the frontal/parietal lobes - supplied by the anterior cerebral artery

Question 30

Which cerebral artery supplies the anterior limb of the internal capsule?

Answer 30

ACA

Question 31

which hemisphere is generally the 'dominant' one

Answer 31

left

Question 32

presentations of lateral medullary syndrome

Answer 32

CN X palsy (dysphagia) ipsilteral facial sensory loss (pain and temp) and contralateral limb sensory loss ataxia nystagmus

Question 33

symptoms of medial medullary syndrome

Answer 33

CN XII palsy contralateral hemiplegia and loss of touch, pressure, vibration and proprioception

Question 34

difference between lateral pontine and medullary syndrome

Answer 34

smptoms same but pontine = CN VII and medullary = CN X

Question 35

what is the secondary management for TIA

Answer 35

clopidogrel and statin Asprin + dipyridamole can be used in patients where clopidogrel is contraindicated

Question 36

what is the HDL aim for statin therapy in TIA

Answer 36

reduce non-HDL cholesterol by >40%

Question 37

What imaging should be done for TIA?

Answer 37

Cartoid imaging to identify atherosclerosis of carotid artery - not CT

Question 38

oxford stroke classification

Answer 38

1. unilateral hemiparesis 2. homonymous hemianopia 3. higher cog dysfunction

Question 39

CT: concave white mass on right side

Answer 39

subdural hematoma

Question 40

CT: white mass near the circle of willis (in sulci)

Answer 40

subarachnoid

Question 41

Patients with a history suggestive of a stroke should have what inital investigations to rule out main differentials

Answer 41

blood glucose - hypoglycemia ECG - arythmias

Question 42

Which imaging to do first for stroke

Answer 42

Non contrast CT - distinguish ischemic from haemorrhaging stroke

Question 43

Pathology of lacunar infarcts

Answer 43

Lipohyalinosis - causes small vessel wall thickening and hayline deposition from chronic hypertension. Leads to vessel narrowing and occlusion - lacunar infarcts

Question 44

What is the most common source of embolia stroke

Answer 44

Atrial fibrillation

Question 45

Antiplatelet for secondary prevention of non cardioembolic stroke

Answer 45

Aspirin and dipyridamole Or clopidogrel

Question 46

what are lacuna infarcts

Answer 46

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

Question 47

initial management of ischaemic strokes within 4.5 hours:

Answer 47

Aspirin 300mg, thrombolysis (alteplase), statin (after 48hrs)

Question 48

when should anticoagulants be restarted after stroke

Answer 48

at least 14 days after onset

Question 49

what scoring system is used to determine if someone has had a stroke while in ED

Answer 49

ROSIER

Question 50

what is the CHADS2-VASC score used for

Answer 50

assess stroke risk in patients with AFib