Stroke

Question 1

What is inattention?

Answer 1

unilateral recognition is fine but bilateral recognition only one side is perceived. Examination= one finger, then the other finger wiggle, then wiggle both at the same time

Question 2

What should you assess in terms of speech at the bedside?

Answer 2

Comprehension
Repetition
Naming
Speech

Question 3

Where is Broca’s located?

Answer 3

frontal lobe

Question 4

Where is wernicke’s located?

Answer 4

temporal lobe

Question 5

Name two examples of aphasias

Answer 5

conductive, global, broca’s, wernicke’s

Question 6

What aspects of cardio exam are important in neuro assessment?

Answer 6

pulse
murmur
(double check)

Question 7

What is the management of TIA?

Answer 7

Admission is reasonable (high risk of stroke)
CT scan
If confirmed stroke then aspirin 300 mg daily for 2 weeks then clopidogrel 75 mg

Question 8

What is the scoring system for TIA?

Answer 8

ABCD2 score

Question 9

What are the features of the ABCD2 score?

Answer 9

Age
Blood pressure
Clinical features
Duration of symptoms
Diabetes

Question 10

Right hemiparesis, right face droop, loss of speech. Where is the stroke?

Answer 10

Left hemisphere (speech!!)

Question 11

What is a sign on CT of acute ischaemic stroke?

Answer 11

hyperdense vessel sign

Question 12

What is the window for thrombolysis?

Answer 12

<4.5 hr

Question 13

List three absolute contraindications for thrombolysis

Answer 13

-haemorrhage on scan
-BP >185/110 (can be treated!!)
-Stroke or head injury within last 3 months
-anticoagulation
-previous intracranial haemorrhage

Question 14

List two relative contraindications for thrombolysis

Answer 14

-recent major surgery
-recent GI haemorrhage
- recent LP (<7 days)
- seizure at onset

Question 15

Which score is used to score the severity of stroke?

Answer 15

NIHSS

Question 16

What is malignant MCA infarction?

Answer 16

rapid neuro deterioration due to middle cerebral artery territory stroke causing oedema

Question 17

What is the criteria for performing carotid endarterectomy?

Answer 17

TIA
male patient stenosis >50%
female >70%

Question 18

Which score on CHAVASC should definitely receive anticoagulation?

Answer 18

> 2 (atrial fibrillation risk of stroke)

Question 19

63 year old presenting with dizziness. She suddenly developed vertigo and nausea, felt very unsteady stumbling to left. Past pointing on left. CT head normal. Is this a stroke?

Answer 19

cerbellar stroke
CT not good modality for visualizing posterior fossa structures
Need to rule out vestibular/peripheral cause

Question 20

Which test can you do to distinguish between central and peripheral cause of nystagmus?

Answer 20

HINTS test. Head impulse test- Hold patient’s head and turn quickly to displace head laterally . Peripheral cause can correct nystagmus.

Central: head impulse negative, vertical skew deviation yes, nystagmus

Peripheral: positive head impulse, no vertical skew deviation, nystagmus (unidirectional)

Question 21

What can carotid dissection lead to?

Answer 21

Horner’s syndrome. Third order neuron runs along carotid artery.

Question 22

Patient has ptosis and miosis but no anyhdrosis. Where is the lesion?

Answer 22

third order neuron alonside carotid artery. Pathway of first and second order neurons would result in anhydrosis

Question 23

What is the treatment of carotid artery dissection with stroke?

Answer 23

anticoagulation. If not stroke then might not be a need for anticoagulation

Question 24

What is the best imaging modality for TIA?

Answer 24

MRI brain with diffusion-weighted imaging is the preferred modality in patients with suspected TIA who require brain imaging. Brain imaging in TIA is used when there is ambiguity about the location of the affected area of the brain.

Question 25

A patient presenting to the emergency department undergoes a CT head scan. The report describes a hypodense collection around the convexity of the brain that is not limited to suture lines.

What is the most likely radiological diagnosis?

Answer 25

chronic subdural haematoma

On CT imaging, acute haematomas appear bright (hyperdense) whereas chronic haematomas appear dark (hypodense). Extradural haematomas are limited by suture lines whereas subdural haematomas are not. Intraparenchymal haematomas arise within the brain substance. Subarachnoid haemorrhage are typically seen as hyperdensity within the basal cisterns and sulci of the subarachnoid space.

Question 26

Name two red flags for the urgent imaging of patient with headache

Answer 26

Vomiting more than once with no other cause.
New neurological deficit (motor or sensory).
Reduction in conscious level (as measured by the Glasgow coma score).
Valsalva (associated with coughing or sneezing) or positional headaches.
Progressive headache with a fever.