Neuro - DWE random facts

Question 1

MRI: relevance of DWI v FLAIR mismatch in CVA

Answer 1

DWI very sensitive for ischaemia, but FLAIR takes ~4.5hrs so if not on FLAIR suggests thrombolysis safe (eg. in wake CVA)

Question 2

CVA: Thrombolysis timeframes

Answer 2

Ideally <4.5hrs onset (or <9hrs from midpoint of Wake UP Stroke)

Question 3

CVA: Thrombolysis contraindications

Answer 3

• Extensive hypodensity on CTB (subacute infarct) - recheck onset time
• BP >185/105 (or BSL <2.7) - fix first!
• Bleeding usual risks (relative if GIB, surg <2-3wks) - DOAC <48hrs (unless Dabigatran reversible)

Question 4

CVA: Thrombolysis What are the specific risks

Answer 4

1. Symptomatic ICH (most are inconsequential)
   - particularly if severe CT hypodensity, lrg ischaemic core
2. Orolingual angioedema
   - 5% if taking ACEI
   - Usually unilateral (Contralat to brain lesion) & <2hrs later
   - Give hydrocort (as bradykinin mediated)

Question 5

CVA: Thrombectomy. Which vessel locations benefit?

Answer 5

• ICA & M1 : definitely!
• M2: case by case (highly variable anatomy etc)
• M3/M4, ACA, PCA : NO
• Basiliar: unclear

Question 6

CVA: Thrombectomy.

Who benefits?

Answer 6

? Deficit
Prognostic effect of age & severity is strong but benefit is preserved

Question 7

CVA: Thrombectomy.

Timeframes

Answer 7

Typically <6hrs but <24hrs if:

i) <70ml core
ii) ICA / M1

Question 8

CVA: Thrombolysis agents
- which is better and when/why

Answer 8

Tenecteplase better than alteplase

• lrg vessel occlusion, better reperfusion & fxnal outcomes

Question 9

Spot dx

Answer 9

Graves ophthalmopathy - thick muscles
Proptosis (rather than ptosis)

Question 10

Encephalitis - fx, causes

Answer 10

• Wernickes encephalopathy
• PRES (similar to HTN encephalopathy)
• ADEM (AI - preceeding vax or infection)
• Limbic (paraneoplastic, AI) - NMDAR
• Infections - HSV commonest fatal, WNV

Question 11

SCC v AIDP

Answer 11

SCC: spasticity & hyperreflexia
Rx - RadioRx & Dex

AIDP: hyporeflexia & flaccid
Rx - IVIg/Plex