Stroke

Question 1

A patients presents to a&e with new onset asymmetrical facial weakness and speech disturbance. What is the likely diagnosis and what is his rosier score?

Answer 1

Stroke

Rosier score = 2

Question 2

What 5 things do you get a point for in the rosier stroke scoring system?

Answer 2

• Asymmetric facial weakness
• Asymmetric arm weakness
• Asymmetric leg weakness
• Speech disturbance
• Visual field defect

Question 3

What 2 things cause a reduction of 1 point in the rosier score, making a stroke less likely?

Answer 3

• Loss of consciousness of syncope

- Seizure activity

Question 4

What four things must you know about the stroke before you can make a full diagnosis?

Answer 4

Type
Size
Laterality
Cause

Question 5

What investigations would you want to perform on a patient with stroke like symptoms?

Answer 5

Urgent CT scan

Question 6

What are the four different types of strokes?

Answer 6

1. Total anterior circulation syndrome
2. Partial anterior circulation syndrome
3. Lacunar syndrome
4. Posterior circulation syndrome

Question 7

A patient comes into a&e unable to move their left arm or left leg. They also have complete loss of vision in the left visual field slurred speech and their mouth is drooping to the left. What kind of stroke are they most likely to be having?

Answer 7

Total anterior circulation syndrome. This is the most severe type of stroke.

Question 8

A patient presents with dropping of the right side of their fact and unable to move their right arm. They can walk fine.

Answer 8

Partial anterior circulation syndrome

Question 9

What is a lacunar infarct?

Answer 9

Small infarcts in the deeper parts of the brain (basal ganglia, thalamus, white matter) and in the brain stem.

Question 10

What type of stroke has the best outcome?

Answer 10

Lacunar stroke

Question 11

Which type of stroke is most likely to present with a cranial nerve palsy?

Answer 11

Posterior circulation syndrome

Question 12

A patient present with bilateral weakness in their arms. They also have a third nerve palsy. What kind of stroke is most likely?

Answer 12

Posterior circulation syndrome

Question 13

What type of stroke may present with cortical blindness?

Answer 13

Posterior circulation syndrome

Question 14

Damage in which hemisphere (right or left) is likely to affect language?

Answer 14

Left.

Question 15

What would damage to the less dominant right hemisphere cause?

Answer 15

Loss of spatial awareness

Question 16

What is cerebral amyloid angiopathy?

Answer 16

Cerebral amyloid angiopathy (CAA), also known as congophilic angiopathy, is a form of angiopathy in which amyloid deposits form in the walls of the blood vessels of the central nervous system.

Question 17

What kind of haemmorhage is cerebral amyloid angipathy most likely to cause?

Answer 17

Lobar

Question 18

What kind of haemmorhage is high blood pressure most likely to cause?

Answer 18

Deep

Question 19

How long are CT scan sensitive to blood for?

Answer 19

One week

Question 20

What type of thrombus is found in a cardioembolic stroke?

Answer 20

Red thrombus

Question 21

What type of thrombus is found in an atheroembolic stroke?

Answer 21

White thrombus

Question 22

A man presents with weakness in his left leg. He also appears to be acting strangely. Which artery has most likely been blocked.

Answer 22

Right anterior cerebral.

Question 23

A women presents unable to move her right arm or leg. Her face is also drooping on the right side and she is unable to speak except for very few words. Which artery has most likely been blocked?

Answer 23

Left middle cerebral

Question 24

What artery is the largest branch of the internal carotid artery?

Answer 24

Middle cerebral

Question 25

What lobes do the posterior cerebral arteries supply?

Answer 25

Occipital and Temporal

Question 26

A man presents with loss of vision in his right visual field with macular sparing. What artery has most likely been occluded?

Answer 26

Posterior cerebral artery

Question 27

A stroke patient present with ataxia. What kind of stroke is this?

Answer 27

PCOS

Question 28

A patients on the stroke ward initially presented with isolated homonymous hemianopia. What kind of stroke is this?

Answer 28

PCOS

Question 29

A patient presents to the stroke unit with left sided weakness of the face arm and leg; homonymous hemianopia and slurred speech. What kind of stroke is this?

Answer 29

Total anterior circulation stroke.

Question 30

A patient presents to the stroke unit with left sided weakness of the face arm and leg and homonymous hemianopia. His speech is fine. What kind of stroke is this?

Answer 30

Partial anterior circulation stroke.

Question 31

What major artery in the brain ins not considered to be part of the circle of willis?

Answer 31

Middle cerebral artery

Question 32

A right handed patient who has had a stroke is struggling to speak. What hemisphere is the stroke likely to have been in?

Answer 32

Left (dominant) hemisphere

Question 33

A right handed patient who has had a stroke is struggling with spatial awareness. Which hemisphere is most likely to have been affected.

Answer 33

Right. (non dominat)

Question 34

What kind of stroke are people with atrial fibrillation most at risk of?

Answer 34

Cardio embolic

Question 35

What kind of stroke are people with a patent foramen ovale most at risk of?

Answer 35

cardio embolic

Question 36

A 50 year old man presented to the A&E complaining of severe headache and loss of consciousness. Upon further questioning, the patient complains of neck stiffness and mild weakness of the right-side of the body. On examination, the patient is apyrexial and you notice that the patient has a disproportionately long, slender limbs with thin, weak wrists and long fingers and toes. What is the best investigation of choice to confirm your diagnosis promptly?

Answer 36

CT scan

Question 37

What structures does the posterior brain circulation supply?

Answer 37

Occipital lobe Brain stem Cerebellum

Question 38

What vessels supplies wernicke and broca's area?

Answer 38

Middle cerebral artery

Question 39

What vessel supplies the motor cortex supplying the leg, the frontal lobe and the corpus callosum?

Answer 39

Anterior Cerebral

Question 40

What artery supplies the part of the motor cortex that supplies the arm and face?

Answer 40

Middle cerebral artery

Question 41

What is homonymous hemianopia?

Answer 41

Visual field loss on the left or right side of the vertical midline.

Question 42

A man comes into a &e with a suspected stroke. What imagine modality would you choose first?

Answer 42

CT

Question 43

What is the best treatment of a patient who has had a stroke 2 hours ago?

Answer 43

Tissue plasminogen activator IV (Thrombolysis)

Question 44

What medications should patients who have had an ischaemic stroke or TIA be discharged on to reduce the risk of recurrence?

Answer 44

1. Low dose aspirin & dipyridamole or clopidogrel 2. Statin 3. Warfarin (aim for INR 2 - 3 4. ACEi and thiazide diuretic

Question 45

A patient recently had a TIA due to atherosclerosis of the carotid artery. What treatment would be most effective at reducing his risk of a further stroke?

Answer 45

Carotid endarectomy

Question 46

What does Rivaroxaban inhibit?

Answer 46

Direct factor 10a

Question 47

What does dabigatran inhibit?

Answer 47

Direct thrombin inhibitor