TIA and Stroke

Question 1

Crescendo TIA =

Answer 1

2< episodes within one week

Question 2

4 causes of TIA

Answer 2

Embolus from carotid artery
Thrombus rom the heart due to AF
Infective endocarditis
Vasculitis

Question 3

How long can’t you drive for with a TIA

Answer 3

4 weeks

Question 4

If the patient has had more than 1 TIA (‘crescendo TIA’) or has a suspected cardioembolic source or severe carotid stenosis:

Management..?

Answer 4

300mg Aspirin immediately

discuss the need for admission or observation urgently with a stroke specialist

cannot drive until they see a specialist

Question 5

If the patient has had a suspected TIA in the last 7 days:

Management..?

Answer 5

300mg Aspirin immediately

arrange urgent assessment (within 24 hours) by a specialist stroke physician

cannot drive until they see a specialist

Question 6

Carotid stenosis 50-99% treatment

Answer 6

referred within 1 weeks for carotid endarterectomy

undergo treatments within 2 weeks

Question 7

Carotid stenosis <50% treatment

Answer 7

no surgery just medical management

Question 8

6 vascular risk factors for TIA

Answer 8

HTN
IHD 
PVD 
Carotid stenosis 
Diabetes 
Smoking

Question 9

4 thrombotic risk factors for TIA

Answer 9

AF
COC
Polycthaemia
Clotting disorders

Question 10

TACS classification (3)

Answer 10

All 3 of ….

• unilateral weakness
• homonymous hemianopia
• higher cerebral dysfunction

Question 11

PACS classification (3)

Answer 11

2 of…

• unilateral weakness
• homonymous hemianopia
• higher cerebral dysfunction

Question 12

PCS classification (3)

Answer 12

1 of….

• cerebellar / brainstem syndromes
• loss of consciousness
• isolated homonymous hemianopia

Question 13

LACS classification (3)

Answer 13

1 of….

• unilateral weakness (purely)
• pure sensory stroke
• ataxia hemiparesis

Question 14

Definition of stroke

Answer 14

syndrome of rapid onset of cerebral deficit, usually focal lasting more than 24hrs

Question 15

5 causes of ischaemic stroke

Answer 15

Thrombosis 
Large artery stenosis 
Small vessel disease 
Cardioembolic 
Hypoperfusion

Question 16

2 causes of haemorrhagic stroke

Answer 16

Intracerebral

subarachnoid

Question 17

3 “other” causes of stroke

Answer 17

arterial dissection
venous sinus thrombosis
vasculitis

Question 18

Clinical deficit associated with left middle cerebral artery

Answer 18

Right sided weakness of face & arm > leg and dysphasia

Question 19

Clinical deficit associated with RMCA

Answer 19

left sided weakness - face & arm > leg, visual / sensory neglect, denial of disability

Question 20

Lesion to corticospinal tracts in BS leads to ….

Answer 20

hemiparesis / tetraparesis

Question 21

Lesion to oculomotor tract in BS leads to ….

Answer 21

dipolpia

Question 22

Lesion to 5th nerve nuclei -

Answer 22

facial numbness

Question 23

Lesion to 7th nerve nuclei -

Answer 23

facial weakness

Question 24

Lesion to 9th and 10th nerve nuclei -

Answer 24

dysphagia and dysarthria

Question 25

Lesion to sympathetic fibres in the BS -

Answer 25

Horners syndrome

Question 26

Lesion to reticular formation -

Answer 26

coma / altered consciousness

Question 27

If haemorrhagic stroke excluded what should be given straight away?

Answer 27

300mg aspirin

Question 28

At what cholestrol level should a statin be started post stroke?

Answer 28

3.5mmol/L

Question 29

Thrombolysis should be given within .....

Answer 29

4.5 hours after the onset of stroke symptoms

Question 30

What thrombolysis is currently recommended?

Answer 30

altepase

Question 31

4 causes of haemorrhagic stroke

Answer 31

HTN Cerebral amyloid angiopathy Aneurysms Cerebral ateriovenousmalformations

Question 32

What stroke scale is used in assessment?

Answer 32

NIHSS (national institute of health stroke scale)

Question 33

Broca's aphasia =

Answer 33

expressive aphasia

Question 34

Wernicke's aphasia

Answer 34

receptive aphasia

Question 35

4 coagulopathies that can cause a stroke

Answer 35

Thromboycythaemia Polycythaemia Hyperviscosity states Thrombophilia

Question 36

Which infections should be considered in stroke?

Answer 36

Neurosyphilis HIV Hepitits

Question 37

Structures that run through the cavernous sinuses (5)

Answer 37

3rd, 4th, 5th and 6th CN | Carotid artery

Question 38

Classical presentation of cavernous sinus thrombosis (3)

Answer 38

Proptosis Chemosis Painful opthalmoplegia

Question 39

Vasculitis can cause strokes secondary to either (2)

Answer 39

Infection | CTD

Question 40

Cerebral venous thrombosis associated with... (5)

Answer 40

``` pregnancy puerperium oral contraception haematological disease infection CTD ```

Question 41

Defining features of cerebral venous thrombosis (4)

Answer 41

headache altered conscious ness seizures papilloedema

Question 42

What should be considered if stroke symptoms after trivial neck trauma?

Answer 42

Dissection

Question 43

If the patient has had a suspected TIA which occurred more than a week previously:

Answer 43

refer for specialist assessment as soon as possible within 7 days cannot drive until they see a specialist

Question 44

anti-platelet therapy started for those who have had a TIA?

Answer 44

Clopidogrel

Question 45

Contraindications to thrombolysis:

Answer 45

- Previous intracranial haemorrhage - Seizure at onset of stroke - Intracranial neoplasm - Suspected subarachnoid haemorrhage - Stroke or traumatic brain injury in preceding 3 months - Lumbar puncture in preceding 7 days - Gastrointestinal haemorrhage in preceding 3 weeks - Active bleeding - Pregnancy - Oesophageal varices - Uncontrolled hypertension >200/120mmHg