ACUTE NEURO 2

Question 1

How do you treat ischaemic stroke <4.5hrs and no CVST?

Answer 1

1. Alteplase IV (rt-PA)
2. Aspirin 300mg 24hrs AFTER rt-PA
3. Supportive care
4. Swallowing assessment (nerve 9-10 affected)
5. VTE prophylaxis (dalteparin/heparin)

Question 2

How do you treat ischaemic stroke >4.5hrs?

Answer 2

1. Aspirin 300mg
2. Supportive care
3. Swallowing assessment
4. VTE prophylaxis (dalteparin/heparin

Question 3

How do you treat cerebral venous sinus thrombosis?

Answer 3

Anticoagulate – Heparin + supportive care

Question 4

How do you prevent ischaemic stoke happening again?

Answer 4

1. Continue with aspirin for 2 weeks
2. then switch to lifelong clopidogrel or dipyramidole
3. Lifelong anticoagulation (AF)

Question 5

What is the onset of a TIA?

Answer 5

sudden onset of focal neurological symptoms <24hr

Question 6

What are the associated symptoms of a TIA?

Answer 6

• loss of function

- vision changes

Question 7

What investigations are needed for a TIA?

Answer 7

CT head/FBC/glucose/PT/PTT/ECG

Question 8

What is the epidemiology for TIA?

Answer 8

1. Older people
2. Black/Hispanic
3. lower lvl of education
4. M>W

Question 9

What are the causes of TIA?

Answer 9

temporary vascular occlusion

Question 10

What are the risk factors of TIA?

Answer 10

1. History of stroke/TIA
2. Hypertension/smoking/DM
3. AF
4. Dislipidiemia

Question 11

What is the treatment of TIA when there is a atherosclerotic cause?

Answer 11

1. Anitplatelets :
   aspirin OR clopidogrel or both can be started immediately after excluding haemorrhage – if both switch to single agent post 2wks
   + statin (atorvastatitn)
2. Lifestyle mod, if carotid >50% - enderartectomy

Question 12

What is the treatment of TIA when there is a cardioembolic cause?

Answer 12

1. Anticoagulation:
   Warfarin/apixaban – start within 2 wks
   + statin

Question 13

What are the complications of TIA?

Answer 13

stroke

Question 14

What is the prognosis of TIA?

Answer 14

10% chance of getting a stroke within 3 months

Question 15

What are UMN diseases?

Answer 15

1. stroke
2. space occupying lesion
3. demyelination (MS)
4. spinal cord pathology

Question 16

What are LMN diseases?

Answer 16

1. MND
2. peripheral neuropathy
3. myasthenia gravis
4. muscular dystrophy

Question 17

What are UMN signs?

Answer 17

1. contralateral signs
2. no fasciculations
3. no muscle wasting
4. spasticity, may be clonus
5. weakness: extensors in arms, 6. flexors in legs
6. hyperreflexia
7. upgoing plantars
8. pronator drift

Question 18

What are LMN signs?

Answer 18

1. unilateral signs
2. fasciculations
3. muscle wasting
4. hypotonia
5. weakness
6. hyporeflexia
7. normal plantar response

Question 19

What is grade 0 MRC for stroke/TIA?

Answer 19

No muscle contraction

Question 20

What is grade 1 MRC for stroke/TIA?

Answer 20

Flicker of contraction

Question 21

What is grade 2 MRC for stroke/TIA?

Answer 21

Some active movement

Question 22

What is grade 3 MRC for stroke/TIA?

Answer 22

Active movement against gravity

Question 23

What is grade 4 MRC for stroke/TIA?

Answer 23

Active movement against resistance

Question 24

What is grade 5 MRC for stroke/TIA?

Answer 24

Normal power allowing for age

Question 25

What are the signs if there is a stroke/TIA in Anterior Cerebral Artery (ACA)? Anterior circulation

Answer 25

1. Contralateral hemiparesis lower limb > upper limb 2. Abulia 3. Confusion 4. Gait apraxia 5. Frontal release sign

Question 26

What are the signs if there is a stroke/TIA in middle cerebral artery (MCA)? Anterior circulation

Answer 26

1. Contralateral hemiparesis upper limb/face > lower limb Contralateral hemisensory loss 2. Apraxia 3. Hemineglect 4. Receptive/expressive dysphasia (if left MCA affected) 5. Quadrantopia (if Meyer’s/Baum’s loop affected)

Question 27

What are the signs if there is a stroke/TIA in posterior cerebral artery (PCA)? posterior circulation

Answer 27

1. Homonymous hemianopia (with macular sparing) | 2. Visual agnosia

Question 28

What are the signs if there is a stroke/TIA in basilar artery? posterior circulation

Answer 28

1. Cranial nerve pathology (III-XII) 2. Visual impairments 3. Cerebellar pathology 4. Impaired consciousness

Question 29

What are cerebellar strokes?

Answer 29

1. Cerebellar strokes or “Dizzy-plus” syndromes | 2. All can present with cerebellar signs

Question 30

What are the signs if there is a stroke/TIA in superior cerebellar (SCA)? posterior circulation

Answer 30

1. dizzy

Question 31

What are the signs if there is a stroke/TIA in anterior inferior cerebellar (AICA)? posterior circulation

Answer 31

1. dizzy | 2. deaf

Question 32

What are the signs if there is a stroke/TIA in posterior inferior cerebellar (PICA)? posterior circulation

Answer 32

1. dizzy 2. dysphagic 3. dysphonic (lateral medullary syndrome)

Question 33

What does a lacunar infarct affecting the internal capsule do?

Answer 33

pure motor deficit

Question 34

What does a lacunar infarct affecting the pontine do?

Answer 34

dizziness/vertigo, bilateral affect

Question 35

What does a lacunar infarct affecting the thalamus do?

Answer 35

affects consciousness

Question 36

What does a lacunar infarct affecting the basal ganglia do?

Answer 36

dyskinesias

Question 37

What does an intracerebral haemorrhage present?

Answer 37

1. Headache and meningism 2. Focal neurological signs 3. nausea/vomiting 4. Signs of raised ICP 5. Seizures 

Question 38

How long do TIAs present?

Answer 38

last 10-15 mins but can last up to 24hrs

Question 39

What symptoms are associated with TIAs?

Answer 39

1. Amaurosis fugax – ”like a curtain descending” | 2. Global events like syncope or dizziness not typical

Question 40

What are the complications for TIAS and strokes?

Answer 40

``` 1. TIAs can complicate to strokes Driving prohibited for 1 month 2, Cerebral oedema (increased ICP)  3. Immobility   4. Infections   5. DVT 6. Psychiatric/mood disturbance 7. Seizures 8. Cardiovascular events   9. Death  ```