Acute Stroke Diagnosis and Management

Question 1

What are the clinical features of L MCA syndrome?

Answer 1

R hemiparesis, aphasia, R sensory/visual inattention, R hemianopia

Question 2

What are the clinical features of R MCA syndrome?

Answer 2

L hemiparesis, dysarthria, L sensory/visual inattention, L hemianopia

Question 3

What does isolated face/arm/leg weakness with dysarthria usually indicate?

Answer 3

stroke in deep perforating vessels

Question 4

What are the clinical features of a posterior circulation stroke?

Answer 4

diplopia, vertigo, dysarthria, dysphagia, ataxia, hemiparesis, ipsilateral face/contralateral body numb/weak

Question 5

What are differential diagnoses for stroke?

Answer 5

migraine
seizure with todd’s paresis
functional
metabolic/sepsis

Question 6

What does an ICH along the floor of the anterior cranial fossa usually indicate?

Answer 6

anterior communicating artery aneurysm

Question 7

What does blood around the sylvian fissue usually indicate?

Answer 7

MCA aneurysm

Question 8

What are the CT findings in acute stroke?

Answer 8

hyperdense artery

subtle loss of grey white matter differentiation

Question 9

What does TTP on CT perfusion indicate?

Answer 9

time to peak

areas where blood flow takes longer to arrive are in yellow/red -> indicates the tissue at risk/penumbra

Question 10

What does CBV on CT perfusion indicate?

Answer 10

Cerebral blood volume -> if low then likely the area is irreversibly damaged

Question 11

What is the most sensitive imaging for ischaemic stroke?

Answer 11

diffusion MRI

Question 12

What is the risk of stroke in the first week after TIA (untreated)?

Answer 12

10%

Question 13

In which patients should a bubble study be performed?

Answer 13

age < 60 and no other cause identified

Question 14

What did the EXTEND trial show?

Answer 14

That CT perfusion or MRI selected patients benefit for alteplase 4.5-9hours after onset or within 9 hours of midpoint of sleep

Question 15

What SBP is required to treat with thrombolysis?

Answer 15

< 185

Question 16

What percentage of patients get the complication of orolingual angioedema post thrombolysis?

Answer 16

2% overall

5% if taking ACE

Question 17

What did the DAWN/DEFUSE trial show?

Answer 17

Benefit for thrombectomy up to 24 hours after stroke with select patients (imaging findings)

Question 18

Which patient’s are eligible for delayed thrombectomy?

Answer 18

6-24 hours with ICA/M1 occlusion and < 70mL core on perfusion imaging

Question 19

Is there an age/severity limit for thrombectomy?

Answer 19

no

Question 20

In which vessels can you do thrombectomy?

Answer 20

ICA, M1, basilar, ?M2

Question 21

Are platelet transfusions indicated in ICH?

Answer 21

no -> associated with worse outcome

Question 22

In what time period can thrombectomy be done?

Answer 22

0-6 hours broad criteria

6-24 hours with imaging criteria

Question 23

In what time period can thrombolysis be done?

Answer 23

0-4.5 hours broad criteria

4.5 - 9 hours with imaging criteria