amu 26/10

Question 1

Differentials for slurred speech (Dysarthria) onset?

Answer 1

Stroke
TIA
Hypoglycaemia
Guillain-Barre
Basilar Migraine
alcohol or drug poisoning
Neuromuscular disorders that often cause slurred speech include amyotrophic lateral sclerosis (ALS), cerebral palsy, muscular dystrophy, and Parkinson’s disease

https://www.osmosis.org/answers/dysarthria

Question 2

…..(?) Are focal neurological deficits due to blockage of blood supply to a part of the brain (focal brain dysfunction) lasting less than 24 hours (but in practice most of these last much less than that!)
Without acute infarction.

Answer 2

TIA

Question 3

What score is used to predict a stroke likleihood after a TIA?

Answer 3

ABCD2

Question 4

WHats included in ABCD2? A score of what indicates high risk.

Answer 4

greater than 4 = high risk for stroke

Question 5

People have had a suspected tia should be given what?

Answer 5

300mg aspirin stat
And referred to tia clinic

Question 6

How to investigate TIA?

Answer 6

bloods
carotid doppler
brain scan (MRI/CT)

Question 7

Long term TIA treatment?

Answer 7

Lifestyle
manage htn
treat hypercholesterolemia
surgical intervention of carotids
antiplatelets

Question 8

Cresendo TIA?

Answer 8

two TIAs in past week, therefore treated as high risk for stroke

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Question 9

If someone has TIA, what organisation should you inform outside of the hospital?

Answer 9

DVLA

Question 10

Symptoms of TIA

Answer 10

Dependent on the arterial territory involved.

Need to go over territories of the brain! Humunculus

Question 11

TIA differentials

Answer 11

Hypoglycaemia
Migraine aura
focal epilepsy,
hyperventilation
retinal bleeds

Question 12

Amaurosis Fugax?

Answer 12

occurs when retinal artery is occluded, causing unilateral progressive vision loss “like a curtain descending”

Question 13

Oxford classification of strokes, what are the 4?

Answer 13

TACs
LACs
PACs
POCs

Question 14

Anterior cerebral artery supplies which part of brain?
Middle cerebral?
Posterior cerebral?

Answer 14

The anterior cerebral arteries supply the anteromedial area of the cerebrum.
The middle cerebral arteries supply the majority of the lateral cerebrum.
The posterior cerebral arteries supply a mixture of the medial and lateral areas of the posterior cerebrum.

Question 15

TACs criteria?

Answer 15

A total anterior circulation stroke (TACS) is a** large cortical stroke** affecting the areas of the brain supplied by both the middle and anterior cerebral arteries.

All three of the following need to be present for a diagnosis of a TACS:

Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

https://geekymedics.com/stroke-classification/

Question 16

PACs Criteria?

Answer 16

A partial anterior circulation stroke (PACS) is a less severe form of TACS, in which only part of the anterior circulation has been compromised. (cortical stroke in middle/anterior cerebral artery areas)

Two of the following need to be present for a diagnosis of a PACS:

Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)*
*Higher cerebral dysfunction alone is also classified as PACS.

Question 17

POCs criteria?

Answer 17

A posterior circulation syndrome (POCS) involves damage to the area of the brain supplied by the posterior circulation (e.g. cerebellum and brainstem).

One of the following need to be present for a diagnosis of a POCS:

Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder (e.g. horizontal gaze palsy)
Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia (with macular sparing)

Question 18

LACs criteria?

Answer 18

A lacunar stroke (LACS) is a subcortical stroke that occurs secondary to small vessel disease. There is no loss of higher cerebral functions (e.g. dysphasia).

One of the following needs to be present for a diagnosis of a LACS:

Pure sensory stroke
Pure motor stroke
Sensori-motor stroke
Ataxic hemiparesis

Question 19

Why in strokes of posterior cerebral artery is the macula spared?

Answer 19

Most of occipitl lobe is lost.
However, occipital pole is supplied by middle cerebral, thus as the occipital pole represents the macula, the macula function will be spared.

Question 20

Patient comes in with sudden onset thunderclap headache on back of head (worst headache they’ve ever had), what could the cause be?

Answer 20

Subarachnoid haemorrhage
sudden onset, thunderclap headache, occipital region often, stiff neck, decrease consciousness, focal signs

Question 21

For which immunosuppressant