Case 16 - Overview Flashcards by Jenna Dymond

what is the first thing to do in cases of suspected stroke

a.give aspirin
b.refer to TIA clinic
c.CT

c.CT

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what investigation is organised by the TIA clinic

a.CT brain
b.NIHSS assessment
c. carotid doppler ultrasound

c. carotid doppler ultrasound
+/- MRI brain
carotid doppler done to show any thrombus formation and calculate risk of future stroke

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following TIA which drug is given 300mg daily starting in the ED

a.low molecular weight heparin
b.warfarin
c.aspirin
d. dabigatran
e.clopidogrel

c.aspirin

antiplatelet drug

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what is done if the carotid arteries are narrowed due to a build up of fatty deposits

a.CT brain
b.NIHSS assessment
c. carotid doppler ultrasound
e.carotid endarterectomy

e.carotid endarterectomy

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symptoms of a TIA usually last a few mins to hour and fully resolve within….

a.24 hrs
b.48 hrs
c.1 week
d.1 month

a.24 hrs

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the majority of strokes are…

a.ischaemic
b.haemorrhagic

b.haemorrhagic

only way to tell them apart is by a ct brain

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causes of ischaemic stroke

large artery atherosclerosis
cardioembolic
small vessel occlusion
other

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occlusion of the proximal MCA or ICA is defined as which type of stroke

a.total anterior circulation stroke
b.partial anterior circulation stroke
c.lacunar stroke
d.posterior circulation stroke

a.total anterior circulation stroke

weakness of at least 2 of face arms and legs
homonymous hemianopia
higher cerebral deficit (dysphagia and dyspraxia)

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occlusion of the branches of the MCA is defined as which type of stroke

a.total anterior circulation stroke
b.partial anterior circulation stroke
c.lacunar stroke
d.posterior circulation stroke

b.partial anterior circulation stroke

2 FROM THE 3 TAC criteria
( weakness of face/arms/legs + homonymous hemianopia + higher cerebral deficit)

or restricted motor or sensory deficits

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ataxic hemiparesis

weakness and ataxia on the same side

ataxia = poor coordination

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ataxic hemiparesis is associated with which type of stroke

a.total anterior circulation
b.partial anterior circulation
c.lacunar
d.posterior circulation

c.lacunar

pure motor
pure sensory
sensorimotor
ataxix hemiparesis

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a lacunar stroke occurs where

a.proximal MCA or ICA
b. MCA branches
c,basal ganglia or pons
d.brainstem , cerebellar or occipital lobes

d.brainstem , cerebellar or occipital lobes

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a stroke affecting the brainstem, cerebellar or occipital lobes or PCA / vertebrobasillar arteries is classified as what

a.total anterior circulating
b.partial anterior circulating
c.lacunar
d.posterior circulation stroke

d.posterior circulation stroke

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what is the main risk factor for stroke

a.hypertension
b.age
c.male sex
d.hyperlipidaemia
e.previous stroke
f.smoking

a.hypertension

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differential diagnoses to consider in cases of stroke

seizures
mass lesions
migraine
hypoglycaemia
neuropathies
MS
meningitis

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examination in cases of tia

inspection
loc
speech
higher mental function
cranial nerve exam
peripheral nerve exam

investigations in cases of TIA

vitals : BP, O2, HR,RR
blood glucose
Hb, platelets, renal function (if giving antiplatelets)
fasting lipids
ecg
neuro - ct
vascular - doppler ultrasound

what should be performed immediately if stroke is suspected

a.MRI
b.CT
c.ECG
d.carotid endarterectomy
e.carotid doppler ultrasound

b.CT

why is a ct brain done immediately in cases of suspected stroke

a.rule out ischaemia
b.location of stroke
c.rule out haemorrhage
d.check severity

c.rule out haemorrhage

which of these vessels circulation is not shown in a CT angiogram

a.carotid
b.vertebral
c.cerebral
d.cerebellar

d.cerebellar

what does penumbra imply

a.salvage of cells surrounding the infarcted core is possible

b.salvage of cells surrounding the infarcted core is not possible

a.salvage of cells surrounding the infarcted core is possible

ischaemic tissue potentially destined for infarction but not yet irreversibly injured is known as what

a.infarcted core
b.penumbra

b.penumbra

at which point post large vessel ischaemic stroke does treatment hold more of a risk of harm than benefit

a.0-90 mins
b.90-180 mins
c.181-270 mins
d.271-360 mins
e.350-400 mins

d.271-360 mins

alteplase, reteplase and tenecteplase

tissue plasminogen activator

cause conversion of plasminogen to plasmin which then dissolves blood clots

IV tissue plasminogen activator is given within how many hours of symptom onset a.1 hr b.2 hrs c.3.5 hrs d.4.5 hrs

d.4.5 hrs

after giving IV tpA when is a CT repeated a.24 hrs b.48 hrs c.1 week d.1 month

a.24 hrs

contraindications to TPA

recent surgery recent stroke liver disease , pancreatitis warfarin with INR> 1.7 or on NOACs (Xa inhibitors have Xa in the name) GCS<8 high BP

thrombectomy can be performed in patients with an ischaemic stroke due to a clot in a large artery (internal carotid/ proximal middle cerebral) and an NIH stroke score of 6 or more , within how many hours of symptom onset a.asap b.2 hrs c.4.5 hrs d.6 hrs

d.6 hrs

which group is indicated for thrombectomy a.wake up strokes b.day time unwittnessed strokes

a.wake up strokes

aspirin is given 300mg po daily for 2 weeks following stroke after how long can the dose be reduced to 75 mg daily a.1 week b. 2 weeks c. 3 weeks d.4 weeks e.5 weeks

b. 2 weeks

if a patient is given tissue plasminogen activator how long is aspirin withheld for a, 24 hrs b.36 hrs c.48 hrs d. 55 hrs

a, 24 hrs

what is given first aspirin or tpa a. tpa b.aspirin

a. tpa if patient given tpa aspirin started 24 hrs later

what is used for the prevention of stroke / tia caused by cardioemboli eg atrial fibrillation a.antiplatelets eg aspirin b.anticoagulants eg lmwh,warfarin, lmwh

b.anticoagulants eg lmwh,warfarin, lmwh

in an acute stroke anti coagulation is usually not started for how long a. 24 hrs b.within 4.5 hrs c.within 6 hrs d.after 2 weeks

d.after 2 weeks

where is large vessel atherosclerosis preceding a stroke most commonly found a.carotids and vertebral arteries b.intracranial arteries c.thrombus formation d.thromboembolism

a.carotids and vertebral arteries

where is large vessel atherosclerosis preceding a stroke most commonly found a.carotids and vertebral arteries b.intracranial arteries c.thrombus formation d.thromboembolism

a.carotids and vertebral arteries

what is the most likely route cause of a cardioembolic stroke a.AF, recent MI, valve disease b.aortic atherosclerosis c.endocarditis d.cardiac tumours

a.AF, recent MI, valve disease

most lacunar strokes are caused by what a.atrial fibrillation b.large vessel atherosclerosis c.lipohyalinosis

c.lipohyalinosis

patients with stable neurological symptoms from recent acute non disabling stroke or TIA with carotid stenosis should be assessed and referred for what a.ct brain b.doppler ultrasound