Case 16 - Overview Flashcards
what is the first thing to do in cases of suspected stroke
a.give aspirin
b.refer to TIA clinic
c.CT
c.CT
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
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
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
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
the majority of strokes are…
a.ischaemic
b.haemorrhagic
b.haemorrhagic
only way to tell them apart is by a ct brain
causes of ischaemic stroke
large artery atherosclerosis
cardioembolic
small vessel occlusion
other
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)
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
ataxic hemiparesis
weakness and ataxia on the same side
ataxia = poor coordination
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
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
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
what is the main risk factor for stroke
a.hypertension
b.age
c.male sex
d.hyperlipidaemia
e.previous stroke
f.smoking
a.hypertension
differential diagnoses to consider in cases of stroke
seizures
mass lesions
migraine
hypoglycaemia
neuropathies
MS
meningitis
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
