Cerebrovascular disease

Question 1

Stroke definition

Answer 1

disruption of blood supply to the brain characterised by rapidly developing signs of focal or global disturbance of cerebral functions, lasting >24h or leading to death

Question 2

TIA definition

Answer 2

temporary inadequacy in circulation to the brain, spinal cord or retina that gives a similar picture to stroke except it is transient (<24h) and reversible

Question 3

What score is used to assess 2 day risk of stroke in TIA?

Answer 3

ABCD2 score

Question 4

What makes up the ABCD2 score? And what do the scores mean?

Answer 4

Age: 1 if >60
BP: 1 if HTN (>140/90)
Clinical features: 1 if dyaphasia, 2 if hemiparesis
D1 duration: 1 if >10 mins, 2 if >60 mins
D2 diabetes: 1 if diabetes

• max 7 points
• 0-3 low risk (1%)
• 4-5 mod risk (4%)
• 6-7 high risk (8%)

Question 5

Antiplatelet therapy post stroke/TIA (secondary prevention)

Answer 5

clopidogrel 75mg (off-label for TIA) or aspirin and/or modified-release dipyridamole

Question 6

Anticoagulation post stroke/TIA

Answer 6

delay 14 days for stroke, can be earlier if mild stroke or TIA (includes TED stockings)

Question 7

First investigation post ?stroke/TIA

Answer 7

CT to rule out haemorrhage

Question 8

3 initial criteria of Oxford/Bamford classification

Answer 8

1. Unilateral hemiparesis and/or hemisensory loss of face, arm and leg
2. Homonymous hemianopia
3. Higher cognitive dysfunction e.g. dysphasia

Question 9

TACI arteries

Answer 9

middle and anterior cerebral arteries

Question 10

PACI arteries

Answer 10

smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery

Question 11

LACI arteries

Answer 11

perforating arteries around internal capsule, thalamus and basal ganglia

Question 12

POCI arteries

Answer 12

vertebrobasilar arteries

Question 13

TACI presentation

Answer 13

all 3 of Bamford criteria

Question 14

PACI presentation

Answer 14

2 of Bamford criteria

Question 15

LACI presentation

Answer 15

1 of:

1. pure motor stroke
2. put sensory stroke
3. sensori-motor stroke
4. ataxic hemiparesis

Question 16

POCI presentation

Answer 16

1 of:

1. cerebellar or brainstem syndromes - cranial nerve palsy + motor/sensory deficit; bilateral motor/sensory deficit; conjugate eye movement disorder; ataxia + nystagmus + vertigo etc.
2. loss of consciousness
3. isolated homonymous hemianopia

Question 17

Indications for thrombolysis and what to use?

Answer 17

• patients who present within 4.5h of ischaemic stroke
• IV alteplase (r-tPA)
• once haemorrhage ruled out on CT
• no CIs
• BP <185/110
• normal BM

Question 18

When might thrombectomy/clot retrieval be used?

Answer 18

major vessel occlusion (may be seen on CTA)

Question 19

Antiplatelet therapy immediately post-stroke/TIA

Answer 19

aspirin 300mg within 24h

Question 20

What score is used to assess stroke severity?

Answer 20

NIHSS (National Institutes of Health Stroke Scale)