Cerebrovascular Disease + Stroke

Question 1

Stroke

Answer 1

Focal neurological deficit of presumed vascular origin that develops suddenly and lasts >24hrs or leads to death

Question 2

TIA

Answer 2

Acute loss of cerebral/ocular function lasting <24hrs. Most resolve within minutes

Question 3

Amurosis fugax

Answer 3

Painless temporary loss vision b/c retinal hypoxia

Question 4

What % strokes occur in <65s

Answer 4

25%

Question 5

What % strokes are ischaemic?

Answer 5

85%

Question 6

What % strokes are haemorrhagic

Answer 6

15%

Question 7

TACS

Answer 7

ALL 3
Higher cortical dysfunction + 
Homonymous visual field defect 
\+ 
Motor +/or sensory deficit contralateral to lesion of at least 2/3 areas out of face, arm, leg

Question 8

PACS

Answer 8

2/3 of TACS or isolated high cortical dysfunction

Question 9

POCS

Answer 9

CN palsy + contralateral motor/sensory deficit, or bilateral stroke, or disorders of conjugate eye movement, or isolated cerebellar stroke, or isolated homonymous hemianopia

Question 10

LACS

Answer 10

Pure motor or pure sensory deficit affecting 2/3 of the face, arm, leg or acute-onset movement disorder

Question 11

RF Stroke (16)

Answer 11

HTN
High cholesterol 
Smoking 
Diabetes
Dietary 
Obese 
Low exercise 
Alcohol 
Male 
AF
Dx - OCP
FHx 
Age
Black
Prev stroke/TIA
Vasculitis

Question 12

Blood for stroke

Answer 12

FBC
U+E
Lipids
Glucose
ESR
TFT
Clotting screen

Question 13

What is a CT used for in Ix stroke?

Answer 13

To establish diagnosis - infarct, haemorrhage, SOL, abscess,, subdural haematoma

Question 14

What is an MRI used for in Ix stroke

Answer 14

DWI sequence to confirm infarcts

MRA - look for intracranial stenosis

Question 15

Ix stroke - ECG

Answer 15

AF
LVH
Cardiac ischaemia

Question 16

Ix stroke - carotid doppler

Answer 16

Ipsilateral cartoid stenosis

Question 17

Echo - Ix stroke

Answer 17

Excludes endocarditis/mural thrombosis - ‘bubble’ ech - patent foramen ovale

Question 18

Indications for urgent (<1hr) neuroimaging (7)

Answer 18

Being considered for acute thrombolysis 
On anticoag therapy 
Any known bleeding conditions 
Depressed GCS
Unexplained fluctuating or progressive Sx 
Papilloedema/neck stiness 
Severe headache @ onset stroke Sx

Question 19

Why is CT good for urgent neuroimaging? (3)

Answer 19

Easily accessible
Quick
Sensitive for bleeding

Question 20

Within how long of an ischaemic stroke should thrombolysis be administered?

Answer 20

4.5hr

Question 21

What else should be administered ASAP in an ischaemic stroke?

Answer 21

Clopidogrel

Question 22

If a patient on Warfarin has a haemorhagic stroke, what should be done?

Answer 22

Vit K + prothrombin concentrate

Question 23

If a patient on Heparin has a haemorrhagic stroke, what should be done?

Answer 23

Protamine sulfate

Question 24

C/I thrombolysis (6)

Answer 24

Rapidly improving stroke Sx
Stroke/serious head injury in last 3 months
Major surgery/obstetric delivery in last 14/7
Seizure @ onset stroke
Bleeding tendancy
Hx CNS damage

Question 25

Acute Mx stroke (4)

Answer 25

O2 if hypoxic Maintain blood gluc Swallowing assessment Rx vascular surgery

Question 26

LT Mx stroke (4)

Answer 26

Rehab ASAP CV risks Mx Lifestyle advice - smoking + exercise Rx psych as depression common

Question 27

If pt has AF, what should be given post stroke

Answer 27

Anti-coag therapy

Question 28

If pt has speech problems post stroke, what should be done

Answer 28

S+L therapist

Question 29

If pt has ophthal abornmalities post stroke, what should be done?

Answer 29

Rx to optometry

Question 30

If Persistent dysphagia after stroke, what should be considered?

Answer 30

PEG

Question 31

Mx spasticity post stroke

Answer 31

Exercise + splinting

Question 32

Stroke mimics (7)

Answer 32

``` SOL MS Functional disorders Metabolic disturbances Seizure Migraine Transient global amnesia ```