Chapter 8. Post Stroke Complication

Question 1

This is classically attributed to thalamic stroke

Answer 1

Central post stroke pain

Question 2

First line of treatment of Central post stroke pain

Answer 2

Amitryptiline

Question 3

What is the drug of choice in elderly with Central post stroke pain

Answer 3

Nortriptyline

Question 4

What are the non pharmacologic management for Central post stroke pain

Answer 4

rTMS and vestibular caloric stimulation

Question 5

What is the mobilization technique for Hemiplegic Shoulder Pain Syndrome

Answer 5

ER and abduction

Question 6

What should be avoided in Hemiplegic Shoulder Pain Syndrome

Answer 6

Overhead pulley

Passive movement beyond 90degrees flexion and abduction

Question 7

What are the pharmacologic treatment for CRPS pain

Answer 7

Pamidronate
Alendronate
Clodronate

Question 8

Defined as early onset post stroke seizure

Answer 8

within 7 days

Question 9

Late onset seizure usually occurs during

Answer 9

beyond 7 days

Question 10

What is the explanation for early onset seizure

Answer 10

celullar biochemical dysfunction

Question 11

What is the explanation of late onset seizure

Answer 11

“true post stroke seizure”

due to gliosis and development of meningocerebral cicatrix

Question 12

What type of stroke will seizure be likely its manifestation

Answer 12

ICH

Question 13

Rate of post stroke seizure in the following stroke:
Multiple stroke \_\_
ICH \_\_\_
SAH \_\_\_
Unspecified hemorrhage \_\_\_
Ischemia \_\_\_

Answer 13

Multiple stroke 7.7%
ICH 4.3%
SAH 4.2%
Unspecified hemorrhage 2.5%
Ischemia 1.6%

Question 14

What is the outcome for early onset seizure

Answer 14

High incidence of status epilepticus and in-hospital mortality

Question 15

What is the recurrence of late onset seizure

Answer 15

50% 5 year period recurrence

Question 16

This is the most important and common neuropsychiatric complication affecting post-stroke

Answer 16

Post stroke depression

Question 17

The incidence of post stroke depression

Answer 17

52%in 5 years

Question 18

The prevalence of post stroke depression

Answer 18

29%

Question 19

What are the sensitive predictor of post stroke depression

Answer 19

Depressed mood
Decreased appetite
Crying

Question 20

Prophylaxis using antidepressant is associated with

Answer 20

reduction of incidence of post stroke depression

Question 21

What medication is associated with maximum motor recovery in depressed patient

Answer 21

Fluoxetine

Question 22

Incidence of post-stroke demetia

Answer 22

7%

Question 23

Prevalence of post-stroke dementia

Answer 23

30%

Question 24

How to assess vascular dementia

Answer 24

test for executive function
Trail making test
CDT

Question 25

BP lowering is associated with what effect in cognitive decline

Answer 25

improve 3-4 points in MMSE

Question 26

Distribution of type of stroke in SIY

Answer 26

50% infarct 30% SAH 20% ICH

Question 27

What is the most common symptoms associated with missed diagnosis of stroke

Answer 27

Dizziness

Question 28

Hemorrhagic stroke in SIY are associated with

Answer 28

35% Hypocholesterol 20% Tobacco 13% hypertension 10% alcohol use

Question 29

Most common drug implicated to ICH in SIY

Answer 29

phenylpropanolamine

Question 30

Cavernous angioma is located in

Answer 30

Brainstem

Question 31

Drug of choice for PFO

Answer 31

ASA

Question 32

When is inferior vena cava filter indicated in PFO

Answer 32

When there is stroke/TIA despite anticoagulation and antiplatelet

Question 33

What is contraindicated in patients with migrain with aura

Answer 33

Triptans and ergots

Question 34

What is the lifestyle modification in patients with Migrane with Aura

Answer 34

Smoker cessation

Question 35

What is the recommended OCP if the patient insist to use one

Answer 35

Progestin and should be stop when there is occurrence of stroke

Question 36

Recommendation for hypercoagulable state in SIY

Answer 36

1. initiate anticoagulation | 2. if anticoagulation is contraindicated use antiplatelet

Question 37

Recommendation for APAS

Answer 37

1. APAS with alternative explanation for ischemic event is not recommended 2. If (+) APA but did not fulfill the APS criteria: antiplatelet 3. If meet APS criteria: anticoagulation but may use antiplatelet if contraindicated to anticoagulation

Question 38

What are the recommendation for sicle cell disease

Answer 38

1. Chronic blood transfusion to decrease hgb S to < 30% of total hgb 2. Stroke with SCD and BT is not available: may give hydroxyurea

Question 39

In Helsinski Young Stroke Registry: | Cumulative risk at 1 month, 1 years and 5 years

Answer 39

1 month: 2.7% 1 years: 4.7% 5 years: 10.7%

Question 40

In Helsinski Young Stroke Registry: | 5 year recurrence rate

Answer 40

11.5%

Question 41

In Helsinski Young Stroke Registry: | Epilepsy rate

Answer 41

10.5%