Diagnosis and management of stroke

Question 1

Majority of strokes are ……. in nature

Answer 1

Ischemic

Question 2

first branch of the ICA is

Answer 2

Opthalmic artery

Question 3

Basal ganglia are perfused by which artery

Answer 3

MCA perforators

Question 4

Thalamus is perfused by

Answer 4

top of the basilar and proximal PCA

Question 5

contralateral hemianesthesia and hemiparesis

Leg affected more than arm or face

Answer 5

ACA

Question 6

Contralateral hemisensory and motor loss
Face, arm more than leg
contralateral homonymous hemianopsia
hemineglect 
ipsilateral gaze deviation

Answer 6

MCA syndrome

Question 7

No motor no sensory deficits

Contralateral homonymous hemianopsia

Answer 7

PCA

Question 8

Lesions to the vermis cause

Answer 8

truncal instability

gait ataxia

Question 9

Lesions to the cerebellar hemispheres

Answer 9

ipsilateral limb ataxias and nystagmus

vertigo, nausea, vomiting

Question 10

No language or visual impairment but have dense deficits in one modality you should think about

Answer 10

Small vessel ischemia - lacunar syndromes

Question 11

Pure hemi-motor, sensory or hemisensory motor
Ataxis hemiparesis
Dysarthria-clumsy hand syndrome

Answer 11

Lacunar

Question 12

Contralateral sensory loss - progressing to numbness and pain

Answer 12

thalamic lesion

Question 13

Crossed symptoms with eye movement abnormalities and nystagmus

Answer 13

brainstem stroke

Question 14

Main etiologies of ischemia

Answer 14

• thrombosis
• embolism
• hemorrhage
• systemic hypoperfusion

Question 15

Common site of atherosclerosis

Answer 15

Internal carotid

Question 16

Stroke risk factors contribute to

Answer 16

• atherosclerotic changes

- abnormal cardiac function

Question 17

what % of stroke etiology is atherosclerotic in nature

Answer 17

45%

20% - cardiogenic

Question 18

Most important modifiable risk factor

Answer 18

Hypertension

Question 19

Modifiable stroke risk factors

Answer 19

Dyslipidemia
hypertension
diabetes

Question 20

HbA1C levels for diabetics

Answer 20

< 7%

Question 21

each 10 % reduction in LDL reduces stroke risk by

50% reduction

Answer 21

13%

31% RRR

Question 22

Lipid targets for stroke prevention

Answer 22

LDL < 2

TC: HDL < 4

Question 23

A fib forms thrombus where?

Answer 23

left atrium -

Question 24

treatment of choice for A fib?

Answer 24

Warfarin better than ASA

Question 25

What should INR levels be in Afib patient?

Answer 25

between 2-3

Question 26

TIA =

Answer 26

No infarction ischemia self-limited

Question 27

TIA increases your risk for stroke in

Answer 27

90 days | especially high in first week or 2

Question 28

For established atherosclerosis how do you treat

Answer 28

give an anti-platelet - ASA

Question 29

How large is the absolute benefit from giving ASA

Answer 29

vERY SMALL but low cost

Question 30

Standard ASA therapy for preventing vascular events after stroke

Answer 30

over 30 mg | 81 mg PO

Question 31

second line antiplatelet therapy for patients on ASA presenting with a stroke

Answer 31

Plavix 75 mg | Aggrenox 1 tab BID

Question 32

when are the benefits for carotid endarterectomy the largest?

Answer 32

2 weeks after stroke or TIA and >70% stenotic

Question 33

after 2 weeks of a stroke or TIA who benefits from endarterectomy?

Answer 33

> 70% stenosis

Question 34

which method is favored over 70 yo endarterectomy or stenting?

Answer 34

endarterectomy

Question 35

Who should be considered for endarterectomy or stenting?

Answer 35

> 50% stenosis patients

Question 36

7 key points to manage a stroke or TIA

Answer 36

1) treat early (most recurrent strokes in 2 weeks) 2) Start on ASA or plavix or aggrenox 3) revascularize if > 70% stenosis 4) anticoagulate A fib 5) lower BP 6) add a statin 7) screen and treat diabetes

Question 37

Most significant advance in stroke care is

Answer 37

TPA

Question 38

when is it most beneficial to use tPA

Answer 38

within 4.5 hrs of a stroke

Question 39

major risks for tPA

Answer 39

ICH