Evaluation and Treatment for Acute Ischemic Stroke Flashcards
In case of acute stroke, treatment benefits are time dependent. Initial evaluation steps include history/physical examination, noncontrast brain CT, blood glucose level, and CTA in some cases. What is the optimal time of administration of tissue plasminogen activator alteplase in a patient with acute ischemic stroke?
● A. Within 3.5 hours
● B. Within 4 hours
● C. Within 4.5 hours
● D. Within 5 hours
● E. Within 6 hours
C. Within 4.5 hours
Following are included in the NIH stroke scale except?
● A. Level of consciousness, level of consciousness questions, and level of consciousness commands
● B. Best gaze and visual
● C. Facial palsy, motor arm, motor leg, limb ataxia, and sensory
● D. Ophthalmoplegia and dysphagia
● E. Best language and dysarthria
● F. Extinction and inattention and distal motor function
D. Ophthalmoplegia and dysphagia
Which of the following statements is incorrect regarding treatment of hypertension in a patient with acute ischemic stroke?
● A. If diastolic blood pressure is more than 140 mmHg, then 20 to 30% reduction is desirable with cardene infusion or IV labetalol is the agent of choice
● B. Systolic blood pressure more than 230 or diastolic blood pressure 120 to 140 for 20 minutes is treated with 10 mg slow IV infusion over 2 minutes of labetalol. The dosage of labetalol is doubled every 10 minutes (20, 40, 80, then 160 mg IV slow until controlled or total of 300 mg is given)
● C. Maintenance is effective dose of labetalol every 6 to 8 hours for SBP more than 180 or DBP more than 110
● D. SBP 180 to 230 or DBP more than 105 to 120 is treated with oral labetalol
● E. If labetalol is contraindicated, nicardipine is never used
E. If labetalol is contraindicated, nicardipine is never used
What are the indications of emergency surgery in case of acute stroke?
● A. Herniation from subdural hematoma
● B. Suboccipital craniectomy for progressive neurologic deterioration due to brainstem compression from cerebellar hemorrhage or infarction
● C. Decompressive craniectomy for malignant MCA territory stroke
● D. Carotid endarterectomy for high-grade carotid stenosis ipsilateral to fluctuating neuro deficit
● E. All of the above
E. All of the above
Which of the following are the early signs of infarction within 6 hours (hyperacute) of onset of ischemic stroke?
● A. Hyperdense artery sign
● B. Focal low attenuation within the gray matter and loss of the gray–white interface
● C. Attenuation of the lentiform nucleus or mass effect with effacement of cerebral sulci or with midline shift
● D. Lost of the insular ribbon sign which is hypodensity involving the insular cortex, susceptible to ischemia due to poor collaterals
● E. Infarction with IV contrast which occurs in only 33% of cases
● F. All of the above
F. All of the above
Most strokes can be identified as low density after 24 hours. When does stroke approaches that of CSF density?
● A. At 1 to 2 weeks
● B. At 3 weeks
● C. At 6 weeks
● D. At 3 months
● E. None of the above
B. At 3 weeks
Preoperative management of carotid endarterectomy includes acetylsalicylic acid 325 mg TID for at least 2 days or preferably for 5 days. Postoperative management after the procedure includes ICU monitoring with BP at 110 to 115 mmHg and avoidance of antiplatelet therapy for 24 to 48 hours postoperatively. Which of the following are the postoperative complications that can occur after the procedure?
● A. Disruption of arteriotomy closure
● B. Stroke
● C. Postoperative TIAs and seizures
● D. Cerebral hypoperfusion syndrome
● E. Cranial nerve injury
D. Cerebral hypoperfusion syndrome
Indications of carotid endarterectomy includes stroke in evolution, crescendo TIAs, or following intra-arterial thrombolysis. Emergent carotid endarterectomy (CEA) is indicated for residual critical carotid stenosis. Which of the following are the possible techniques for management of thrombus?
● A. Spontaneous extrusion is attempted using back pressure
● B. If A fails then removal using smoothened suction catheter is attempted
● C. If B fails then balloon embolectomy catheter is used by passing it as far as base of the skull
● D. Intraoperative angiogram is obtained unless thrombus emerges and backflow is excellent
● E. Plicate ICA (avoid creating a blind pouch at origin) if there is good backflow or if satisfactory angiography cannot be obtained
● F. All of the above
F. All of the above
What is the most sensitive test to detect ischemic stroke within 24 hours of occurrence?
● A. MRI with contrast
● B. CT with contrast
● C. DWI MRI
● D. CT angiography of brain
● E. CT perfusion
C. DWI MRI
Contraindications for administration of tissue plasminogen activator includes intracerebral hemorrhage, patients with history of more than 10 cerebral microbleeds, clinical presentation of SAH, active internal bleeding, known intracranial
aneurysm, or SVM, known bleeding diathesis, serious head trauma, and systolic blood pressure more than 185 mmHg or diastolic blood pressure more than 110 mmHg. Which of the following are included in the eligibility criteria in the administration of tissue plasminogen activator?
● A. Age above 18 years
● B. Time since last seen normal less than or equal to 4.5 hours prior to administration
● C. AIS in adults with known sickle disease
● D. tPA is reasonable in otherwise eligible patients with history of less than or equal to 10 cerebral microbleeds on MRI
● E. All of the above
E. All of the above
