More Stroke

Question 1

What does the CHADS-VASc score measure

Answer 1

Risk of embolic stroke with chronic AF

Question 2

What does the HAS-BLED score measure

Answer 2

Risk of bleeding with long term anticoagulation in chronic AF

Question 3

Score for CHADS-VASc

Answer 3

CCF (1)
HTN (1)
Age - 65-74 (1)
Age - >74 (2)
Diabetes (1)
Previous stroke/TIA/thromboembolism (2)
Vascular disease (1)
Female (1)

Question 4

Score for HAS-BLED

Answer 4

All 1:
HTN
Abnormal liver function
Abnormal renal function
Age >65
Previous stroke
Previous major bleeding
Labile INR
Alcohol >8 drinks per week
Drugs - anticoagulation, antiplatelets, NSAIDs

Question 5

What CHADS-VASc score should prompt starting a DOAC

Answer 5

1 for male

2 for female

Question 6

What HAS-BLED score should prompt alternatives to anticoagulation

Answer 6

3 or over

Question 7

Contraindications for thrombolysis (10)

Answer 7

Haemorrhagic stroke
>4.5 hours since onset
Anticoagulation
Bleeding in non compressible site
Peptic ulcer disease
Major surgery <1 month
Ischaemic stroke <1 month 
Head injury
<16 year old
CPR <24 hours

Question 8

What drug is used in thrombolysis and what route

Answer 8

Alteplase (tissue plasminogen activator)
10% IV injection
90% IV infusion

Question 9

Definition of stroke

Answer 9

Acute onset of focal neurological deficit (negative symptoms) attributable to vascular cause
In a specific vascular territory

Question 10

Risk factors for stroke (10)

Answer 10

Obesity
Smoking
Hypercholesterolaemia 
HRT/COCP
Diabetes mellitus
AF
Anticoagulation
Antiphospholipid syndrome 
PKD
Carotid artery atherosclerosis

Question 11

What are the categories of oxford stroke classification

Answer 11

Total anterior circulation stroke
Partial anterior circulation stroke
Posterior circulation stroke
Lacunar stroke

Question 12

Criteria for TACS

Answer 12

All 3:
Unilateral muscle weakness or sensory loss in face, arm and leg
Contralateral homonymous hemianopia
Higher cerebral dysfunction (aphasia or neglect)

Question 13

Criteria for PACS

Answer 13

2 out of 3:
Unilateral muscle weakness or sensory loss in face, arm and leg
Contralateral homonymous hemianopia
Higher cerebral dysfunction (aphasia or neglect)

Question 14

Criteria for POCS

Answer 14

1 of:
Contralateral homonymous hemianopia
Cortical blindness
CN palsy with contralateral muscle weakness or sensory loss
Loss of consciousness
Cerebellar symptoms

Question 15

Criteria for LACS

Answer 15

1 of:
Isolated sensory loss
Isolated muscle weakness in 2/3 of face, arm or leg

Question 16

What does the NIHSS score measure

Answer 16

Quantify impairment of stroke

Question 17

What does the modified Rankin scale measure

Answer 17

Degree of dependence of a patient following a stroke

Question 18

Investigations of stroke

Answer 18

History and examination 
Baseline observations 
Capillary blood glucose
Bloods - FBC, U+E, LFTs, clotting, lipid profile 
ECG
CT head

Question 19

Drug management of ischaemic stroke

Answer 19

Thrombolysis if not CI
Aspirin 300mg OD started 48 hours after thrombolysis for 14 days
When stopped aspirin, start clopidogrel 75mg OD
Start statin

Question 20

Management of ischaemic stroke

Answer 20

Drugs
Manage risk factors
ICA stenosis >70% need carotid endarterectomy within 2 weeks
OT/PT
SALT
Screen for depression 
Monitor bowel and bladder

Question 21

Management of haemorrhagic stroke

Answer 21

Lower BP
Reverse high INR (vitamin K, octaplex)
Stop anticoagulants
Surgery to clamp aneurysm

Question 22

Scoring system for TIA

Answer 22

Age 60 or over (1)
BP 140/90 (1)
Clinical features:
- unilateral muscle weakness (2)
- speech disturbance (1)
Diabetes mellitus (1)
Duration:
- >1 hour (2)
- 10-59 minutes (1)

Question 23

What TIA score needs CT head and referral to TIA clinic within 24 hours

Answer 23

4 or above

Question 24

Definition of TIA

Answer 24

Ischaemic neurological event with symptoms lasting <24 hours

Question 25

Risk factors for TIA

Answer 25

Carotid atherosclerosis 
AF
Hyperviscosity e.g polycythaemia    
Coagulopathy
Hypertension
Obesity
Diabetes
Smoking

Question 26

Management of TIA

Answer 26

Modify risk factors
14 days 300mg aspirin OD then lifelong 75mg clopidogrel OD
Start statin
No driving for 1 month
Notify DVLA if multiple TIAs (no driving for 3 months)