Neuro

Question 1

Lacunar Strokes?

Answer 1

Lacunar infarcts account for around 20-25% of ischaemic strokes. They involve occlusion of a single penetrating branch of a large cerebral artery and affect the internal capsule, thalamus and basal ganglia.

Features
purely motor - most common lacunar syndrome
purely sensory
sensorimotor stroke
ataxic hemiparesis - ipsilateral weakness and limb ataxia that is out of proportion to the motor deficit
dysarthria-clumsy hand syndrome

Question 2

Aphasia? - Fluent speech that makes little sense, word substitution and neologisms
But comprehension is relatively intact.

Answer 2

Conduction aphasia

Question 3

Aphasia? - Fluent speech that makes little sense, word substitution and neologisms
And comprehension is impaired

Answer 3

Wernicke’s aphasia

Question 4

Aphasia? - Speech is non fluent (laboured, haliting). Content words may be preserved
And comprehension is impaired

Answer 4

Global aphasia

Question 5

Contraindications to thrombolysis

Answer 5

Absolute:
Previous intracranial haemorrhage
Seizure at onset of stroke
Uncontrolled HTN
Active bleeding
Intracranial neoplasm
GI bleeding in last 3 weeks
Oesophageal varices
Suspected SA haemorrhage
Stroke or traumatic brain injury in preceding 3 months
Lumbar puncture in preceding 7 days

Relative:
Pregnancy
- Concurrent anticoagulation (INR >1.7)
- Haemorrhagic diathesis
- Active diabetic haemorrhagic retinopathy
- Suspected intracardiac thrombus
- Major surgery / trauma in the preceding 2 weeks