Neuro conditions: Stroke, infections

Question 1

What condition does this suggest + most important acute tx

1. Confusion
2. Ataxia
3. Nystagmus/ opthalmoplegia

Answer 1

Wernicke’s encephalopathy

Give Pabrinex (IV Vit B12, C)

Question 2

What is the medical management after ischaemic stroke

Answer 2

Aspirin 300mg for 14w

Change to clopigogrel at discharge

Question 3

Contraindications to thrombolysis

Answer 3

Apixaban

BP >185/110

Question 4

Would blood or infarct show faster on CT? What to do if no signs on CT at first?

Answer 4

Blood shows faster
Infarct can take a while to show

Repeat CT in 24h

Question 5

What stroke mimic can epileptics get

• how does it present
• what kind of epilepsy

Answer 5

Todd’s paresis (in focal epilepsy)

Focal weakness after focal seizure which resolves within 24h

Question 6

Main risk factors for stroke

Answer 6

• AF

- Carotid artery stenosis

Question 7

Which antiplatelet is best after a stroke

Answer 7

Clopidogrel

But it also comes with higher bleeding risk, so give aspirin 300mg for 2 weeks before switching to clopidogrel

Question 8

What scale is used for neuro disability after a stroke

Answer 8

Modified Rankin scale

Question 9

Window for thrombolysis vs thrombectomy

Answer 9

Thrombolysis: 4h
Thrombectomy: 6h

Question 10

Speech problems means stroke in which area/ side of brain

Answer 10

L side brain

Question 11

Same side face + contralateral loss of sesnation + nystagmus + ataxia

=problems with which part/ blood vessel of the brain

Answer 11

Lateral medullary syndrome

Posterior inferior cerebellar artery

Question 12

Normal lumbar puncture opening pressure

Answer 12

10-25cm CSF

Question 13

Gram positive coccus cause of meningitis

Gram negative coccus cause of meningitis

Answer 13

Gram positive coccus: pneumococcus (p = positive)

Gram negative coccus: meningococcus (m = minus)

Question 14

Renal side effect of IV aciclovir for encephalitis

Answer 14

Crystal nephropathy