Neurology

Question 1

13 Risk factors for stroke

Answer 1

1. HTN
2. Smoking
3. Diabetes
4. Hyperlipedemia
5. Heart disease = AFib
6. PVD
7. Prev TIA/stroke
8. Carotid bruit
9. OCP
10. Alcohol
11. Coagulopathy
12. Syhphllis
13. Homocystinuria

Question 2

Presentation of ACA stroke

Answer 2

• Contralateral weakness of leg
• Contralateral lower limb sensory loss
• Loss of bladder control

Question 3

Presentation of MCA stroke

Answer 3

1. Superior division
   
   • Contralateral face and arm paresis
   • Contralateral face and arm sensory loss
   • Broca expressive aphasia = dominant
     hemisphere.
2. Inferior division
   
   • Contralateral homonomous
     hemianopsia.
   • Contralateral agraphesthesia
   • Contralateral anosognosia
   • Contralateral neglect
   • Wernicke’s receptive aphasia.
3. Proximal occlusion
   
   • Involves all of the above

Question 4

Presentation of stroke involving ICA

Answer 4

• Predominantly TIA or transient monocular
  blindness; amaurosis fugas
• Or presentation similiar to MCA
  occlusion.

Question 5

Lacunar infarct: Presentation

Answer 5

1. Pure motor:
   
   • Contralateral leg, arm and face
2. Pure sensory
   
   • Hemisensory loss
3. Ataxic hemiparesis:
   
   • Ipsilateral ataxis
   • Leg paresis
4. Dysarthria clumpsy hand syndrome
   
   • Dysarthria
   • Facial weakness
   • Dysphagia
   • Mild hand weakness
   • Clumsiness.

Question 6

Acute treatment of stroke

Answer 6

Acute treatment:
-  Ensure patient stability
-  ABC's
-  Check glucose
-  Urgent CT to rule out hemorrhage.
-  LABS:  CBC, PT, INR
-  ECG
-  Give 300mg aspirin or clopidogrel if 
   aspirin CI.
-  Give dipyridomole
-  BP control only if > 220/120; IV Labetolol.
-  Thrombolysis (rt-PA) if no 
   contraindications and presents within 
    4.5hrs.
-  NPO - especially if dysphagia
-  DVT prophylaxis while in hospital
-  Initiate rehab therapy

Question 7

Primary and secondary prevention of stroke

Answer 7

Primary prevention:
-  Before stroke occurs
-  Control risk factors.
-  Treat HTN, DM, hyperlipds, carotid 
   disease with endarterectomy.
-  Quit smoking.
-  Life long anti-coagulation in heart valve 
   patients + RHD.

Secondary prevention
- Preventing further strokes
- Control RF as above
- Give antiplatelets after stroke: aspirin or
clop
- Anti-coag = Warfarin 2 weeks post stroke
used only instead of aspirin if it was an
embolic stroke.