Neurology of stroke

Question 1

What characteristics of symptoms would suggest a vascular event has occurred?

Answer 1

sudden onset
focal neurological symptoms
negative symptoms rather than positive (loss of function)
symptoms maximal at onset (not gradually getting worse)

Question 2

Virchow’s triad

Answer 2

hypercoagulability
stasis
vessel wall injury

Question 3

What can cause blood to be hypercoagulable?

Answer 3

sickle cell disease
leukaemia
APLS
antithrombin 3 deficiency
Protein C/S deficiency
increased factor 8
DIC
thrombocytosis
polycythaemia vera
TTP
venous occlusion

Question 4

What conditions can cause a cardiogenic embolism?

Answer 4

atrial fibrillation
mitral stenosis
prosthetic cardiac valve
recent MI
thrombus in LV or LA appendage
atrial myxoma
infective endocarditis
dilated cardiomyopathy
PFO with ASA

Question 5

Stroke mimics

Answer 5

seizures
migraine
metabolic (hypoglycaemia)
inflammatory (MS/Bell’s)

Question 6

Stroke chameleons (weird stroke presentations)

Answer 6

hemiballismus/dyskinesia
‘confused’ - fluent aphasia
‘unconscious’ - locked-in syndrome

Question 7

What contraception should patients who have migraine with aura not be on?

Answer 7

combined oral contraceptive pill
increases stroke risk
should either be changed to POP or LARC

Question 8

Can patients with migraine with aura have HRT?

Answer 8

yes (but topical better than oral)
HRT is replacing physiological oestrogen not providing extra so generally considered safe

Question 9

What is PRES?

Answer 9

posterior reversible encephalopathy syndrome

Question 10

What presentations when together should raise suspicion of a mitochondrial disorder?

Answer 10

short
diabetes
deafness
cardiomyopathy
epilepsy

Question 11

What could be found in the CSF of a patient with a mitochondrial disorder?

Answer 11

CSF lactate high
due to loss of aerobic respiration so anaerobic takes over and produces lactate
as mitochondria is the site of the electron transport chain in aerobic respiration