PoS

Question 1

Contraindications to thrombolysis (STEMI)

Answer 1

active internal bleeding
recent haemorrhage, trauma or surgery (including dental extraction)
coagulation and bleeding disorders
intracranial neoplasm
stroke < 3 months
aortic dissection
recent head injury
pregnancy
severe hypertension

Question 2

Side effects

Answer 2

Haemorrhage
Hypotension - more common with streptokindase
Allergic reactions may occur with steptokinase

Question 3

Stroke syndromes symptoms

- Primary intracerebral Haemorrhage

Answer 3

Headache
Vomiting
LOC

Question 4

Stroke syndromes symptoms

Total anterior circulation infarcts (TACI)

Answer 4

Involves middle and anterior cerebral arteries
Hemiparesis
Homonymous Hemianopia
Higher cognitive dysfunction - Dysphasia

Question 5

Stroke syndromes symptoms

Partial anterior circulation infearcts (PACI)

Answer 5

Involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
Higher cognitive dysfunction or two of the three TACI features

Question 6

Stroke syndromes symptoms
Lacunar infarcts (LACI)

Answer 6

Involves perforating arteries around the internal capsule, thalamus and basal ganglia
Present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

Question 7

Stroke syndromes symptoms

Posterior circulation infarcts (POCI, c. 25%)

Answer 7

Vertebrobasilar arteries
Presents with features of brainstem damage
Ataxia, disorders of gaze and vision, cranial nerve lesions

Question 8

Stroke syndromes symptoms

Pontine

Answer 8

VI nerve: horizontal gaze palsy
VII nerve
Contralateral hemiparesis

Question 9

Stroke syndromes symptoms
Lateral medulla (posterior inferior cerebellar artery)

Answer 9

Ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy

Question 10

Superior orbital fissure syndrome Results in?

Answer 10

Complete opthalmoplegia and ptosis (Cranial nerves 3, 4, 6 and nerve to levator palpebrae superioris)
Relative afferent pupillary defect
Dilatation of the pupil and loss of accommodation and corneal reflexes
Altered sensation from forehead to vertex (frontal branch of trigeminal nerve)

Question 11

Structures passing thorugh SOF

Answer 11

Long Fissures Seem To Store Only Nerves, Instead Of Arteries, Including Ophthalmic Veins
The order of the contents passing through the superior orbital fissure form superior to inferior:

L: lacrimal nerve (branch of CN V1)
F: frontal nerve (branch of CN V1)
S: superior ophthalmic vein (tributary to cavernous sinus)
T: trochlear nerve (CN IV)
SO: superior division of the oculomotor nerve (CN III)
N: nasociliary nerve (branch of CN V1)
IO: inferior division of the oculomotor nerve (CN III)
A: abducens nerve (CN VI)
IOV: inferior ophthalmic vein (tributary to both cavernous sinus and pterygoid venous plexus)

Question 12

Indications for hemicranieotomy?

Answer 12

Age under 60 years
Clinical deficit in middle cerebral artery territory
Decreased consciousness
>50% territory infarct