stroke

Question 1

symptoms of an ACA stroke

Answer 1

disinhibition // contralat limb weakness + sensory // legs > arms

Question 2

symptoms MCA stroke

Answer 2

contralateral weakness + paralysis upper limbs // aphasia // contralateral heminopia

Question 3

PCA stroke symptoms

Answer 3

contralteral heminopia // visual symptoms

Question 4

weber’s syndrome stroke vessels

Answer 4

branching arteries of PCA – > midbrain

Question 5

webers syndrome stroke syndrome

Answer 5

ipsilateran CNIII palsy // contralteral limb weakness

Question 6

cerebellar stroke symptoms

Answer 6

vertigo, ataxia, contralteral torse pain + temp loss // posterior = ipsilat face pain + temp loss // anterior = ipsilat face paralysis + deafness

Question 7

when does lateral medullary syndrome occur + symptoms

Answer 7

posterior cerebellar stroke –> ataxia, nystagmus, ipsilateral facial weakness + dysphagia (horners), contralateral sensory loss

Question 8

opthalamic artery stroke symptoms

Answer 8

Amarousis faugux

Question 9

vertebral artery stroke symptoms

Answer 9

locked in syndrome

Question 10

what causes lacunar stroke

Answer 10

hypertension + atherosclerosis of smaller vessels

Question 11

area affected by lacunar stroke

Answer 11

basal ganglia, thalamus, internal capsule

Question 12

symptoms lacunar infarcts (LACI)

Answer 12

(usually affect one limb) one of: ataxic hemiparesis // sensory loss // unilateral weakness

Question 13

oxford stroke classification criteria

Answer 13

unilateral hemiparesis +/- sensory loss // heminopia // cognitive dysfunction eg dysphagia

Question 14

TACI vessels

Answer 14

ACA + MCA

Question 15

TACI symptoms

Answer 15

all 3 criteria (hemiparesis, heminopia, dysphagia)

Question 16

PACI vessels

Answer 16

lower branches of ACA

Question 17

PACI symptoms

Answer 17

2/3 criteria (hemiparesis, heminopia, dysphagia)

Question 18

POCI vessels

Answer 18

vertebral

Question 19

POCI symptoms

Answer 19

one of: cerebellar, LOC, heminopia

Question 20

most common types of stroke

Answer 20

ischaemic 85% vs haemorrhage 15%

Question 21

symptoms more common in haemorrhagic stroke patients

Answer 21

headache, deacreased LOC, N+V, seizure

Question 22

RF stroke

Answer 22

atheromas, hypertension, hyperlipidaemia, obesity, age, T2DM, drugs, smoking

Question 23

what should be excluded 1st in a stroke

Answer 23

hypoglycaemia

Question 24

what assessment is used for stroke + what result indicates stroke is likelu

Answer 24

rosier - score >0

Question 25

imaging + findings stroke

Answer 25

urgent non-contract CT: ischaemia = hypodense affected area + hyperdense artery // haemorrhage = hyperdense blood

Question 26

what drug should be given as soon as haemorrhagic stroke is excluded

Answer 26

300mg aspirin rectallu

Question 27

1st line mx ischaemic stroke

Answer 27

IV thrombolysis with alteplase (tPa)

Question 28

when can stroke thrombolysis be given

Answer 28

within 4.5 hours of symptoms + haemorrhagic excluded

Question 29

contraindications thrombolysis

Answer 29

previous haemorrhage // seizure at same time // recent TBI, LP or GI bleed // pregnant // hypertension >200 // oeseophageal varisces

Question 30

in what 2 scenarios is thrombectomy offered in stroke

Answer 30

within 6 hours of onset, anterior circulation stroke (ACA or MCA), give with thrombolysis // OR give between 6-24 hours if patient well + can salvage brain tissue

Question 31

what scenario is thrombectomy considered in stroke

Answer 31

with IV thrombolytsis in people who have been well for 24 hours + posterior circulation (basilar or PCA)

Question 32

what scenario is thrombectomy considered in stroke

Answer 32

with IV thrombolytsis in people who have been well for 24 hours + posterior circulation (basilar or PCA)

Question 33

what prophylaxis mx is 1st + 2nd line post stroke

Answer 33

1 = lifelong clopidogrel // 2 = aspirin + dipyridamole of clopidogrel contraindicated // give a statin if lipids >3.7

Question 34

when is BP management allowed after an ischaemic stroke

Answer 34

hypertensive encephalopathy, nephropathy, CF // aortic dissection // pre-eclampsia

Question 35

what must be assessed post-stroke

Answer 35

swallow function

Question 36

post-stroke prophylaxis in AF

Answer 36

warfarin or Xa inhibitor

Question 37

in afib when should anticoag be started post-TIA

Answer 37

immediately

Question 38

in afib when should anticoag be started post-stroke

Answer 38

after 2 weeks - give antiplatelets in interim

Question 39

what is a TIA

Answer 39

transient neuro dysfunction, vascular ischaemia of brain, spinal cord or retina // no acute infarction

Question 40

symptoms TIA

Answer 40

last <1 hour // unilateral weakness, aphasia, vertigo, ataxia, sudden vission loss

Question 41

immediate mx TIA

Answer 41

aspirin 300mg

Question 42

mx for TIA patient with bleeding disorder/ taking anti-coag

Answer 42

urgent admission to exclude haemorrhage

Question 43

invx TIA

Answer 43

MRI // CT only if suspected alternative diagnosis // carotid imaging with USS

Question 44

when is carotid artery endartectomy considered (2)

Answer 44

if carotid TIA or stroke but not disabled // if carotid stenosis >70%

Question 45

DVLA driving after stroke/ TIA

Answer 45

1 month

Question 46

DVLA dricing after multiple TIAs

Answer 46

3 months

Question 47

disability survery post stroke

Answer 47

barthel