Stroke

Question 1

Stroke assesment tools

Answer 1

ROSIER
FAST

Question 2

On non-contrast CT, acute ischaemic strokes will show

Answer 2

Hyperdense artery sign

Question 3

1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

What artery(ies) is involved
Bamford classification

Answer 3

MCA and ACA
TACI

Question 4

2 of 3 are present
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia

What artery
Bamford

Answer 4

ACA
PACI

Question 5

presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis

What artery
Bamford

Answer 5

involves perforating arteries around the internal capsule, thalamus and basal ganglia

Lacunar infarcts (LACI)

Question 6

presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

What artery
Bamford

Answer 6

involves vertebrobasilar arteries
POCI

Question 7

Stroke by anatomy
Contralateral hemiparesis and sensory loss, lower extremity > upper

Answer 7

Anterior cerebral artery

Question 8

Stroke by anatomy
Contralateral hemiparesis and sensory loss, upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

Answer 8

MCA

Question 9

Stroke by anatomy
Contralateral homonymous hemianopia with macular sparing
Visual agnosia

Answer 9

PCA

Question 10

Stroke by anatomy
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Answer 10

Weber’s syndrome
branches of the posterior cerebral artery that supply the midbrain

Question 11

Stroke by anatomy
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Answer 11

Posterior inferior cerebellar artery
Wallenberg, lateral medullary syndrome

Question 12

Stroke by anatomy
Ipsilateral: facial paralysis and deafness
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Answer 12

Anterior inferior cerebellar artery (lateral pontine syndrome)

Question 13

Stroke by anatomy
Amaurosis fugax

Answer 13

Retinal/ophthalmic artery

Question 14

Stroke by anatomy
‘Locked-in’ syndrome

Answer 14

Basilar artery

Question 15

Stroke by anatomy
present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia
strong association with hypertension
common sites include the basal ganglia, thalamus and internal capsule

Answer 15

Lacunar strokes

Question 16

Once hemorrhagic stroke excluded, what to give

Answer 16

aspirin 300mg orally or rectally should be given as soon as possible if a haemorrhagic stroke has been excluded

Question 17

Thrombolysis within

Answer 17

4.5 hours
Haemorrhage excluded

Question 18

Thrombectomy

Answer 18

Within 6 hours
INCLUDING thrombolysis (within 4.5 hours)

Question 19

Indication of thrombectomy

Answer 19

Confirmed PCA stroke on angiography

Question 20

Offer thrombectomy as soon as possible to people who were last known to be well between 6 hours and 24 hours previously (including wake-up strokes) if

Answer 20

Confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA

AND

if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume

Question 21

Consider thrombectomy together with intravenous thrombolysis (if within 4.5 hours) as soon as possible for people last known to be well up to 24 hours previously (including wake-up strokes):

Answer 21

who have acute ischaemic stroke and confirmed occlusion of the proximal posterior circulation (that is, basilar or posterior cerebral artery) demonstrated by CTA or MRA

AND

if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume

Question 22

Secondary prevention (ischaemic stroke)

Answer 22

Clopidogrel
2nd line aspirin plus MR dipyridamole

Question 23

Carotid endarterectomy

Answer 23

recommend if patient has suffered stroke or TIA in the carotid territory and are not severely disabled

should only be considered if carotid stenosis > 70% according ECST** criteria or > 50% according to NASCET*** criteria

Question 24

AF management post-stroke

Answer 24

warfarin or a direct thrombin or factor Xa inhibitor

Question 25

anticoagulation for AF should start immediately following a

Answer 25

TIA

Question 26

anticoagulation therapy should be commenced after 2 weeks in a

Answer 26

acute stroke
(Aspirin in the meantime)