Stroke

Question 1

Multiple TIA dvla advice
Inform dvla

Answer 1

Not driving for 3 months

Question 2

Stroke or 1 TIa dvla

Answer 2

Doesn’t need to be informed
Stop driving for a month

Question 3

Dvla narcolepsy

Answer 3

Stop driving until satisfied control of sx

Question 4

Craniotomy dvla

Answer 4

1 year off driving

Question 5

TIa rx intolerant of clopidogrel

Answer 5

Aspirin + dipyridamole lifelong

Question 6

Thrombolysis window

Answer 6

4.5 hrs

Question 7

Weber’s syndrome
Locations
Artery
SX

Answer 7

Location: Midbrain
Artery: PCA
SX:
1. CN III palsy (eyes get caught in a web)
2. Contralateral weakness of upper and lower extremity

Question 8

Medial pontine syndrome
-Art
-sx

Answer 8

• paramedian branches of the basilar artery.

1. corticospinal tract: contralat. hemiplegia
2. Medial lemniscus: contralateral loss of proprioception & vibration
3. middle cerebellar peduncle: ipsilateral ataxia
4. facial nerve (CN VII): ipsilateral facial weakness
5. abducens nerve (CN VI) nucleus: lateral gaze paralysis and diplopia (affected eye looks down and towards the nose)

BASILAR (branch’s of the base = face )

Question 9

Lateral Pontine Syndrome
- Art
-Sx 4

Answer 9

AICA (Pons)
1. Contralat. loss P&T (spinothalamic tract)
2. Ipsilat ataxia arm and leg (spinocerebellar tract)
3. ipsilateral Horner’s
(sympathetic pathway)
4. Ipsilateral face loss P&T (sensory nucleus of trigeminal nerve)
“facial droop means AICA is pooped”
similar to Wallenberg’s, but:
Ipsilateral: facial paralysis and deafness

Question 10

‘Locked-in’ syndrome
Location
Sx

Answer 10

• Basilar artery
  Pons, cerebellum
  Quadriplegia
  Anarthria
  Restricted horizontal eye movement

Question 11

CN Medial Medullary Syndrome

Answer 11

CN12 is the only midline CN
deviation of the hypoglossal nerve to the ipsilateral side (side of the infarction)
“lick your wounds”

Question 12

CN lateral pontine syndrome

Answer 12

cranial nerves 5, 7, and 8 *
loss of function of cranial nerve 7 (facial nerve) = facial paralysis
“facial droop means AICA is pooped”

Question 13

CN Medial Medullary Syndrome

Answer 13

CN12 is the only midline CN
deviation of the hypoglossal nerve to the ipsilateral side (side of the infarction)
“lick your wounds”

Question 14

CN of Lateral Medullary Syndrome

Answer 14

CN 9, 10, and 11
Mainly 9glossopharyngeal, hoarseness
CN 10 vagus nerve= dysphagia
“Never pick a (PICA) horse (hoarseness) that cannot eat (dysphagia)

Question 15

CN lateral pontine syndrome

Answer 15

cranial nerves 5, 7, and 8 *
loss of function of cranial nerve 7 (facial nerve) = facial paralysis
“facial droop means AICA is pooped”

Question 16

CN Medial Medullary Syndrome

Answer 16

CN12 is the only midline CN
deviation of the hypoglossal nerve to the ipsilateral side (side of the infarction)
“lick your wounds”

Question 17

Rule of 4 localize brainstem vascular syndromes

Answer 17

First Rule: 4 midline structures that begin with the letter M

Second Rule: 4 lateral structures that begin with the letter S
Third Rule: 4 CN below the pons, 4 in the pons, and 4 above the pons
Fourth Rule: There are 4 midline CN motor nuclei

Within each of the 4 rules are 4 additional guidelines necessary to understand in order to localize the site of vascular occlusion [13].

Medulla: CN 9–12,
9= glossopharyngeal, 10= vagus, 11= spinal accessory, 12= hypoglossal

Pons: trigeminal, abducens, facial, vestibulocochlear (CN 5–8, respectively)

Midbrain: oculomotor, trochlear (CN 3–4, respectively)

Fourth rule: There are 4 midline motor nuclei: The nuclei of cranial nerves 3, 4, 6, and 12:

Question 18

Location of stroke

Answer 18

Medial medullary syndrome
Contralat weakness & loss Vibrations & Proprioception
INO
Divation of tongue to site of lesion

Question 19

Answer 19

Lateral medullary/ Wallenberg
Pica
IPs. Facial loss of P&T, horners, hoarseness dysphasia
N/v vertigo nystagmus

Question 20

Answer 20

Medial medullary
IPs Hypglossal nerve
Contralat. Hemiplegia
Contralat loss of v&p

Question 21

Answer 21

Pat. Pontine
Aica
ISP. Facial paralysis horners, sensory hearing neuro loss, loss of P&T face,
Contralat P&T loss

Question 22

MCA non dominant

Answer 22

Hemineglect

Question 23

MAC dominant

Answer 23

Broca aphasia