Stroke

Question 1

Contralateral hemiparesis and sensory loss
lower extremity > upper

Answer 1

Anterior cerebral artery

Question 2

Contralateral hemiparesis and sensory loss
upper extremity > lower
Contralateral homonymous hemianopia
Aphasia

Answer 2

Middle Cerebral artery

Question 3

Contralateral homonymous hemianopia with macular sparing
Visual agnosia

Answer 3

Posterior cerebral artery

Question 4

Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity

Answer 4

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

Question 5

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

Answer 5

Posterior inferior cerebellar artery

(lateral medullary syndrome, Wallenberg syndrome)

Question 6

Ipsilateral: facial paralysis and deafness

Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus

Answer 6

Anterior inferior cerebellar artery (lateral pontine syndrome)

Question 7

Amaurosis fugax

Answer 7

Retinal/Ophthalmic artery

Question 8

‘Locked-in’ syndrome

Answer 8

Basilar artery

Question 9

Present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

Strong association with hypertension

Answer 9

Lacunar stroke

Question 10

In what areas of the brain do Lacunar strokes usually occur?

Answer 10

basal ganglia
thalamus
internal capsule

Question 11

Blood pressure should NOT be lowered in the treatment of acute stroke. TRUE/FALSE?

Answer 11

TRUE - unless there are complications e.g. Hypertensive encephalopathy*

if the cholesterol is > 3.5 mmol/l patients should be commenced on a statin. Many physicians will delay treatment until after at least 48 hours due to the risk of haemorrhagic transformation

Question 12

When should aspirin 300mg be given?

Answer 12

aspirin 300mg orally or rectally

• as soon as haemorrhagic stroke has been excluded

Question 13

Thrombolysis window

Answer 13

within 4.5 hours of onset of stroke symptoms

** ensure haemorrhage excluded

Question 14

Absolute contraindications to thrombolysis

Answer 14

• Previous intracranial haemorrhage
• Seizure with stroke
• Intracranial neoplasm
• Suspected SAH
• Stroke or traumatic brain injury in past 3 months
• LP in last 7 days
• GI haemorrhage in last 3 weeks
• Active bleeding
• Pregnancy
• Oesophageal varices
• Uncontrolled hypertension >200/120mmHg

Question 15

Relative contraindications to thrombolysis

Answer 15

• Concurrent anticoagulation (INR >1.7)
• Haemorrhagic diathesis
• Active diabetic haemorrhagic retinopathy
• Suspected intracardiac thrombus
• Major surgery / trauma in the preceding 2 weeks

Question 16

To be offered thrombectomy, NIHSS score must be above what?

Answer 16

5

Question 17

THrombectomy window

Answer 17

6 hours

Question 18

Thrombectomy and thrombolysis can both be used for the same stroke TRUE/FALSE

Answer 18

TRUE

Question 19

Secondary prevention

Answer 19

Aspirin and clopidogrel in acute phase, followed by clopidogrel lifeong

Question 20

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

Answer 20

Total anterior circulation infarcts (TACI)
involves middle and anterior cerebral arteries

Question 21

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

Answer 21

Partial anterior circulation infarcts (PACI)

involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery

Question 22

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

Answer 22

Lacunar infarcts (LACI)
- involves arteries around internal capsule, thalamus and basal ganglia

OR Posterior circulation infarcts (POCI)
- involves vertebrobasilar arteries