Stroke

Question 1

Stroke risk factors ?

Answer 1

Stroke history , Age ( >65 ) , blood pressure > 140/90 , carotid artery narrowing > 70% , AF rythme , diabetes , chf , coronary diseases , OCP , alcohol consumption , smoking , post menopause women that estrogen therapy , sleep apnea , high salt , low activity

Question 2

DDX for stroke

Answer 2

Inflammatory disease ( MS)
Infective and degenerative diseases
Hypoglycemia
Tumor
Trauma
Electrolyte imbalance

Question 3

Etiology of recurrent TIA

Answer 3

Emboli which is sent from heart

Question 4

What should be checked in a patient with focal neurological deficit ?

Answer 4

Glucose , blood , trauma , seizure

Question 5

Top of basilar syndrome

Answer 5

Circulation of cerebellum is disturbed by a emboli from heart
Signs and symptoms: vertigo , imbalance , coma , even death

Question 6

Giant cell arthritis signs

Answer 6

Head ache ( severe and persistent)
Unilateral or bilateral transient loss of vision
Jaw claudication
Aneurysm
Polymylagia rheumatica

Question 7

Seizure is common in which type of stroke?

Answer 7

Embolic stroke

Question 8

SAH symptoms ?

Answer 8

Sudden onset and very severe headaches
Patient hasn’t experienced this pain before

Question 9

Lab tests in stroke ?

Answer 9

Cbc , diff
Blood sugar
Inr pt ptt
Platelets
Troponin
Factor 10
LP ( if infective or SAH )

Question 10

In posterior circulation disturbances what are the signs ?

Answer 10

Gong hastan
Dizziness
Vision defects
Low loss of consciousness

Question 11

What are signs of ICH

Answer 11

Severe headache
Loss of consciousness
Neurologic deficits ( not single blood vessel )

Question 12

Common ICH sites ?

Answer 12

Basal ganglia
Putamen
Thalamus
Ventricles ( IVH )

Question 13

Common etiologies of ich ?

Answer 13

1. Trauma
2. Hypertension

Question 14

Treatment for SAH?

Answer 14

1. Anti-epileptic + anti-spastic + complete bed rest
2. Angiography ( ASAP)
3. Four DSA
4. ICU ( for prevention from vasospasm and edema)

Question 15

Common etiology for SAH?

Answer 15

Brain aneurysm rupture

Question 16

Stroke in superior MCA ( signs)

Answer 16

Limbs and face
Hemiplasia
Hemisensory loss
Brocha aphasia ( comprehension + , fluent speech - )
No homonymous anopia

Question 17

Stroke in inferior MCA

Answer 17

occipital and temporal -> contralateral homonymous anopia
Sensory loss
Agraphesthesia
Astragnosia
Apraxia
Wernike aphasia ( comprehension - , fluent speech + )

Question 18

Contralateral homonymous anopia happens in which vessels involved in stroke?

Answer 18

Inferior MCA
PCA

Question 19

Stroke happened because of PCA ( signs )

Answer 19

Homonymous anopia
Vision field defect
Oculomotor palsy
Vertical gaze palsy
Ataxua
Internuclear ophtalmoplegia
Double vision
Prosopagnosia ( عدم توانایی تشخیص چهر)
Cortical blindness
مشکلات رفتاری
If occipital involvement-> alexia without apraphia نمی تونه بخونه ولی میتونه بنویسه
If temporal invovlvement -> memory defecy

Question 20

Stroke caused by basillar artery ( signs)

Answer 20

Abducens palsy ( vertical nistagmus , pupil test - )
Hemiplesia or quadriplesia
Coma
Lucked in syndrome
Loss of consciousness
Visual field defect
Homonymous anopia
اختلال رفتاری

Question 21

Major drug treatment for brain stroke ?

Answer 21

Thrombolytics ( alteplase )
Under 4.5 hours if the patient doesnt have contraindications

Question 22

Choice anti hypertensive drugs for a person who wants to get thrombolytic?

Answer 22

Nikardipine , labetolol

Question 23

Thrombectomy can be done till … hours

Answer 23

6 hours
If the perfusion ct / mri showed living tissue till 24 hours