Stroke

Question 1

meningeal signs: rapid onset of headache with nuchal rigidity, headache and photophobia

Answer 1

subarachnoid haemorrhage or meningitis

Question 2

imaging

Answer 2

Non contrast head CT to rule out haemorrhage
MRI/CTA

Question 3

if imaging is negative but suspicion for sub arachnoid haemorrhage remains high

Answer 3

Lumbar puncture - CSF may show xanthochromia
the presence of bilirubin in the CSF secondary to the breakdown of RBCs resulting in yellow discolouration
may be falsely negative in the first 12 hours of symptoms onset as xanthochromia is a late sign

Question 4

findings of ischaemic stroke on non contrast CT

Answer 4

hyperdense MCA sign (suggesting presence of a thrombus)
effaceemnt of sulci
loss of cortico-medulllary differentiation
oedema

Question 5

findings on CT for intracranial haemorrhage

Answer 5

hyperdense lesion within cerebral parenchyma

Question 6

findings on non contrast head CT for subarachnoid haemorrhage

Answer 6

extensive area of hyperdense signals around the circle of willis

Question 7

treatment for ishcaemic stroke

Answer 7

tPA (tissue plasminogen activator) if within 4.5 hours on onset of symptoms
intra arterial thrombolysis
thrombectomy
aspirin or clopidogrel for secondary prevention

Question 8

tissue plasminogen activator

Answer 8

a serine protease found on endothelial cells of blood vessels
catalyses the conversion of plasminogen to plasmin, which is the main enzyme responsible for clot breakdown
recombinant tissue plasminogen activators (eg. alteplase, reteplase, tenecteplase) are used as thrombolytics in patients with acute coronary syndrome, pulmonary embolism, or ischaemic stroke

Question 9

treatment for intrecerebral haemorrhage

Answer 9

reversal of coagulopathy
blood pressure management
surgical intervention if there are signs of herniation or increased ICP

Question 10

treatment of subarachnoid haemorrhage

Answer 10

reversal of coagulopathy
blood pressure management
prevention of vasospasm
surgical clapping
endovascular coiling

Question 11

inconclusive non contrast CT with thunderclap headache

Answer 11

lumber puncture for sub arachnoid haemorrhage

Question 12

if a non contrast CT shows no haemorrhage

Answer 12

ischaemic stroke
is the patient elligible for tPA
is it <4.5 hours from symptom onset -> IV tPA
then consider antiplatelet therapy and supportive management
and initiate secondary prevention

Question 13

if non contrast CT shows haemorrhage

Answer 13

intracranial haemorrhage
neurovascular imaging: CTA, carotid duplex sonography
consider neurosurgery
treat hypertension
stop anticoagulation
supportive management

Question 14

MCA stroke

Answer 14

contralateral weakness and sensory loss more marked in upper limbs and lower half of face than lower limbs
gaze deviated toward the side of infarction
aphasia if in dominant hemisphere
hemineglect if in nondominat hemisphere

Question 15

damage to optic radiations in MCA stroke

Answer 15

contralateral homonymous hemianopia without macular sparing
or contralateral superior or inferior quatrantanopsia

Question 16

Anterior cerebral artery stroke

Answer 16

contraletral weakness and sensory loss in the lower limbs more marked than in upper limbs
abulia
urinary incontinence
dysarthria
transcortical motor aphasia
frontal release signs
limb apraxia

Question 17

abulia

Answer 17

a milder from of akinetic mutism that is characterised by disinterest and slowed mental state
when asked to perform centrain motor or verbal tasks, patients display a delay in the motor and/or verbal response, or fail to continue the assigned task after intiially complying
usually results from damage to frontal lobe or its connections

Question 18

posterior cerebral artery stroke

Answer 18

contralateral homonymous hemianopia with macular sparing due to occipital lobe involvement
contralateral sensory loss due to lateral thalamic involvement - light touch, pinprick, and positional sense may be reduced
memory deficits
vertigo, nausea

Question 19

PCA territory stroke in the dominant hemisphere

Answer 19

(usually left hemisphere)
alexia without agraphia
anomic aphasia
agnosia: impairment of recognition of sensory stimulus (most commonly visual)

Question 20

PCA territory stroke in the non dominant hemisphere

Answer 20

usually right hemisphere
prosopagnosia

Question 21

features of thalamic injury

Answer 21

because the thalamus contains various nuclei with distinct functions, symptoms depend on the exact location of the lesion
decreased arousal
variable sensory loss
aphasia
visual feild losses
apathy, agitation, personality changes

Question 21

prosopagnosia

Answer 21

inability to recognise familiar faces, but still able to name parts of the face or identify known individuals by clothes or voices