Stroke

Question 1

What scale can be used to assess the liklihood of impending stroke in a patient with TIA?

Answer 1

Age>60
Blood pressure >140/90
Clinical  (unilateral weakness = 2 points, speech impediment = 1)
Duration (over 60 minutes = 2 points) 
Diabetes (= 1 point) 
4-5 points = 4% risk
6-7 = 8% risk

Question 2

What are the cortical signs?

Answer 2

aphasia
apraxia
neglect
field cut

Question 3

A patient presents with leg weakness greater than arm weakness, numbness, abulia, perseveration. The area affected is..

Answer 3

ACA

Question 4

A patient presents with contralateral hemiparesis, sensory loss, hemianopsia and difficulty speaking. This is..

Answer 4

left MCA

Question 5

A patient presents with contralateral hemiparesis, sensory loss, hemianopsia and neglect and extinction. This is..

Answer 5

right MCA

Question 6

A patient presents with contralateral hemiparesis, crossed sensory findings and cranial nerve findings. This is..

Answer 6

brainstem lesion

Question 7

A patient presents with ataxia, vomiting, occipital headaches, gaze palsy and facial weakness. The location of this lesion is..

Answer 7

cerebellum

Question 8

A patient prejsents with deep coma and paraplegia, pinpoint reactive pupils and decerebrate rigidity. Suspect…

Answer 8

pontine hemorrhage

Question 9

What is the window of opportunity for stroke tPA?

Answer 9

3.5-4 hours

Question 10

A patient presents with nystagmus, vertigo, ipsilateral face loss of pain and temperature, contralateral trunk and limb loss of pain and temperature. There may be associated weakness of muscles in the bulbar region as well as Horner’s syndrome. The lesion is…

Answer 10

lateral medulla - wallenburg syndrome

Question 11

A patient presents with headaches, progressive mental decline and multiple neurologic defects after a SAH. Suspect..

Answer 11

subacute hydrocephalus

Question 12

What are the contraindications to TPA treatment?

Answer 12

more than 4.5 hours
recent surgery
rapidly improving
BP > 185/100
signs of hemorrhage
no seizure
INR > 1.7
head trauma, MI, stroke in last 3 months
crazy off glucose 
prior hemorrhage or tumor

Question 13

What are other steps that can be taken in management of ischemic stroke?

Answer 13

maintain bed at level
IV normal saline
remain normothermic
remain normaglycemic

Question 14

What blood pressure should be maintained in stroke?

Answer 14

permissive hypertension - hold all antihypertensives, only lower if above 220

Question 15

What are the major categories of etiology for stroke?

Answer 15

artery (hyperlipidemia, smoking, eg)
blood (coagulation disorder)
cardiac (e.g. atrial fibrillation)

Question 16

Who are the patients that should receive carotid endarectomy?

Answer 16

symptomatic patients with 70-99% lesion or asymptomatic patients with 60-99% lesion

Question 17

What steps should be taken in management of hemorrhagic stroke?

Answer 17

bed at 30 degrees below, lower BP

Question 18

What is the most common cause of non traumatic ICH in the elderly?

Answer 18

amyloid angiopathy

Question 19

What are some of the factors that determine prognosis in a patient with ICH?

Answer 19

infratentorial?
blood volume >30cm
age >80
intraventricular
glasgow coma scale

Question 20

What are some of the common causes of stroke in younger populations?

Answer 20

patent foramen ovale, carotid dissection AVMs, moyamoy disease - cerebral vasculopathy, drugs, TB,

Question 21

What is the most common cause of acute new onset seizure in adults?

Answer 21

tumor or stroke until proved otherwise

Question 22

If a patient has an aneurysm clipped and deteriorates a few days later, what might have happened? how do you treat?

Answer 22

vasospasm - treat with nimodipine

Question 23

A 43 year old woman comes to the ER with LOC, severe headache and photophobia. CT shows no bleeding. What is your next step?

Answer 23

LP