Stroke

Question 1

Internal Capsule stroke

Answer 1

Pure motor hemiparesis (suddent face, arm, leg weakness), give aspirin! And manage w/ statin

Question 2

Hemorraghic stroke

Answer 2

Embolic event from endocardtitis to ACA, gets hemorrhagic,

Question 3

Saturday Night palsy

Answer 3

Radial nerve, only extensors affected, check by pronating forearm and testing each flexor

Question 4

Lateral Medullary syndrome

Answer 4

Lower cranial nerve dysfn + crossed sensory signs!
Vertigo, dysphagia, left facial numb, right arm/leg numb, left face numb, left palatal paresis, left horner’s, right nystagmus! yikes!
Either vert art occlusion or PICA occlusion, Risk of propagation of thrombosis, so fully anticoag w. coumadin for a while

Question 5

Also give coumadin for

Answer 5

afib, fake valve, venus thrombosis, down EF, mural thrombus, venous thromboembo!

Question 6

Internal Carotid Occlusion

Answer 6

Hx of TIA, now completed stroke (fluctuating farm/facial numbness)
Outside TPA window (3 hours), endarterectomy w/ reperfusion might be dangerous..so just give aspirin

Question 7

Nondominant Parietotemporal stroke

Answer 7

Inferior branch MCA, nondom so no aphasia, has inferior quadrantoanopsia and sensory neglect!

Question 8

Fall on coumadin!

Answer 8

Subdural hematoma?! Concave on CT, correct coagulopathy temporarily, evacuate the hematoma!

Question 9

TIA?

Answer 9

Carotid setnosis, w/ bruit, episode of weakness? When do we do endaraterectomy If lesion is sufficently stenosed >70%

Question 10

Greatest risk for TIA to stroke

Answer 10

=60 min 2 points, diabetes,!

6-7 pts = 8.1% 2 day risk, mod = 41%, low = 1%

Question 11

Venus sinus thrombosis

Answer 11

Pregnant lady w/ headache lethargy and then seizure! Anticoag (even though its frequently hemorrghaci?)

Question 12

Sudden onset of coma

Answer 12

Brainstem disease or simultaneous supratentorial disease- pontine hemorraghe or basilar occlusion!! YIKES