Stroke

Question 1

What must be excluded if FAST is present

Answer 1

hypoglcaemia

Question 2

Initial management of TIA

Answer 2

300 mg aspirin daily

Question 3

Imaging in TIA

Answer 3

Offer MRI for damage but not CT

Question 4

Perform non0enhanced CT on suspected stroke patients with:

Answer 4

indications for thrombolysis or thrombectomy

on anticoagulant treatment

a known bleeding tendency

a depressed level of consciousness (Glasgow Coma Score below 13)

unexplained progressive or fluctuating symptoms

papilloedema, neck stiffness or fever

severe headache at onset of stroke symptoms.

Question 5

Thrombolysis drug and window

Answer 5

Alteplase, 4.5 hours

Question 6

Thrombolysis important factors:

Answer 6

treatment is started as soon as possible within 4.5 hours of onset of stroke symptoms and

intracranial haemorrhage has been excluded by appropriate imaging techniques

Question 7

Early thrombectomy indications

Answer 7

It is within 6 hours of symptom onset, together with intravenous thrombolysis to people who have:

Acute ischaemic stroke and

Confirmed occlusion of the proximal anterior circulation demonstrated by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA)

Question 8

Later thrombectomy window

Answer 8

6-24 hours

Question 9

When can later thrombectomy be indicated?

Answer 9

who have acute ischaemic stroke and confirmed occlusion of the proximal anterior circulation or
proximal posterior circulation demonstrated by CTA or MRA and

if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume

Question 10

Acute ischaemic stroke

Anticoagulant treatment

Answer 10

Haemorrhage must be excluded

aspirin 300 mg orally if they do not have dysphagia or

aspirin 300 mg rectally or by enteral tube if they do have dysphagia.

Continue aspirin daily 300 mg until 2 weeks after the onset of stroke symptoms, at which time start definitive long-term antithrombotic treatment.

offer PPI

Question 11

acute venous stroke anticoagulation

Answer 11

Heparin and warfarin

Question 12

Total anterior circulation stroke (TACS)

Answer 12

A total anterior circulation stroke (TACS) is a large cortical stroke affecting the areas of the brain supplied by both the middle and anterior cerebral arteries.

All three of the following need to be present for a diagnosis of a TACS:

Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 13

Partial anterior circulation stroke (PACS)

Answer 13

A partial anterior circulation stroke (PACS) is a less severe form of TACS, in which only part of the anterior circulation has been compromised.

Two of the following need to be present for a diagnosis of a PACS:

Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

Question 14

Posterior circulation syndrome (POCS)

Answer 14

A posterior circulation syndrome (POCS) involves damage to the area of the brain supplied by the posterior circulation (e.g. cerebellum and brainstem).

One of the following need to be present for a diagnosis of a POCS:

Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder (e.g. horizontal gaze palsy)
Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia

Question 15

Lacunar stroke (LACS)

Answer 15

A lacunar stroke (LACS) is a subcortical stroke that occurs secondary to small vessel disease. There is no loss of higher cerebral functions (e.g. dysphasia).

One of the following needs to be present for a diagnosis of a LACS:

Pure sensory stroke
Pure motor stroke
Senori-motor stroke
Ataxic hemiparesis