Stroke and TIA

Question 1

Lobar strokes are usually due to what?

Answer 1

Amyloid angiopathy

AV malformations

Tumours

Aneurysms

Venous-sinus thrombosis

Question 2

What are some conditions that mimic a stroke?

Answer 2

Seizure

Sepsis

Toxic/metabolite

Space occupying lesion

Syncope

Question 3

Deep brain strokes are usually due to what?

Answer 3

HTN

Rupture of deep penetrating arteries

Question 4

What is a semantic error of speech?

Answer 4

Mistake with word finding eg bus instead of train

Question 5

What is a dysphasia?

Answer 5

Disorder of language

Question 6

What are the new anticoagulants being used instead of warfarin?

Answer 6

Dabigatran

Apixaban

Rivaroxaban

Edoxaban

Question 7

What is the risk of haemorrhage while on anticoagulants?

Answer 7

1-1.5% per annum

Question 8

How do you differentiate a TIA from a seizure?

Answer 8

Seizure will have positive signs as well eg jerks or tingling

Question 9

According to the CHADS2 scoring system, when are oral anticoagulants indicated?

Answer 9

If hypertensive and >75 years of age or,

Diabetes

Previous TIA

Heart failure

2 or more = Warfarin

Question 10

How do you differentiate a TIA from a migraine?

Answer 10

All the symptoms will come on immediately with a TIA while they will progress more slowly with a migraine

Question 11

What is a lacunar infarct?

Answer 11

Infarct result from occlusion of one of the deep penetrating arteries

Question 12

What is the major difference between a stroke and TIA?

Answer 12

Permanent brain injury occurs in a stroke

Question 13

When do you perform a carotid endarterectomy?

Answer 13

Generally if the stentosis is >50% or

If it produces symptoms

Question 14

What percentage of strokes are intracerebral haemorrhages?

Answer 14

15% in Aus

Question 15

What is a phemonic error of speech?

Answer 15

Error of the sound of a word eg last instead of past

Question 16

What is the mechanism of action of Dabigatran?

Answer 16

Direct thrombin inhibitor

Question 17

What is the CHADS2 score used for?

Answer 17

Assessing stroke risk for patients with non-valvular AF

Question 18

What are the rates of recurrence in stroke patients?

Answer 18

5-10% within 1 week

10-20% within 3 months

Question 19

What is the mechanism of action of Rivaroxaban?

Answer 19

Inhibitor of factor 10a

Question 20

What is haemorrhagic transformation?

Answer 20

Haemorrhage post embolism in the setting of thrombolysis

Question 21

What is the most common location for thrombotic occlusion in the brain?

Answer 21

Basilar artery

Question 22

When does cavitation start to occur post infarction?

Answer 22

After 7 to 10 days

Question 23

What is lipohyalination?

Answer 23

Introduction of lipids into arterial walls, typically in deep perforating arteries that can lead to a HTN haemorrhage

Question 24

Outline your approach to assessing a patient with stroke on physical exam?

Answer 24

ABCs - Particularly the gag reflex

BSL

Neurological Assessment

• GCS
• Localising the lesions using focal signs

Question 25

What are some pathologies that mimic the presentation of a stroke?

Answer 25

Space occupying lesions Extra-axial haemorrhage Venous sinus thrombosis Metabolic: hyponatriaemia, hypo/hyperglycaemia, Wernicke's Todd's paresis Demyelinating disease Migraine Hysteria

Question 26

What Ix would you perform in the acute setting for stroke?

Answer 26

Bloods - FBE, UEC, BSL, Coags, fasting blood lipids 12-lead ECG CXR and CT brain (C-, angio, perfusion)

Question 27

How do you approach the management of a patient with a stroke acutely?

Answer 27

IV access Correct hypo/hyperglycaemia Nil by mouth