Stroke/TIA

Question 1

What is the definition of a TIA?

Answer 1

Sudden onset focal neurological deficit
Usually lasts approx 1 hour
(definition < 24 hours)

Question 2

What are some risk factors for stroke/TIA?

Answer 2

Prior TIA/stroke
Hypertension
AF
Diabetes
History of IHD
Smoking

Question 3

Which investigations should be done in a patient with suspected TIA?

Answer 3

MRI --> ischaemic brain damage
Carotid artery doppler
FBC for blood disorders
Renal function
Glucose (hypoglycaemia can cause transient neurological symptoms)
ESR --> GCA or other vasculitis 
ECG --> AF

Question 4

How do you assess someone’s risk of having a stroke after a TIA?

Answer 4

Everyone is high risk

do not use ABCD2 score

Question 5

How do you manage a TIA?

Answer 5

Aspirin 300mg daily
Refer to specialist
Secondary prevention with clopidogrel
Modify risk factors 
Carotid imaging +/- carotid endarterectomy

Question 6

When should you do a CT scan in a suspected stroke?

Answer 6

• if considering thrombolysis/thrombectomy
• anti coagulated or bleeding tendency
• GCS < 13
• progressive/fluctuating symptoms
• papilloedema, neck stiffness, fever
• severe headache at onset of symptoms

Question 7

What are the indications for thrombolysis following a stroke and what do you give?

Answer 7

• < 4.5 hours since onset AND
• CT has ruled out haemorrhage

Give alteplase

Question 8

What is the management following an ischaemic stroke?

Answer 8

• thrombolysis
• anti platelets
• thrombectomy if occlusion demonstrated on angiogram and potential to salvage brain tissue
• admit to acute stroke unit
• nil by mouth until speech and language assessment
• statin after 48 hours
• carotid endarterectomy if > 50% stenosis

Question 9

Which anti platelets are given for secondary prevention following stroke?

Answer 9

aspirin 300mg daily for 2 weeks, then clopidogrel for life

Question 10

If a patient with AF has a stroke, when should warfarin be reintroduced?

Answer 10

2 weeks

Question 11

Injury to which part of the brain causes receptive dysphasia?

Answer 11

Wernicke’s area

Question 12

Injury to which part of the brain causes expressive dysphasia?

Answer 12

Broca’s area

Question 13

Which visual field defect is most commonly seen following ischaemic stroke?

Answer 13

Contralateral homonymous hemianopia

Question 14

What is a lacunar infarct and what are the features?

Answer 14

Occlusion of single deep penetrating artery

• PURE motor or PURE sensory stroke or
• ataxic hemiparesis (weakness + ataxia on same side)

Question 15

What is the criteria for a total anterior circulation infarct (TACI)?

Answer 15

All three of:

• higher cerebral dysfunction e.g. dysphasia, neglect
• homonymous hemianopia
• ipsilateral motor + sensory deficit of at least to areas (out of face, arm and leg)

Question 16

What is the criteria for a partial anterior circulation infarct?

Answer 16

2 out of 3 of the criteria for TACI

Question 17

What are the 6 different presentations of a posterior circulation infarct?

Answer 17

• ipsilateral cranial nerve palsy + contralateral motor and/or sensory deficit
• bilateral motor +/- sensory deficit
• cerebellar dysfunction
• isolated homonymous visual field defect
• cortical blindness
• conjugate eye movement disorders

Question 18

Which artery is most likely involved if face and upper limbs are primarily affected?

Answer 18

Middle cerebral artery

Question 19

Which artery is most likely involved in the lower limbs are primarily affected?

Answer 19

Anterior cerebral artery