TIA/Stroke

Question 0

Amaurosis fugax

Answer 0

Transient monocular blindness caused by ischemia to the retinal artery. Described as shade being pulled down.

Question 1

Patient with suspected TIA. Next step?

Answer 1

High resolution carotid ultrasound or MRA to evaluate for carotid artery stenosis

Question 2

TIA?

Answer 2

Onset of focal neurologic deficit with spontaneous resolution within 24 hours

Question 3

Differential for TIAs?

Answer 3

Migraine, postictal paralysis, seizures, subdural hematoma, abscess, tumor

Question 4

Types of focal neurologic symptoms?

Answer 4

1 amaurosis fugax
2 hemiparesis
3 heavy anesthesia
4 aphasia
5 dizziness/vertigo

Question 5

Most common causes stroke/TIA and which part of the brain they affect?

Answer 5

1. Carotid atherosclerosis
2. Cardioembolism– MCA
3. Lipohyalinosis– lenticulostriate arteries

Question 6

Hollenhorst plaques?

Answer 6

Cholesterol emboli that often lodge in with no artery causing amaurosis fugax

Question 7

Pros and cons of noncontrast CT scan brain?

Answer 7

Pro: very sensitive at detecting acute cerebral hemorrhage

Con: insensitive to acute ischemic strokes, especially if stroke is small (<12 hours) or located in the brainstem

Question 8

Stroke prevention - drugs?

Do not use this combination of drugs?

Answer 8

Antiplatelet therapy.

Plavix or combination of aspirin and dipyridamole > aspirin alone

Plavix + aspirin does not provide greater stroke prevention and increases bleeding

Question 9

Long-term drug treatment for patients with AFIB? For patient with Lacunar infarcts?

Answer 9

Warfarin; blood pressure agents and antiplatelets

Question 10

Surgical interventions reduce long-term risk of stroke? Use especially in which patients?

Answer 10

Carotid endarterectomy. Benefits begin after two years post surgery so use in patients with long life expectancy