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20 Cards in this Set
- Front
- Back
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Which is incorrect regarding TACI : Total Anterior Circulation Infarct?
A. It is usually a large MCA +/- ACA infarct B. It is usually due to embolic source. (heart) C. It has a high likelihood of Long term dependency-death D. Signs include Ipsilateral Hemiparesis and Homonymous hemianopia |
D.
1. Contralateral hemiparesis +/- Hemisensory [ arms / legs / face ] 2. Higher cortical dysfunction [ dysphasia / neglect] 3. Homonymous Hemianopia |
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Which is incorrect regarding Stroke Syndromes-infarcts?
A. LACI are of 2 types B. POCI have brainstem or cerebellar signs C. PACI have isolated cortical dysfunction such as dysphasia or neglect AND limited motor / sensory deficits. D. LACI are typically silent, with a good prognosis. |
A. 4 types for Lacunar infarcts:
1. Pure motor 2. pure Sensory 3. Sensory-motor 4. Ataxic hemiparesis |
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Which is incorrect regarding stroke / infarct categorisation ?
A. Posterior Circulation Infarct (POCI) can have an isolated homonymous hemianopia B. POCI infarcts occur in the posterior cerebral hemisphere or brainstem or cerebellum. C. POCI can range form mild deficits to death. D. Brainstem signs of POCI include Coma, Ipsilateral CN deficits + Ipsilateral motor / sensory deficits. |
D.
a. Brainstem signs +/- Isolated homonymous hemianopia: 1. Ipsilateral CN deficit with CONTRALATERAL motor / sensory deficit 2. Bilateral motor / sensory deficit 3. Conjugate eye movement disorder 4. Coma b. Cerebellar signs c. Isolated homonymous hemianopia |
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According to the Modified Rankin Score, " moderately severe disability " scores what?
A. 2 B. 4 C. 3 D. 5 |
B.
Unable to attend to own bodily needs without assistance -unable to walk unassisted. ( 3 = moderate disability = requires some help-but able to walk unassisted ) |
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Which is correct regarding Stroke and thrombolysis?
A. Studies suggest a 15-20 % reduction in the risk of developing moderate-severe disability. B.The ischaemic penumbra is s variable region of partially perfused tissue, and is the focus for thrombolysis. C. The patient should have a NIHSS grading of > 6 to be a candidate for thrombolysis. D. Coma is not a contraindication to thrombolysis. |
B.
A = 30% C = >4 D = It is. |
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Which is correct regarding Stroke and Thrombolysis?
A. A modified Rankin Score of 3 is a contraindication. B. A Platelet count less than 150 is a contraindication. C. Blood pressure must be reduced below 180/100 by GTN infusion or Hydralazine, to allow thrombolysis. D. Alteplase is given as a single IV bolus of 0.9 mg/kg. |
C.
A = 4 B = < 100 D. bolus (10%) + infusion(90%) (of the one dose) |
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Which is correct regarding Basilar artery infarction (BAI)?
A. The therapeutic window for thrombolysis is 4-6 hours B. Vertigo without hearing loss is one symptom typical for BAI. C. CT angiography is the best investigation for basilar stroke. D. The options for intervention include intrarterial thrombolysis with urokinase, or mechanical embolectomy. |
D.
A = < 12 hours B = Vertigo with hearing loss C = MRA is the best investigation- but- CT angiography is usually performed due to access and availability. |
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What are the Clinical features of brainstem Stroke?
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1. Altered conscious state / coma
2. Diplopia 3. Dysarthria 4. Bilateral visual disturbance 5. Vertigo + hearing loss 6. Pupillary abnormalities The fully developed syndrome has coma + quadraparesis + pupillary abnormalities + dysconjugate eye movements + bilateral upgoing planters. |
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Outline the scores for the Modified Rankin Scale.
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0-6
0 = no symptoms 1 = No significant disability- some symptoms present. 2 = Slight disability 3 = Moderate disability [ Requires some help-able to walk unassisted ] 4.*** Moderately severe disability - Unable to attend own bodily needs / walk without assistance 5. Severe disability - Bedridden + incontinent 6. Dead |
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What Classification system is used to assess the vascular territory of cerebral infarctions?
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OCSP : Oxford Community Stroke Project
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What Scale is used to Clinically assess the degree of impairment of cerebral infarction?
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NIH Stroke Scale
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What makes up the Triad of signs for TACI ( Total Anterior Circulation Infarct ) ?
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1. Contralateral hemiparesis [ face / arm / leg ]
2. Higher cortical dysfunction [ dysphasia ; neglect ] 3. homonymous hemianopia |
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How does PACI differ from TACI in regards to the Clinical Signs of cerebral infarction?
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PACI has only 2 of the Clinical features of TACI
1. Limited Motor / Sensory deficit - one limb / face + hand 2. Isolated Higher cortical dysfunction |
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List the more important "Stroke Mimics".
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1. Metabolic : hypoglycaemia
2. Space occupying lesion 3. Todd's paresis 4. Extra-axial traumatic haemorrhage [ subdural / extradural ] |
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List the standard stroke sequences for MRI in acute cerebral infarction.
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1. Diffusion weighted images (DWI)**
2. Flair 3. T2 weighted images 4. MRA / MRV 5. Perfusion imaging scans |
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What is the blood pressure required for eligibility for thrombolysis in stroke?
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< 185 / 110 mmHg
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What is the tolerated upper blood pressure limit in acute stroke, not being thrombolysed?
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210 /120 mmHg
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Antiplatelet options for stroke? (After haemorrhage excluded on CT brain-and thrombolysis not proceeding)
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1. Aspirin 150-300 mg daily ( oral / NGT / rectal )
- If aspirin allergy : 2. Clopidogrel 75 mg daily - failed first line treatment: ( stroke on aspirin) 3. Clopidogrel 75 mg daily or 4. Asasantin ( dipyridamole + aspirin) BD Asasantin preferred for Long term prevention of stroke. |
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List the types of Neurointervention in acute stroke.
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1. Intra-arterial thrombolysis ( within 6 hours ) -urokinase
2. Percutaneous Transluminal angioplasty and stenting 3. Mechanical clot removal -within 8 hours Typically only available in large urban centres. |
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List the indications for Urgent hemicraniectomy in Acute stroke.
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1. Large Middle cerebral artery infarction with significant cerebral oedema: "malignant infarction"
2. Age 18-60 3. Surgery is within 48 hours of symptom onset. |
