4.4E Neuro Tia Cva Gab

Front 1

ABCD2 score for TIA?

Back 1

- Age>60 = 1 point
- BP >140/90 = 1 point
- Clinical features:
Unilateral weakness = 2 points
Speech impairment w/out weakness = 1 point
- Duration of symptom:
>60 mins = 2 points
10-59 mins = 1 point
- Diabete = 1 point

Score 6-7 (high risk, 30% 7days stroke), 4-5 (mod risk 25%), 0-3 (low risk 15%) OR NSF > 4 = high risk, < 4 = low risk

Front 2

Admission criteria for TIA?

Back 2

- 4 TIAs in 2 weeks or 2 within 24 hours
- crescendo TIA - 3 within 72 hrs
- high grade cartoid stenosis
- presumed cardiac source
- embolic TIAs despite anticoagulation
- high risk ABCD2 score

Front 3

Which regard to stroke revention is not true? (Dunn 632)
a) CAST & IST trial confirmed Aspirin is the only proven antiplatelet agent for use in ischaemic stroke
b) Warfarin shows short term benefit in patient with ischaemic stroke without AF
c) Risk of stroke is 5% per year in patient with AF
d) Warfarin prevent 30 strokes and causes at least 2 major haemorrhage each year
e) aspirin reduce the risk of stroke by 20-30%

Back 3

b) warfarin shows no benefit (long term aabd short term) to prevent stroke in patient without AF

Front 4

Which is not true in prevention of recurrent of stroke?
a) blood pressure treatment reduce risk by 4 %
b) 66% risk reduction from cessation of smoking
c) Clopidogrel plus aspirin is recommended for all patients with stroke
d) Aspirin alone can prevent 15 strokes pre year in every 1000 patient with AF
e) Statin should be used for all ischaemic stroke

Back 4

c) Clopidogrel plus aspirin is not recommended for patients with stroke who do not have ACS or PCI

Front 5

Recommadation for cartoid endarterectomy?

Back 5

- Should be undertake in patient with non-disabling carotid aartery measure >70% & only if <6 % peri-operative mortality/ mobility
- Symptomatic cartoid stenosis of 50-69% or asymptomatic stenosis > 60% with <3% of peri-operative mortality/ morbility
- Endarterectomy is not recommended for symptomatic stenosis <50% or asymptomatic stenosis <60%

Front 6

Cause of stroke?

Back 6

Infarction (75%)
- unknown 50%
- Lacunar 25%
- embolic 20%
- Atherosclerotic 5%
Haemorrhage (25%)
- intracerebral 50%
- subarachnoid 50%

Front 7

Which is not a feature of Middle cerebral artery syndrome?
a) Contralateral hemiplegia
b) Contralateral hemisensory loss
c) Homonymous hemianopia
d) Eyes deviated to side of lesion
e) leg weakness is usually greater than arm and face
f) Distal occlusion leads to more limited signs

Back 7

e) arm and face weakness is usually greater than legs

Front 8

Right sided face and arm weakness associated with global aphasia is most likely related to?
a) Left M1
b) Right M1
c) Right superior M2
d) Left inferior M2
d) Right inferior M2

Back 8

a) Left M1
others:
R) M1 - left sided neglect
L) M2 superior - expressive aphasia
R) M2 superior - Left sided neglect
L) M2 inferior - receptive aphasia & minimal weakness
R) M2 inferior - minimal weakness

Front 9

Features of Anterior cerebral artery syndrome?

Back 9

- Paralysis of contralateral leg and foot
- Confusion
- Abulia
- Grasp reflex
- Behaviour disturbance
- urinary incontinence

Front 10

Features of posterior cerebral artery syndrome?

Back 10

- hemianopia
- quadrantanopias
- cortical blindness
- memory loss
- dystexia
- hemisensory loss
- ipsilateral third nerve palsy

Front 11

Features of vertebrobasilar infarction?

Back 11

- cerebellar & brain stem lesion
- ataxia
- dizziness
- nausea, vomiting
- nystagmus
- wide variety of cranial nerve palsy
- internuclear ophthalmoplegia

Front 12

Which is not a features of Lateral medullary syndrome?
a) ipsilateral upper motor neuron VII, IX & X palsy
b) ipsilateral Horners syndrome (ptosis, miosis & lack sweating)
c) Contralateral spinothalamic loss (pain and temp)
d) Conjugat gaze palsy
e) visual field defects

Back 12

e) visual field defects

Front 13

how to interpret NIH stroke scale?

Back 13

0 = no stroke
1-4 = minor stroke
5-15 = moderate stroke
15-20 = moderate/ severe
21-42 = severe stroke
(NIHSS < 25 is a must for tPA administration)

Front 14

Indication for tPA in CVA (there is 4)

Back 14

1. onset of CVA within 4.5 hours
2. Measurable and clinically significant fdeficit on NH stroke scale examination
3. CT no show haemorrhage or non-vascular causees of CVA
4. age >18yr

Front 15

Absolute contraindcation for tPA in CVA: (there is 11)

Back 15

1. uncertain time of onset
2. Coma or severe obtundation with fixed eye deviation and complete hemiplegia
3. only minor stroke deficit which is rapid improving
4. seizure observed
5 . Hypertension: SBP > 185mmHg or DBP >110mmHg ]
6. clinical presentation of SAH even if CT is normal
7. Presumed septic embolus
8. Received heparin last 48 hours and elevated APTT
9. INR >1.5
10. platelet < 100,000/uL
11. serum glucose <2.8 or >22

Front 16

Relative contraindication for tPA in CVA (there is 12)

Back 16

1. severe neurological impairment NHSS score >22
2. Age >80
3. CT evidence of extensive MCA (sulcal effacement or blurring of gray-wite >1/3 of MCA territory)
4. Stroke or series head trauma within past 3 months
5. Major surgery within 14 days
6. known history of IC, SAH, AVM, intracranial neoplasm
7. AMI within 30days
8. biopsy of organ within 30 days
9. ulcers or trauma within 30 days
10. GI, Urinary haemorrhage last 30 days
11. Arterial puncture at non-compressible site within 7 days
12. Advance or terminal illness