Question 1

A previously healthy 30-year-old patient is brought to the emergency department with signs of stroke. Diagnostic testing determines an ongoing ischemic cause. The patient's spouse reports that symptoms began approximately 2 hours prior to transport. What is the recommended treatment?

A) Administration of low-molecular-weight heparin
B) Neurosurgical consultation for possible surgery
C) Observation for complications prior to initiating tPA
D) Tissue plasminogen activator (tPA) administration

D

Accepted Answer

Time is critical when treating ischemic stroke, and given the time frame of 2 hours since symptom onset, tPA is the recommended treatment. tPA is a clot-busting medication that can be administered intravenously to help dissolve the clot causing the stroke. It is important to note that not all patients with stroke are eligible for tPA and there are certain criteria that must be met before administration. Close monitoring for complications is also necessary. Low-molecular-weight heparin may be used for prophylaxis of thromboembolism in some cases but is not the recommended treatment for an ongoing ischemic stroke. Neurosurgical consultation may be necessary in some cases but is not the recommended initial treatment for a patient with an ongoing ischemic stroke.

Question 2

A patient exhibits visual field defect, ataxia, and dysarthria and complains of a mild headache. A family member reports that the symptoms began several hours prior. An examination reveals normal range of motion of the neck. What type of cerebrovascular event is most likely?

A) Hemorrhagic stroke
B) Hypertensive intracerebral hemorrhage
C) Ischemic stroke
D) Transient ischemic attack (TIA)

C

Accepted Answer

Ischemic stroke is most likely given the symptoms of visual field defect, ataxia, and dysarthria, which suggest a cerebrovascular event affecting multiple brain regions. The onset of symptoms several hours prior without rapid progression or severe headache is more characteristic of ischemic stroke than hemorrhagic stroke or hypertensive intracerebral hemorrhage. A TIA typically resolves within minutes to hours, making ischemic stroke more likely given the persistence of symptoms.

Question 3

An elderly patient is brought to the emergency department after being found on the floor after a fall. The patient has unilateral sagging of the face, marked slurring of the speech, and paralysis on one side of the body. The patient's blood pressure is 220/190 mm Hg. What is the likely treatment for this patient?

A) Carotid endarterectomy
B) Close observation until symptoms resolve
C) Neurosurgical consultation
D) Thrombolytic therapy

C

Accepted Answer

Neurosurgical consultation is the likely treatment for this patient because the symptoms suggest a stroke, which is a medical emergency that requires prompt diagnosis and treatment.

Deck 173: Cerebrovascular Events