Test Game of Stroke - Neuro

A 28-year-old man presented to ED with neck pain and left Horner’s syndrome. He suffered from Covid infection 2 weeks ago with sore throat, running nose and bad cough. The CTA of neck as shown below. What is the diagnosis?

• A) Bow Hunter Syndrome

• B) Eagle Syndrome with Left ICA dissection

• C) Post Covid infection related vasculitis with Horner’s syndrome

• D) Fibromuscular Dysplasia with bilateral ICA dissection and pseudo-aneurysm

88-year-old woman with background history of hypertension, chronic smoker, and mild cognitive impairment. Presented with 2 stereotypical episodes of transient right face tingling sensation which spread to right hand and resolved within 15 min. Further history noted she suffer from migraine with aura during young, but denied any headache prior to this episode. What is the likely diagnosis? MRI brain as below:

• A) Transient Ischemic Attack with underlying hypertension

• B) Transient Focal Neurology secondary to possible CAA

• C) Transient Neurology Episode cause by Epileptic Seizure

• D) Multiple Brain Metastasis with hemorrhagic changes

Which is the latest RCT shown intensive sugar control with insulin infusion with target sugar 4.4-7.2 during acute stroke shown significant improvement of functional outcome?

• A)    Shine trial

  None of above

• B) Elan trial

• C) Select -2 trial

• D) None of above

In ASPECT-ANGEL large core Trial, what is the percentage of patient in intervention arm achieve functional independent at 90 days?

• A)    11.6%

• B)     30.0%

• C)     20.0%

• D)    7.1%

Which are the 2 randomized trials show positive result favoring EVT in Basilar Artery Occlusion?

• A.     BEST and BASICS TRIAL

• B.     BEST and BAOCHE TRIAL

• C.     ATTENTION and BAOCHE TRIAL

• D.     ATTENTION and BASICS TRIAL

When was the first study of thrombolysis for ischemic stroke by Sussman published?

• A.     1958

• B.     1959

• C.     1968

• D.    1995

Answer explanation

Sussman suggested using thrombolytic therapy in cerebral artery occlusions under cerebral angiography using fibrinolysin, a bovine plasma enzyme derived in 1958.

36-year-old gentleman presented with recurrent thunderclap headache with right sided arm and face weakness. CT brain shown left precentral gyrus convexal SAH. Below is his cerebral angiogram.

Which of the following agent may improve the thunderclap headache?

• A.     Amlodipine

• B.     Nimodipine

• C.     Prednisolone

• D.    Rituximab

Answer explanation

Treatment for RVCS

A 33-year-old lady with no background medical history, nonsmoker, presented with recurrent lacunar stroke. There was no headache or history of migraine prior. She also suffers from some kidney impairment. Her Father has history of young stroke at age of 40 but never investigated. MRI showed widespread confluent white matter hyperintensities in T2 and multiple cerebral microhemorrhages, predominantly centrum semiovale.

Which is the likely genetic study to be positive?

• A.     NOTCH 2

• B.     NOTCH 3

• C.     HTAR1

• D.    COL4A1

According to “Global, regional, and national burden of stroke and its risk factors, 1990-2019” publish in the lancet neurology, stroke remained the second-leading cause of death, which consist of how many % of total death?

• A. 10.5%

• B. 11.6%

• C. 12.7%

• D. 15.0%

Answer explanation

In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019.

A 28-year-old lady with 6-month history of chronic headache and mild cognitive impairment presented with acute stroke. She has history epilepsy diagnosed after 2 unprovoked seizures and persistent, erythematous and violaceous discoloration of the skin behind her thighs and knees.

Her MRI as below:

• A.     Cerebral Lupus with underlying SLE

• B.     MELAS

• C.     Sneddon syndrome

• D.    Reversible Cerebral Vasoconstriction Syndrome

Answer explanation

MRI typically shows non-specific multi-territory infarcts and cortical atrophy, however, less commonly may also show hemorrhagic changes such as cerebral microhemorrhages.

Rash is livedo racemosa