Neurology Board Review

Rolling test (satellite sign) and pronator drift

Facial paresis, pronator drift, dysarthria (LR 5.5, LR- 0.39)- age > 45, no sz hx, sx < 24 hrs, not wheelchair bound, any unilateral facial, arm, or grip weakness, with normal blood sugar (60-400) LR 31, LR- 0.09

Monofilament test touch 1st and 5th metatarsal 3 times (with some shams where you don't touch and wait a while), < 2/3 67% sensitivity for neuropathy

Cerebral amyloid angiopathy, neoplasms, vascular malformations, vasculitis, Moya moya, antithrombotic use etc.

Age > 60, bp > 140 or 90, clinical presentation (2 for unilteral weakness, 1 for speech problem without weakness), duration (2 pts > 1 hr, 1 pt 10 minutes)low risk 0-3, mod 4-5, high 6-7

Cardioembolic Large vessel intracranial (atherosclerosis, dissection, moya moya, inflammatory arteriopathies)Large vessel extracranial (aortic disease, noninflammatory ateriopathy, inflammatory: takayasu, GCA)Small vessel (atherosclerosis)Coagulopathies (sickle cell, DIC, TTP, homocyteinemia, MP disorders, protein C, S, ATIII, APL syndrome

1. all pts with moderate to high ABCD2 score2. first time TIA within 48 hours of event3. multiple or recurrent TIA4. symptomatic carotid stenosis5. probable cardioembolic source6. hypercoaguable state
If > 48 hrs and none of above, expedited 7 day work up

Lipids, panel 7, CBC, MRI/MRA (or CT/CTA), cardiac echo (if pt < 45 and negative work-up, should get TEE with bubble study)

Inability to do finger to nose when targets are 30 cm apart 32 or more times in 15 seconds

1. focal neuro deficit, 2. persistent neuro deficit, 3. onset in last wk, 4. no trauma hx0 = LR 0.14, 1.4% chance; 1-3 > 10% chance; 4 factors = LR 40, > 80% chance of stroke

BG < 140 at all times

ICH 6.4 vs. 0.6 in patients on placeboNNT 3, NNH 30

> 80% stenosis, < 80 y.o., > 5 yr life expectancy, < 3% mortality at center of surgery

Depends, age, sex, severity of sxs

Should be performed within 2 weeks of small stroke and 6 weeks of large stroke