ASC Neurological Assessment & Monitoring 2 — Questions and Answers
Question 1: A patient with a right MCA stroke presents with left-sided neglect. Which assessment tool best quantifies this deficit?
- Barthel Index
- Catherine Bergego Scale (Correct answer)
- Montreal Cognitive Assessment
- Berg Balance Scale
Correct answer: Catherine Bergego Scale
The Catherine Bergego Scale (CBS) is specifically validated to assess unilateral neglect in functional activities after stroke.
Question 2: When performing serial NIH Stroke Scale assessments, a 4-point worsening is considered clinically significant because it indicates:
- Hemorrhagic transformation
- Early neurological deterioration requiring intervention (Correct answer)
- Successful thrombolysis
- Cerebral edema peak
Correct answer: Early neurological deterioration requiring intervention
A ≥4-point increase in NIHSS score defines early neurological deterioration (END), which triggers urgent reassessment and intervention.
Question 3: A patient's pupils are 3mm bilaterally and reactive. Six hours later they are 6mm and sluggish on the left. This change most likely indicates:
- Pontine hemorrhage
- Uncal herniation compressing CN III (Correct answer)
- Bilateral Horner syndrome
- Metabolic encephalopathy
Correct answer: Uncal herniation compressing CN III
Unilateral pupil dilation with sluggish reactivity is a classic sign of uncal herniation compressing the ipsilateral oculomotor nerve (CN III).
Question 4: Which finding on continuous EEG monitoring in a post-stroke patient indicates subclinical seizure activity requiring treatment?
- Burst suppression pattern
- Periodic lateralized epileptiform discharges (PLEDs) evolving into rhythmic ictal pattern (Correct answer)
- Diffuse theta slowing
- Alpha coma pattern
Correct answer: Periodic lateralized epileptiform discharges (PLEDs) evolving into rhythmic ictal pattern
PLEDs that evolve into a rhythmic ictal pattern on cEEG represent non-convulsive seizures requiring antiepileptic intervention.
Question 5: The 'locked-in syndrome' following basilar artery occlusion is best distinguished from coma by the presence of:
- Absent corneal reflexes
- Preserved vertical eye movements and blinking (Correct answer)
- Flaccid quadriplegia
- Absent oculocephalic reflexes
Correct answer: Preserved vertical eye movements and blinking
Locked-in syndrome spares the dorsal midbrain, preserving vertical gaze and volitional blinking as the only motor output.
Question 6: A patient 24 hours post-thrombolysis develops sudden headache and NIHSS worsens by 6 points. The priority neurological assessment is:
- Repeat NIHSS documentation
- Immediate non-contrast CT head to rule out hemorrhagic transformation (Correct answer)
- Lumbar puncture for xanthochromia
- MRI DWI sequence
Correct answer: Immediate non-contrast CT head to rule out hemorrhagic transformation
Symptomatic hemorrhagic transformation post-tPA requires immediate non-contrast CT as the fastest way to detect intracranial blood.
Question 7: When assessing swallowing safety in an acute stroke patient, which bedside screening finding is the strongest predictor of aspiration pneumonia risk?
- Dysarthria with normal gag reflex
- Silent aspiration identified on water swallow test (Correct answer)
- Facial droop alone
- Hoarse voice quality
Correct answer: Silent aspiration identified on water swallow test
Silent aspiration — aspiration without cough — detected on bedside swallow screening carries the highest risk for subsequent aspiration pneumonia.
ASC Neurological Assessment & Monitoring 2
A patient with a right MCA stroke presents with left-sided neglect.
Which assessment tool best quantifies this deficit?