ASC Neurological Assessment & Monitoring 3 — Questions and Answers
Question 1: Which intracranial pressure (ICP) waveform component, when elevated above the P1 amplitude, signals compromised cerebral compliance in a stroke patient?
- P1 (percussion wave)
- P2 (tidal wave) (Correct answer)
- P3 (dicrotic wave)
- AMP component
Correct answer: P2 (tidal wave)
When P2 exceeds P1 amplitude, it indicates reduced intracranial compliance and impaired autoregulation, signaling early herniation risk.
Question 2: A patient with large hemispheric infarction is being monitored for malignant edema. The Stroke Coordinator should anticipate peak cerebral swelling at:
- 12–24 hours post-stroke
- 48–72 hours post-stroke (Correct answer)
- 5–7 days post-stroke
- 24 hours only in hemorrhagic strokes
Correct answer: 48–72 hours post-stroke
Cytotoxic edema following large ischemic stroke peaks at 48–72 hours and is the window of highest herniation risk.
Question 3: A right-handed patient presents with inability to name objects but intact repetition and comprehension. This pattern best localizes to:
- Broca's area (left inferior frontal gyrus)
- Anomic aphasia, often with angular gyrus involvement (Correct answer)
- Wernicke's area (left superior temporal gyrus)
- Conduction aphasia (arcuate fasciculus)
Correct answer: Anomic aphasia, often with angular gyrus involvement
Anomic aphasia (isolated naming deficit with intact repetition and comprehension) most commonly involves the angular gyrus or temporal-parietal junction.
Question 4: When using transcranial Doppler (TCD) to monitor for vasospasm after subarachnoid hemorrhage, a mean flow velocity above which threshold in the MCA indicates severe vasospasm?
- 100 cm/s
- 120 cm/s
- 200 cm/s (Correct answer)
- 80 cm/s
Correct answer: 200 cm/s
MCA mean flow velocity >200 cm/s on TCD is classified as severe vasospasm and correlates with high risk of delayed cerebral ischemia.
Question 5: The Lindegaard ratio in TCD monitoring is calculated to differentiate vasospasm from hyperemia. A ratio above what value confirms vasospasm rather than systemic hyperemia?
- 2
- 3 (Correct answer)
- 4
- 5
Correct answer: 3
A Lindegaard ratio (MCA velocity / extracranial ICA velocity) >3 indicates true vasospasm rather than hyperdynamic flow from systemic causes.
Question 6: A stroke patient in the ICU has cerebral perfusion pressure (CPP) of 48 mmHg with ICP of 22 mmHg. The MAP is:
- 26 mmHg
- 70 mmHg (Correct answer)
- 44 mmHg
- 110 mmHg
Correct answer: 70 mmHg
CPP = MAP − ICP; therefore MAP = CPP + ICP = 48 + 22 = 70 mmHg.
Question 7: Which pupillometry parameter measured by quantitative pupillometry (NPi) best predicts early neurological deterioration in neurocritical care?
- Maximum pupil diameter
- Neurological Pupil index (NPi) below 3 (Correct answer)
- Constriction velocity alone
- Dilation velocity alone
Correct answer: Neurological Pupil index (NPi) below 3
An NPi <3 on automated infrared pupillometry has been validated as an early and sensitive predictor of neurological deterioration and herniation.
ASC Neurological Assessment & Monitoring 3
Which intracranial pressure (ICP) waveform component, when elevated above the P1 amplitude, signals compromised cerebral compliance in a stroke patient?