CEP Neurological Emergencies & Stroke Management 2 — Questions and Answers
Question 1: Which type of stroke accounts for approximately 87% of all strokes?
- Hemorrhagic stroke
- Subarachnoid hemorrhage
- Ischemic stroke (Correct answer)
- Lacunar infarct only
Correct answer: Ischemic stroke
Ischemic stroke, caused by arterial occlusion (thrombotic or embolic), accounts for approximately 87% of all strokes.
Question 2: A patient who has had a seizure is now postictal. Appropriate prehospital management includes:
- Administering another dose of benzodiazepines prophylactically
- Placing in the recovery position and continuously monitoring airway, breathing, and circulation (Correct answer)
- Performing immediate endotracheal intubation regardless of airway status
- Administering phenytoin IV to prevent recurrence en route
Correct answer: Placing in the recovery position and continuously monitoring airway, breathing, and circulation
During the postictal state, recovery positioning protects the airway while continuous ABCs monitoring guides further intervention; medications are reserved for recurring seizures.
Question 3: Todd's paralysis refers to:
- Permanent hemiplegia following hemorrhagic stroke
- Transient focal weakness following a seizure (Correct answer)
- Spastic paralysis from spinal cord compression
- Bilateral leg weakness during status epilepticus
Correct answer: Transient focal weakness following a seizure
Todd's paralysis is a temporary focal neurological deficit, most commonly weakness, following a focal seizure, typically resolving within 24 hours.
Question 4: A patient with suspected subarachnoid hemorrhage typically reports:
- Gradual onset headache worsening over several days
- Sudden onset 'thunderclap' headache described as the worst of their life (Correct answer)
- Dull occipital headache with neck stiffness lasting one week
- Migraine-like headache with visual aura and nausea
Correct answer: Sudden onset 'thunderclap' headache described as the worst of their life
Subarachnoid hemorrhage classically presents with a sudden-onset thunderclap headache — the worst headache of the patient's life — from blood rapidly filling the subarachnoid space.
Question 5: When transporting a patient with suspected acute ischemic stroke, you should:
- Elevate the head of the stretcher to 45 degrees
- Keep the head flat or at 15–30 degrees and transport rapidly to a stroke center (Correct answer)
- Place the patient in Trendelenburg position to increase cerebral blood flow
- Sit the patient fully upright at 90 degrees to reduce ICP
Correct answer: Keep the head flat or at 15–30 degrees and transport rapidly to a stroke center
Current guidelines recommend supine or slight head elevation (15–30°) to maintain cerebral perfusion pressure during rapid transport to a stroke-capable facility.
Question 6: The FAST acronym used for public stroke recognition stands for:
- Face drooping, Arm weakness, Speech difficulty, Time to call 911 (Correct answer)
- Facial pallor, Ataxia, Seizure, Temperature
- Focal deficit, Altered mental status, Slurred speech, Tachycardia
- Face symmetry, Arm grip, Speech clarity, Triage priority
Correct answer: Face drooping, Arm weakness, Speech difficulty, Time to call 911
FAST stands for Face drooping, Arm weakness, Speech difficulty, and Time to call 911, offering a simple tool to rapidly recognize stroke symptoms.
Question 7: Which intervention is contraindicated in a patient with suspected ischemic stroke who has a BP of 195/105 mmHg?
- Administering supplemental oxygen if SpO2 is below 94%
- Aggressively lowering blood pressure with IV antihypertensives in the prehospital setting (Correct answer)
- Establishing IV access and drawing blood samples
- Performing a point-of-care blood glucose check
Correct answer: Aggressively lowering blood pressure with IV antihypertensives in the prehospital setting
Aggressive prehospital BP reduction in ischemic stroke is contraindicated because elevated BP may be compensatory to maintain perfusion in the ischemic penumbra.
CEP Neurological Emergencies & Stroke Management 2
Which type of stroke accounts for approximately 87% of all strokes?