Cerebrovascular Disease & Stroke Flashcards

Which of the following is an absolute contraindication to IV alteplase in acute ischemic stroke?

Answer: Intracranial surgery, serious head trauma, or prior stroke within 3 months

Intracranial surgery, serious head trauma, or prior ischemic stroke within the preceding 3 months are absolute contraindications to IV tPA due to markedly increased hemorrhage risk.

First-line antiplatelet therapy for secondary prevention of non-cardioembolic ischemic stroke or TIA includes:

Answer: Aspirin alone or clopidogrel alone

Aspirin and clopidogrel are both first-line options for secondary prevention of non-cardioembolic stroke; dual antiplatelet therapy (DAPT) with both agents is used short-term for minor stroke/high-risk TIA.

For secondary stroke prevention in a patient with ischemic stroke caused by non-valvular atrial fibrillation, the preferred long-term treatment is:

Answer: Oral anticoagulation with a DOAC or warfarin

Oral anticoagulation (DOACs preferred over warfarin where applicable) is the standard of care for secondary prevention in AF-related cardioembolic stroke, reducing recurrence risk by ~60–70%.

In patients with acute ischemic stroke NOT receiving IV thrombolysis, current guidelines recommend which blood pressure management approach?

Answer: Permissive hypertension — allow BP up to 220/120 mmHg unless end-organ damage is present

Permissive hypertension (allowing BP up to 220/120 mmHg) is recommended in the first 24–48 hours for non-thrombolysis stroke patients to maintain cerebral perfusion in the ischemic penumbra.

The most feared and clinically significant complication of IV alteplase therapy in acute ischemic stroke is:

Answer: Symptomatic intracranial hemorrhage (sICH)

Symptomatic intracranial hemorrhage (sICH) occurs in approximately 6% of tPA-treated patients and is associated with high mortality and disability, making it the most feared complication.

Decompressive hemicraniectomy within 48 hours is most clearly indicated in which stroke scenario?

Answer: Malignant MCA infarction with severe cerebral edema causing herniation risk in patients ≤60 years

Decompressive hemicraniectomy significantly reduces mortality in malignant MCA syndrome (large hemispheric infarct with life-threatening edema) when performed within 48 hours in patients ≤60 years, per DESTINY and HAMLET trials.

Current guidelines recommend which statin strategy for secondary prevention after atherosclerotic ischemic stroke or TIA?

Answer: High-intensity statin therapy (e.g., atorvastatin 40–80 mg) regardless of baseline LDL

High-intensity statin therapy is recommended for all patients with atherosclerotic ischemic stroke or TIA to reduce recurrent vascular events, based on SPARCL and other trials showing benefit independent of baseline LDL.