Neurologists Exam Cerebrovascular Disease & Stroke 3

Question 1

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

Accepted Answer

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

Answer

Age over 80 years

Answer

NIHSS score less than 5

Answer

Blood pressure of 180/105 mmHg treated to below 185/110 mmHg

Question 2

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

Accepted Answer

Aspirin alone or clopidogrel alone

Answer

Warfarin

Answer

Dabigatran

Answer

Unfractionated heparin infusion

Question 3

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

Accepted Answer

Oral anticoagulation with a DOAC or warfarin

Answer

Aspirin 325 mg daily

Answer

Dual antiplatelet therapy with aspirin and clopidogrel

Answer

IV heparin bridging indefinitely

Question 4

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

Accepted Answer

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

Answer

Aggressive lowering to below 120/80 mmHg within 1 hour

Answer

Maintain below 140/90 mmHg immediately

Answer

Immediate antihypertensive therapy for any BP above 160/90 mmHg

Question 5

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

Accepted Answer

Symptomatic intracranial hemorrhage (sICH)

Answer

Angioedema causing airway compromise

Answer

Acute kidney injury from contrast load

Answer

Pulmonary embolism from reperfusion paradox

Question 6

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

Accepted Answer

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

Answer

Small lacunar infarct causing pure motor hemiparesis

Answer

Subarachnoid hemorrhage with communicating hydrocephalus

Answer

Posterior fossa hemorrhage measuring 8 mL

Question 7

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

Accepted Answer

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

Answer

No statin unless baseline LDL-C exceeds 130 mg/dL

Answer

Low-dose statin to minimize myopathy risk

Answer

Statin therapy only if concurrent coronary artery disease is present