Neurology Shelf Exam Sample Questions

The correct answer is E. The risk of stroke is highest in the period immediately following and soon after a TIA

Explanation: This patient had a TIA, which is a brief episode of focal neurologic dysfunction caused by ischemia without cerebral infarction. It is important to recognize TIAs and evaluate them since patients who have TIAs are at higher risk of stroke. Around 10% to 15% of patients who suffer a TIA will have a stroke within 3 months, and the risk is higher soon after the TIA, with 50% of the strokes occurring within 48 hours. Therefore, patients presenting with TIAs should be urgently assessed, with a detailed analysis of their risk factors for stroke. Work up should be obtained to evaluate the vascular origin of the symptoms, to exclude alternative nonischemic causes, and to assess prognostic factors. The current proposed definition of TIA is based on lack of tissue damage and the absence of infarcted tissue. Brain imaging with MRI and diffusion-weighted imaging (DWI) is helpful in detecting the presence of infarcted tissue, even in the absence of persistent symptoms. Guidelines recommend the following: Neuroimaging within 24 hours, preferably an MRI with DWI Noninvasive vascular imaging of the extracranial arteries Noninvasive imaging of the intracranial vasculature if it is considered that this will alter management Patients should be evaluated as soon as possible Given that in the acute presentation a TIA (when symptoms are still present) is indistinguishable from an acute stroke, all patients presenting with acute neurologic symptoms should be assessed similarly and considered candidates for intravenous tPA until proven contraindication is determined. No period of observation should be allowed in this setting since on acute presentation these two spectrums of the disease cannot be differentiated