Cerebrovascular Diseases and Acute Stroke — WACS Viva & Clinical Scenarios (Neurology)

Exam-style cerebrovascular diseases and acute stroke viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: Hyperacute Ischemic Stroke Evaluation and Thrombolysis Eligibility: A 62-year-old known hypertensive man presents to the emergency department with sudden-onset right hemiparesis and global aphasia that started 2 hours prior to presentation. Blood pressure is 195/115 mmHg, random blood glucose is 6.2 mmol/L, and oxygen saturation is 96% on room air. Outline your immediate emergency triage, neuroimaging protocol, blood pressure management, and eligibility evaluation for intravenous thrombolysis.
• SCENARIO 2: Management of Acute Spontaneous Intracerebral Hemorrhage: A 55-year-old woman is brought to the acute medical unit with sudden severe headache, vomiting, and progressive deterioration of consciousness (Glasgow Coma Scale score 10/15). Non-contrast cranial CT reveals a 35 mL acute left basal ganglia hematoma with midline shift of 4 mm. Detail your acute medical resuscitation, target hemodynamic thresholds, elevated intracranial pressure management, and criteria for neurosurgical consultation.
• SCENARIO 3: Cryptogenic and Young Stroke Diagnostic Pathway: A 28-year-old woman with homozygous sickle cell disease (HbSS) presents with sudden-onset left-sided hemiplegia. Cranial MRI reveals acute right middle cerebral artery territory infarction without intracranial hemorrhage. Discuss the pathophysiological mechanisms of stroke in young adults within the West African subregion, diagnostic evaluation, and acute exchange transfusion protocol.
• SCENARIO 4: Posterior Circulation and Brainstem Stroke Syndromes: A 68-year-old man presents with acute vertigo, intractable hiccups, dysphagia, right-sided facial numbness, right Horner syndrome, right limb ataxia, and loss of pain and temperature sensation over the left trunk and extremities. Localize the lesion to the specific vascular territory, identify the clinical syndrome, and outline the acute management and aspiration risk mitigation strategy.
• SCENARIO 5: Secondary Prevention Stratification in Ischemic Stroke: A 70-year-old male with persistent non-valvular atrial fibrillation and carotid duplex evidence of 75% symptomatic left internal carotid artery stenosis suffers an acute partial anterior circulation infarct. Formulate an evidence-based timeline and strategy for antithrombotic therapy, high-intensity statin initiation, blood pressure control, and indications for carotid revascularization.