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Minutes to let some of the people join and also also set things up. Cool. So, hi guys. Um, thank you for joining our teaching session today on neurology. Um So I'm Catherine and we'll be presenting with you as well. Um As usual, it's just 10 S pa style questions. Um We'll present five each and we'll give you about 30 seconds to answer each one with um an explanation. If you've got any questions, just pop them in the chat and we're happy to answer them, uh, if we can. All right. So let's get started. So, uh today we're gonna cover um different types of things in neurology. We try to make it as high yield as possible, um, and relevant to your exams. Um So we're gonna talk about different types of stroke, uh the risk factors and the management. We'll talk about seizures, um, classifications, causes and treatment. We'll talk a little bit about MS uh its presentation, diagnosis and treatment. We'll talk about Parkinson's disease, diagnosis, management and medications and we'll talk about headaches and the neurological examination as well. So, let's get started with the first question. So a 74 year old man with a history of hypertension and af presents to the emergency department with sudden onset right sided weakness and expressive aphasia. He arrived 45 minutes after symptom onset. A non contrast CT head shows no acute hemorrhage. His ECG shows af with a ventricular rate of 88 BPM and his BP is 100 and 78/96. What is the most likely under underlying mechanism of his stroke? So I'll give you about half a minute to sort that one. Yeah. So if we go to the answer, so the answer is b so the answer would be an embolic infarct from cardiac source. Uh well done to those of you that got it right. Um If we just go on to the explanation, so the patient's af and the sudden focal neurological deficit are what is suggestive of a cardioembolic stroke. So those kind of result in cortical signs. So things like aphasia, like not being able to speak properly or visual field defects. So kind of like that tunnel vision thing um is kind of what you would see in your exams quite commonly. So the CT being normal early on doesn't, doesn't exclude that they've got an ischemic stroke. So they can have the symptoms, but you may not be able to see the effect of the ischemia kind of on the CT straight away. Um So small vessel strokes are usually causing kind of pure motor or sensory deficits without those kind of cortical visual change or um kind of speaking signs. So you kind of get that classic right sided weakness. Um And, and things like that and shed infarcts are associated with like low BP or not perfusing their organs properly. Um And that's all not the case here. So it kind of generally um points to the cardio embolic source and often if you presented with this kind of thing, af is a major risk factor. Um So if they're mentioning it, then think about it. Nice. So if we go to the next question, um so kind of leading on from that. Um but I may have also given you a bit of a red herring there. Um Which of the following is the strongest modifiable risk factor for ischemic stroke. Cool. So let's reveal the answer. So the answer here is hypertension or high BP. Um So hypertension is the most significant kind of modifiable risk factor for actually both types of strokes. So, ischemic and hemorrhagic strokes um if we just move on. Yeah, perfect. Um So that means that chronic high BP is kind of the thing that puts people at risk of stroke as a modifiable factor. Um the most because it damages the BP walls over time. Um So that means that it accelerates atherosclerosis, makes the walls more sticky. Um It increases the risk of small vessel disease and it also increases the risk of vessel rupture causing hemorrhage as well. So it increases both of those risks kind of equally. So, af smoking diabetes and hyperlipidemia all contribute to smoke risk, stroke risk. Um But hypertension is the most prevalent across the population. So those people that don't smoke may still have high BP. Um but obviously the smoking risk wouldn't affect people that don't smoke. So, yes, the most prevalent a lot across everybody, especially at population level. Um So that means that effective BP control is really, really important, especially in the community because it really significantly reduces population stroke risk. So, if we go to question three, so a 64 year old man presents 1.5 hours after onset of left sided weakness, the CT hedge confirms no bleed. What is the next best step?