A 60-year-old patient remains intubated with a reduced consciousness level 6 hours following endovascular clot retrieval (ECR) for an acute middle cerebral artery (MCA) stroke. Sedation was stopped immediately post procedure.
a. List six likely causes of the reduced conscious state (3 marks) b. Outline your assessment of this patient’s reduced conscious level (7 marks)
Syllabus topic/section: 2.1.8 Neurological Intensive Care
This question was answered well by most candidates and was assessed to be an easy question to pass. Better marks were scored by candidates who described an assessment that was tailored to the clinical scenario, rather than a more generic description of how to assess someone with a decreased conscious state.
For instance, the above standard answer would include both stroke AND procedure related history with relevant details for investigations and examination.
a)
b)
Leslie-Mazwi, Thabele, et al. "Post-thrombectomy management of the ELVO patient: Guidelines from the Society of NeuroInterventional Surgery." Journal of neurointerventional surgery 9.12 (2017): 1258-1266.
van de Graaf, Rob A., et al. "Periprocedural antithrombotic treatment during acute mechanical thrombectomy for ischemic stroke: a systematic review." Frontiers in neurology 9 (2018): 238.
Torbey, Michel T., et al. "Evidence-based guidelines for the management of large hemispheric infarction." Neurocritical care 22.1 (2015): 146-164.
Jung, Simon, et al. "Adverse Effect of Early Epileptic Seizures in Patients Receiving Endovascular Therapy for Acute Stroke." Stroke 43.6 (2012): 1584-1590.
Prabhakaran, Shyam, et al. "2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association." Stroke 57 (2026).
Li, Xiangyu, et al. "The predictors and prognosis for unexpected reocclusion after mechanical thrombectomy: a meta-analysis." Annals of Translational Medicine 8.23 (2020): 1566.
Caldwell, Stephanie, et al. "Bridging the Distance for Ischaemic Stroke Treatment in Regional Australia: A Retrospective Cohort Study." Australian Journal of Rural Health 34.2 (2026): e70177.
Zaidat, Osama O., et al. "Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement." Stroke 44.9 (2013): 2650-2663.
Gurbani, Saumya S., et al. "Post-Stroke Thrombectomy Evaluation: Expected Findings and Unexpected Complications." RadioGraphics 46.1 (2025): e250045.
Shahid, Adnan H., et al. "Risk Factors of Futile Recanalization Following Endovascular Treatment in Patients With Large-Vessel Occlusion: Systematic Review and Meta-Analysis." Stroke: Vascular and Interventional Neurology 2.6 (2022): e000257.
Wang, Jeffrey Z., et al. "Incidence and management of seizures after ischemic stroke: systematic review and meta-analysis." Neurology 89.12 (2017): 1220-1228.
Shapiro, S. Z., et al. "Access-site complications in mechanical thrombectomy for acute ischemic stroke: a review of prospective trials." American Journal of Neuroradiology 41.3 (2020): 477-481.
Prabhakaran, Shyam, et al. "2026 Guideline for the early management of patients with acute ischemic stroke: a guideline from the American Heart Association/American Stroke Association." Stroke (2026).