10 - Stroke Rehabilitation

Question 1

What is special about a comprehensive stroke centre?

Answer 1

They do everything including thrombectomy, hyperacute and acute stroke

Question 2

How does HASU differ from comprehensive stroke centres?

Answer 2

HASU = doesn’t do mechanical thrombectomy - does do everything else

Question 3

Which Ps does ASU take?

Answer 3

Stroke Ps after initial interventions

Question 4

Who is involved in stroke Ps rehab?

Answer 4

Everyone

Question 5

What are potential obstacles to successful rehabilitation?

Answer 5

Question 6

How should you respond to challenges in rehabilitation?

Answer 6

Be truthful with Ps
Consistent & flexible approach

Question 7

What are potential complications of stroke?

Answer 7

Question 8

Why should you be careful about hemiplegic shoulder injury?

Answer 8

Can easily dislocate shoulder - have to be very careful with this. If dislocated can cause long term pain

Question 9

What do you need to do for secondary prevention of stoke?

Answer 9

Unequivocal evidence that statins reduce the chance of repeat stroke

Question 10

What anti-thrombotic agents can be given to Ps post stroke?

Answer 10

Aspirin
Clopidogren
DAPT
Anticoagulants - Warfarin or DOAC

Question 11

What Rx is given for large stroke or low risk of TIA?

Answer 11

Aspirin (300mg OD 2w) then 75mg OD or clopidogrel 75mg OD

Question 12

What Rs is given for a smaller stroke or high risk of TIA?

Answer 12

DAPT (Aspirin 75mg OD + Clopidogrel 75mg OD) for 3 w
Then Clopidogrel 75mg OD

Question 13

What is a TIA defined as?

Answer 13

Transient neurological dysfunction secondary to ischaemia without infarction.

Question 14

What is a crescendo TIA?

Answer 14

When 2 or more TIAs occur within a risk - high risk of progression to a full stroke

Question 15

What are the sudden onset Sx of a stroke?

Answer 15

Sudden
- weakness of limbs
- facial weakness
- onset dysphagia
- onset visual or sensory loss

Question 16

What are the RF for a stroke?

Answer 16

CVD or PVD
Previous stroke or TIA
AF
Carotid artery disease
HT
DM
Smoking
Vasculitis
Thrombophilia
Combined oral contraceptive pill

Question 17

How should a stroke be managed?

Answer 17

Admit to specialist stroke centre
Exclude hypoglycaemia
Immediate CT (exclude intracerebral haemorrhage)
Aspirin 300mg stat post CT

If intracerebral haemorrhage excluded - can give alteplase (window 4.5 hrs). Monitor for complications after.

Dont lower BP during a stroke - risks reducing perfusion to the brain.

Question 18

How should TIAs be managed?

Answer 18

Start aspirin 300mg daily
Start secondary measures for CVD
If crescendo TIA - seek specialist

Question 19

What is the gold standard imaging for stroke?

Answer 19

Diffusion-weighted MRI

Question 20

What imaging can detect carotid stenosis?

Answer 20

Carotid ultrasound

Question 21

What technique can be used to remove plaques in the carotids?

Answer 21

Endarterectomy

Question 22

What is standard secondary prevention of stroke?

Answer 22

Atorvastatin 80mg - although dont start immediately

Aspirin 300mg OD or DAPT (clopidogrel) = both for 2-3w
If sinus rhythm - then clopidogrel
If AF - DOAC

Question 23

When is anticoagulation for AF given
- after a TIA
- after a very small stroke
- after a moderate stroke
- after a large stroke

Answer 23

• Immediately
• Immediately
• 3-7 days after moderate stroke
• 14 days after a large stroke - provided repeat brain imaging has been done

Question 24

What investigations should be done after a stroke or TIA?

Answer 24

Question 25

What Qs should ask about a TIA?

Answer 25