4 Stroke - Consultant Flashcards
What is the difference between as stroke and a TIA?
TIA
Definition of stroke
A syndrome of rapidly developing clinical signs of focal disturbance of cerebral function
>24 hours
with no apparent cause other than vascular origin
What is the time frame to treat patients using rt-PA?
4.5h don’t use except in selected patients
What are the two main causes of stroke?
Haemorhage
Clot (infarct)
What is the best way to diagnose type of stroke?
CT scan
although this does not tell us the extent of damage of infarct as it evolves
Post stroke what are our treatment aims? (2)
Secondary prevention
Rehabillitation
Factors increasing risk of stroke
Smoking Lipids BP Hypertension Diabetes AF Vascular disease TIA Alcohol Physical inactivity
Does weight and diet change your risk of stroke
There is inconsistent evidence for this
Does weight and diet change your risk of stroke
There is inconsistent evidence for this
What causes AF?
The pacemaker isn’t working properly, contraction is not in sink so the blood pools and clot forms
TIA differential diagnosis
fainting epileptic seizure migraine hypo vertigo brain injury neuroinfection
Is HRT associated with stroke?
Yes - take anyone off it if suspected of TIA
Action in suspected TIA?
ABCD score
Age > 60
BP systolic >140 diastolic >90
Clinical features: unilateral weakness (+2), speech disturbance (+1)
Duration of symptoms > 60min (+2) 10-59min (+1)
Diabetes (+1)
What is the ABCD scored used for?
Assess risk of stroke in TIA patients - used to see how soon they should be seen for treatment
Secondary prevention (6)
Antiplatelet
BP
Statins
Smoking
Carotid endartectomy for carotid stenosis
Anticoagulants for AF
What is the ABCD scored used for?
Assess risk of stroke in TIA patients - used to see how soon they should be seen for treatment
> 4 within 24h
Secondary prevention (6)
Antiplatelet
BP
Statins
Smoking
Carotid endartectomy for carotid stenosis
Anticoagulants for AF
What is the long term management of stroke?
???? see workshop?
What is the long term management of stroke?
???? see workshop?
Post stroke should a statin be initiated?
Yes - 48 hours after - regardless of lipid levels
following stroke what is target BP?
What should not be used to treat BP post stroke
Beta blockers - unless indicated for another reason
Long term treatment of TIA - what antiplatelet is recommended?
Aspirin and MR dipridamole
Long term treatment post ischemic stroke - what anti platelet is recommended?
Clopidogrel
first line statin used post stroke
Atorvastatin
