B.10 Stroke

Question 1

What is a stoke?

Answer 1

Interruption of cerebral blood flow, which leads to cerebral infarction ‘brain attack’

Question 2

What is Transient Ischaemic Attack (TIA)?

Answer 2

Interruption in the blood supply to the brain, where blood flow in the brain temporarily stops. also known as a ‘mini stroke’

Question 3

What are the two types of stroke?

Answer 3

Thromboembolic/Ischaemia - a blood clot in the brain

Haemorrhage - bleeding in the brain

TIA- mini stoke

Question 4

What type of stroke has a higher mortality rate?

Answer 4

Ischaemic of about 85%

1/4 die in the first month

Question 5

What is thromboembolic stroke associated with?

Answer 5

cerebral artery occlusion

Question 6

What is a major risk factor for thromboembolic stroke?

Answer 6

Hypertension

Question 7

What are the risk factors of stroke?

Answer 7

age 
Afro-Caribbean/Asian
family history
diabetes 
hypertension
smoking 
hyperlipidemia
obesity
high alcohol intake 
antipsychotic drugs

Question 8

What is the pharmacology of a thromboembolic stroke

Answer 8

1. Interruption of blood flow:
   - thrombosis
   - embolism
2. region becomes ischaemic
   - irreversible neuronal death
3. neurological deficit leads to diability:
   - Depends on the region affected

Question 9

What is the pharmacology of haemorrhagic stroke?

Answer 9

Aneurysm:

1. Bulge in a blood vessel caused by weakness in the blood vessel wall.
2. This is prone to bursting, which can interrupt blood flow
3. Causes the vessels to constrict
4. Leads to the death of neurons (ischemia)

Question 10

What are the clinical features of stroke?

Answer 10

Neurological deficiencies

Altered consciousness

Numbness, weakness, paralysis

Altered speech

Altered coordination

Sudden loss of vision

Question 11

What are the symptoms of hemorrhage stoke?

Answer 11

Severe headache

Explosive pain

Stiff neck

Question 12

How would you diagnose the different forms of strokes?

Answer 12

Brain CT or MRI scan

Question 13

What drugs would you use to treat acute ischaemic stroke?

Answer 13

Thrombolysis with alteplase (given within 4hrs)

Antiplatelet drug immediately after onset and for 2 weeks

Question 14

How does alteplase work pharmacologically?

Answer 14

1. Dissolve clot
2. Restore blood flow
   The first line of treatment

Question 15

When treating acute ischaemic stroke what should you avoid?

Answer 15

Avoid lowering BP substantially

Don’t immediately start stains: Wait for 48hrs

Question 16

What is secondary prevention of ischemic stroke?

Answer 16

Clopidogrel is antiplatelet after two weeks of aspirin

Question 17

What is secondary prevention of TIA?

Answer 17

Dipyridamole and aspirin

Question 18

How would you treat a patient with atrial fibrillation after a stroke?

Answer 18

Aspirin for 14 days 300mg
Start warfarin 2 weeks after onset of stroke

INR target 2-3

Question 19

What primary preventions can be done to prevent stroke?

Answer 19

Smoking cessation 
Blood pressure 
Limit alcohol 
Activity
Statins 
Detection: ultrasound of the carotid
Endarterectomy: surgical management of carotid stenosis