Cardiovascular Health

Question 1

Risk of recurrence of stroke in people surviving a first stroke?

Answer 1

11. 1% at 1 year
12. 4% at 5 years
13. 2% at 10 years

18% of recurrent strokes are fatal
25% of recurrent vascular events occur within 3 months and half of these within 4 days

Question 2

Differential diagnosis of stroke/TIA

Answer 2

• toxic/ metabolic: low BM, drug/ alcohol intoxication
• balance disorders: syncope, peripheral vestibular disorders
• neurological conditions: seizure, migraine with aura, demyelination, peripheral neuropathies, spinal epidural haematoma
• trauma
• systemic or local infection
• encephalopathies
• SOL
• Other: delirium, dementia, vasculitis, functional

Question 3

Indications for brain imaging within 1 hour (stroke/tia)

Answer 3

• If within 3-4.5 hours of start of symptoms
• On anticoagulants or bleeding tendency
• Decreased GCS
• Progressive or fluctuating symptoms
• Signs of alternative pathology
• Sudden onset severe headache at onset of symptoms

Question 4

Secondary prevention following stroke/tia

Answer 4

• Lifestyle changes
• Anti-platelet therapy: clopidogrel 75mg OD or aspirin 75mg OD + dipyridamole MR 200mg BD (+/- PPI)
• BP target <130/80
• Anticoagulate if AF
• Statin recommended for all with ischaemic stroke
• Carotid artery surgery if indicated

Question 5

Driving guidance post stroke/TIA?

Answer 5

Should not drive for at least 1 month. DVLA and insurance company should be informed.

Question 6

Longer term management of stroke patients

Answer 6

• primary care review at 6 weeks, 6 months and then annually
• assess social care needs, ensure involvement of community rehab team + ensure they have had an MDT assessment
• assess health care needs eg depression, bowel/bladder problems
• optimise secondary prevention