Case 5 (stroke)

Question 1

What are the treatment options for ischaemic stroke?

Answer 1

• tPA (thrombolysis within 4.5hrs)
• warfarin/heparin (anticoagulation)
• anti-platelet drugs (aspirin)
• endarectomy
• antihypertensives (if patient is hypertensive)

Question 2

What are the treatment options for haemorrhagic stroke?

Answer 2

• antihypertensives (reduces BP)
• anticonvulsants (reduce risk of seizure)
• mannitol (= osmotic diuretics, decrease ICP)

Question 3

What is the MOA of tissue plasminogen activator (tPA)?

Answer 3

1. Inactivates thrombin and ADP
2. tPA cleaves plasminogen into plasmin which initiates fibrinolysis = degrades thrombi (clots)

Question 4

What is an endarectomy?

Answer 4

Removes atheromatous plaques from internal carotid artery

Question 5

Where do stroke-causing thrombi usually form?

Answer 5

• bifurcation of common carotid into internal/external carotids
• aortic arch

Question 6

What do osmotic diuretics (e.g mannitol) do to treat haemorrhagic strokes?

Answer 6

Decrease intracranial pressure (ICP) in subarachnoid space