FN: Stroke Management

Question 1

Acute management

Answer 1

1. Resuscitate
2. Monitor
3. Imaging
4. Medical
5. Surgical
6. Stroke unit

Question 2

Resuscitation

Answer 2

Airway - NGT
NBM until swallowing assessed
Dont overhydrate: risk of cerebral oedema

Question 3

Monitor

Answer 3

1. Glucose:4-11mM: sliding scale if DM
2. BP: 185/110 (for thombolysis)
3. Neuro obs

Question 4

Imaging

Answer 4

1. URgent CT/MRI
2. Diffusion-weighted MRI is most sensitive for acute infarct
3. CT will exclude primary haemorrhage

Question 5

Medical

Answer 5

1. Consider thromboylsus if 18080 yrs and

Question 6

Thrombolysis

Answer 6

Alteplase (eh-tPA)
Aspirin 300mg PO/PR once haemorrhagic stroke excluded ± PPI
Clopidgrel if aspirin sensitive

Question 7

Surgery

Answer 7

Neurosurgical opinion if intracranial haemorrhage
May coil bleeding aneurysms
Decompressive hemicraniectomy for some forms of MCA infarction

Question 8

Stroke unit

Answer 8

Specialist nursing and physio
Early mobilsation
DVT prophylaxis

Question 9

Primary prevention

Answer 9

1. Control RFs: HTN, hypercholesterol, DM, smoking cardiac disease
2. Consider ife-long anticoagulation in AF (use CHADS2)
3. Carotid endarterectomy if symptomatic 70% stenosis
4. Excercise

Question 10

Secondary PRevention

Answer 10

1. Risk Factor control as above - start statin after 4h
2. ASpirin/clopidogrel 300mg for 2 wks after stroke then either
   a. clopidogrel 75mg OD (preferred option)
   b. Aspiin 75mg OD + dipyridamole MR 200mg BD
3. Warfarin instead of aspirin/clopidegrel if
   a. cardioembolic stroke or chronic AF
   b. Start from 2 weeks post-stroke (INR 2-3)
   c. Dont use aspirin and warfarin together
4. Carotid endarterectomy if good recovery + ipsilateral stenosis >70%

Question 11

Rehabd

Answer 11

MENDS
MDT
Eating
Neurorehab
DVT
Sores