Ischaemic Stroke

Question 1

Define ischaemic stroke.

Answer 1

Stroke is defined as an acute neurological deficit lasting more than 24 hours and caused by cerebrovascular aetiology.

Question 2

Explain the aetiology/risk factors of ischaemic stroke.

Answer 2

Older age
Family history of stroke
Hypertension
Smoking
Diabetes mellitus
Atrial fibrillation
Comorbid cardiac conditions
Carotid artery stenosis
Sickle cell disease
Dyslipidaemia

Question 3

Summarise the epidemiology of ischaemic stroke.

Answer 3

The most common type of stroke. Stroke is the third leading cause of death and a major cause of disability in the US and in England and Wales.

Question 4

Recognise the presenting symptoms of ischaemic stroke. Recognise the signs of ischaemic stroke on physical examination.

Answer 4

Vision loss or visual field deficit
Weakness
Aphasia
Impaired coordination (ataxia)
Sudden onset of symptoms
Negative symptoms (i.e., loss of function)
Altered sensation
Headache
Diplopia
Sensory loss
Dysarthria
Gaze paresis
Arrhythmias, murmurs, or pulmonary oedema

Question 5

Identify appropriate investigations for ischaemic stroke and interpret the results.

Answer 5

CT head
MRI brain
Serum glucose
Serum electrolytes
Serum urea and creatinine
Cardiac enzymes
ECG
FBC
Prothrombin time and PTT (with international normalised ratio)

Question 6

Generate a management plan for ischaemic stroke within 4.5 hours and no contraindication to thrombolysis.

Answer 6

Alteplase (recombinant tissue plasminogen activator or r-tPA)

Adjunct:
Aspirin 24 hours after r-tPA
Endovascular intervention (stent retriever)
Plus:
Supportive care
Swallowing assessment
VTE prophylaxis + early mobilisation

Question 7

Generate a management plan for ischaemic stroke after 4.5 hours or contraindication to thrombolysis.

Answer 7

Aspirin

Plus:
Supportive care
Swallowing assessment
Adjunct:
VTE prophylaxis + early mobilisation

Question 8

Identify the possible complications of ischaemic stroke and its management.

Answer 8

Deep venous thrombosis (DVT)
Seizure
Haemorrhagic transformation of ischaemic stroke
r-tPA-related orolingual oedema
Brain oedema and elevated intracranial pressure
Depression
Aspiration pneumonia

Question 9

Summarise the prognosis for patients with ischaemic stroke.

Answer 9

In 2013, a total of 3.3 million individuals died of ischaemic stroke worldwide. Between 1990 and 2010, ischaemic stroke mortality decreased 37% in high-income countries and 14% in low- and middle-income countries.