Lecture 1 TIAStroke

Question 1

Describe the definition of a stroke.

Answer 1

Stroke is a clinical syndrome of presumed vascular origin characterized by rapidly developing signs of focal or global disturbance of cerebral functions lasting more than 24 hours or leading to death.

Question 2

What are the types stroke mentioned in the content?

Answer 2

Ischaemic stroke (blockage of blood flow to the leading to cell death)
and Haemorrhagic stroke (caused by bleeding in the brain).

Question 3

Define Transient Ischaemic Attack (TIA).

Answer 3

TIA is an ischaemic blockage lasting less than 24 hours.

Question 4

List some non-modifiable risk factors for stroke.

Answer 4

Increasing age, Ethnicity (Black, South Asian), Family History, Male sex, Personal History of heart issues.

Question 5

What are some modifiable risk factors for stroke mentioned in the content?

Answer 5

Excess alcohol consumption, Diabetes, Poor diet, Overweight/obesity, Smoking, Physical inactivity.

Question 6

How is stroke diagnosed according to the content?

Answer 6

By ruling out hypoglycemia, using a validated screening tool like FAST, performing a brain scan (CT and/or MRI), and considering clinical features, history, and examinations.

Question 7

Describe the eligibility criteria for thrombolysis (alteplase) in ischaemic stroke.

Answer 7

Patients with acute stroke can be considered for thrombolysis within 4.5 hours of known onset. It can also be considered up to 9 hours if brain imaging shows potential to salvage brain tissue.

Question 8

How is alteplase administered in ischaemic stroke management?

Answer 8

Alteplase is given at 0.9mg/kg (max 90mg), with 10% as IV bolus and the remainder as IV infusion over 60 mins. Blood pressure is aimed to be reduced to <185/110 mmHg prior to administration.

Question 9

Define the contraindications for thrombolysis in ischaemic stroke.

Answer 9

Contraindications include high bleeding risk conditions like recent haemorrhagic stroke, recent surgery, recent GI ulcer, and severe uncontrollable hypertension.

Question 10

What is the initial management approach for ischaemic stroke if thrombolysis is not eligible?

Answer 10

Offer antiplatelets like aspirin 300mg OD within 24 hours of presentation, then switch to clopidogrel PO 75mg OD lifelong as secondary prevention.

Question 11

How should anticoagulants be managed in disabling ischaemic stroke patients with atrial fibrillation?

Answer 11

Consider delaying anticoagulation for at least 2 weeks due to the risk of haemorrhagic conversion. Aspirin can be considered initially, followed by full-dose anticoagulation if needed.

Question 12

Describe the management approach for transient ischaemic attacks (TIAs).

Answer 12

Most TIAs resolve within 1 hour but can persist for up to 24 hours. Immediate evaluation and management are crucial to prevent future strokes.

Question 13

Describe the secondary prevention strategies for stroke and TIA

Answer 13

Secondary prevention strategies include modifiable risk factors, using antiplatelet therapy, controlling blood pressure, managing lipids, optimizing glyc control, and considering anticoagulation if indicated.

Question 14

What is the recommended antiplatelet therapy for stroke and TIA?

Answer 14

Clopidogrel 75 mg OD is normally recommended, with aspirin 75 mg OD as an alternative if clopidogrel is not tolerated.

Question 15

Define the target blood pressure for stroke prevention according to guidelines.

Answer 15

The recommended clinic BP target is <130 mmHg systolic, or <125 mmHg for home BP.

Question 16

How is lipid management approached in stroke prevention?

Answer 16

High-intensity statin therapy, such as Atorvastatin 80mg OD, is commonly used to target fasting LDL levels <1.8 mmol/L.

Question 17

What are the considerations for anticoagulation in stroke prevention?

Answer 17

Anticoagulation is not routine and is only considered if there is an indication, such as atrial fibrillation.

Question 18

Describe the lifestyle factors important for secondary prevention of stroke and TIA.

Answer 18

Lifestyle factors include avoiding smoking, moderating alcohol intake, maintaining a healthy weight, following a cardioprotective diet, and engaging in physical activity.

Question 19

What are the key management strategies for hemorrhagic stroke?

Answer 19

Management may involve surgery to remove hematoma, reversal of anticoagulation, urgent blood pressure control, and potentially coiling or clipping to stop the bleed.

Question 20

How does hemorrhagic stroke differ from ischemic stroke in terms of severity and mortality rate?

Answer 20

Hemorrhagic stroke is generally more immediately serious with a higher mortality rate compared to ischemic stroke.

Question 21

What are the main types of hemorrhagic stroke and their respective percentages among all strokes?

Answer 21

Intracerebral hemorrhage accounts for about 10% of all strokes, while subarachnoid hemorrhage accounts for about 5%.