Management of Stroke/TIA Flashcards
For patients with TIA, in a setting of AF, what type of medication will you give the patient?
Anticoagulants within 14 days after the onset of neurological symptoms
What are the investigations you carry out to evaluate a patient with stuttering and fleeting symptoms?
- Fingerprick glucose test to rule out hypoglycemia.
- ABCD2 scoring to test for their risk of stroke.
- Cardiac Monitoring to pick up any relevant dysrhythmia such as AF.
- Pulse Oximetry to evaluate for hypoxia. Give supplementary oxygen if SatsO2 is below 95%
What is a possible indication of AF (with TIA)?
There is known cardiac source of embolus
The patient with TIA is extremely hypertensive at 220/120 mmHg. What is your next step?
Only initiate anti-hypertensive therapy if BP is >220/120 or if there is a comorbid cardiac condition that necessitates reduction of BP. If not, allow BP to auto-regulate.
Do not start antiplatelet treatment until what is ruled out in a patient with suspected acute stroke or TIA?
What investigation is carried out to rule this out?
Give a reason for why antiplatelet therapy cannot be given?
Do not start antiplatelet therapy unless haemorrhagic stroke is ruled out by a brain scan (CT scan)
Giving antiplatelet therapy in an event of a haemorrhagic stroke can increase the risk of intracranial haemorrhage.
If a patient has suspected TIA within the last week, what are the steps you are going to take?
Give aspirin 300MG immediately (with proton pump inhibitor where appropriate) unless:
- they have a bleeding disorder
- they are taking an anti-coagulant
- they are taking low dose aspirin regularly, then continue with current dose
- Aspirin is contraindicated
What happens to blood pressure in a stroke?
BP goes up
What is the thrombolysis window for a suspected stroke?
3 hours
What are the contraindications of thrombolysis?
- If there is a haemorrhage
- It is a massive stroke
- There is uncontrolled high BP of >185/110
- There is a high risk of bleeding (they have a bleeding disorder or is taking an anticoagulant)
When are antiplatelet agents such as… given? What precaution must be taken if patient already has a thrombolytic therapy?
Antiplatelet agents such as Clopidogrel or Aspirin 300MG OD.
Clopidogrel should be given within 48 hours of ischaemic stroke, and continued for the next 14 days.
It must be avoided for 24 hours after thrombolytic drug therapy.
What are the actions taken for investigation if one suspects that the cause of a stroke could be due to problems of the heart?
Why is it relevant to investigate if there is an AF during a stroke or TIA?
Do an ECG (check for AF as it could be a source of embolus) or an ECHO.
It is relevant because if there is a potential embolus, anticoagulants are preferred as a treatment rather than anti-platelets.
What is the difference between anti-coagulants and anti-platelets?
Anti-coagulants are primary therapies for atherosclerotic diseases.
Anti-platelets are preferred for cardioembolic events.
What could be a potential cause of stroke if it involves a medium sized vessel?
What investigations are done to rule this out as a cause?
Carotid stenosis could be a cause of stroke.
Doppler Ultrasound scan, or an angiogram if unclear of USS.
What can be done if there is a carotid stenosis causing the stroke, with >/- 70% of stenosis?
Carotid endarterectomy surgery, within 2 weeks of first presentation.
Or if surgery is not suitable, endovascular carotid artery stenting.
What is a potential cause of stroke, involving small vessels?
Atheroma
