Mx of Ischaemic stroke

Question 1

Acute Ix of a stroke (5)

Answer 1

1. Bloods
2. ECG
3. CXR
4. CT brain
5. Stroke unit

Question 2

What should be done after CT brain?

Answer 2

If no bleed on scan - Asprin 300 mg ASAP

Question 3

When should thrombolysis be offered?

Answer 3

1. Given within 4.5 hours after symptom onset

2. Urgent CT brain to exclude bleed prior to treatment.

Question 4

How does thrombolysis work?

Answer 4

1. IV Ateplase
   - Bolus - 10% of total dose
   - Infusion over 1 hour

Question 5

What are the complications of thrombolysis?

Answer 5

1. Bleeding

2. Angio oedema

Question 6

What should be done prior to thrombolysis?

Answer 6

CT of brain and 300 mg of Asprin

Question 7

What should be done after thrombolysis?

Answer 7

Repeat CT brain at 24 hours

Question 8

What is a thrombectomy?

Answer 8

1. A procedure done under sedation where a catheter is used to access site of occlusion

Question 9

In what circumstances is a thrombectomy offered?

Answer 9

1. Can be 1st line but is usually as 2nd line treatment after failed thrombolysis

Question 10

When can a thrombectomy be offered?

Answer 10

Currently offered up to 6 hours post symptom onset

Question 11

What medication is given as secondary prevention?

Answer 11

1. Clopidogrel 75mg od after 2 weeks of Asrpin 300 mg

2. Statin ( cholesterol < 4.0 )

Question 12

What is the BP target post stroke?

Answer 12

Target > 130/80

Question 13

What is screened for as secondary prevention?

Answer 13

1. Screen for and treat diabetes
2. Smoking intervention
3. Screen for and treat carotid stenosis
4. Screen for and manage AF

Question 14

What are the DVLA restriction post stroke?

Answer 14

Car - 1 month off driving if good functional recovery

Question 15

What Ix should be done as part of secondary prevention?

Answer 15

Echocardiogram