Pathophysiology + Treatment of Stroke Flashcards
What is FAST?
Face
Arms
Speech
Time
What does the management of a stroke/TIA depend on?
Diagnosis = time of incident
Type of stroke
When to suspect a TIA?
Resolved with 24hrs
Cannot be explained by another condition
What are the focal neurological may include for TIA?
Unilateral weakness
Dysphasia
Ataxia = loss of balance
Loss of vision
What to suspect a stroke?
Persisted longer than 24hrs
What are the clinical features of stroke?
Confusion
Headache
Unilateral weakness
Sensory loss
Ataxia
Dysphasia
Visual disturbance
Nausea/ vomiting
What is an ischaemic stroke?
CLOT
Narrowing/weakening of blood vessels
What is a haemorrhagic stroke?
BLEED
On brain or surface of brain
What is a thrombotic ischaemic stroke?
Complication of atherosclerosis
What is an embolic ischaemic stroke?
Embolus of fatty material from atherosclerotic plaque or a clot
What are stroke risk factors?
Previous stroke/TIA
Previous MI
Hypertension
Atrial fibrillation
Heart failure
Age
Diabetes
Smoking
Alcohol
Poor diet
What do you do for someone with suspected stroke?
Immediate emergency admission
What must you tell the hospital about the patient?
Time of onset
Symptom
Evolution
Current condition
Medications
Why do you not start anticoagulation straight away?
You need a brain image first to rule out it isn’t haemorrhagic stroke
What is the 1st step of management of a stroke?
Ensure patent airway to avoid hypoxia
What is the 2nd step of management of a stroke?
Monitor blood glucose
4-11 mmol/L
What is the 3rd step of management of a stroke?
Monitor BP
What is the 4th step of management of a stroke?
Urgent CT scan/MRI scan
What is the 5th step of management of a stroke?
Thrombolysis
Consider if aged 18-80 years + onset of symptoms <4.5 hrs
What is the 6th step of management of a stroke?
Nil by mouth until swallow is assessed
What is the 7th step of management of a stroke?
Keep hydrated
BUT don’t over hydrate = risk of cerebral oedema
What is the 8th step of management of a stroke?
Explain what has happened = fully communicate with patient, relatives + carers
What is the 9th step of management of a stroke?
Antiplatelet agents
ONCE haemorrhagic stroke excluded
What is the 10th step of management of a stroke?
Focus on secondary prevention + QoL
What are the secondary preventative measures?
Arrange follow up in primary care on discharge, at 6 months
Then a least annually
When is antiplatelet therapy initiated?
Secondary care on diagnosis of ischaemic stroke or TIA without paroxysmal or permanent atrial fibrillation
What is the standard treatment?
Clopidogrel 75mg daily
What can be used instead of clopidogrel 75mg?
Aspirin 75mg with modified-release dipyridamole 2x daily
Describe what happens in dual therapy
Aspirin + clopidogrel (up to 90 days)
Aspirin + ticagrelor (for 30 days)
What is the aim of statin therapy?
Reduce non-HDL cholesterol by more than 40%
What are the 4 secondary prevention medications?
Antiplatelet therapy
Statins
Anti-hypertensive
Anticoagulant - hold off 2 weeks
What is an example of anticoagulation?
Warfarin
Describe post-stroke driving advice
Single TIA = not drive for 1 month
Multiple TIA = not drive for 3 month
Stroke = not drive for 1 month
Are people who have had a stroke eligible for a blue badge?
YES
Describe post-stroke return to work advice
Discuss the need for assessment
Work with rehabilitation team
Person to person basis
