Pathophysiology + Treatment of Stroke

Question 1

What is FAST?

Answer 1

Face
Arms
Speech
Time

Question 2

What does the management of a stroke/TIA depend on?

Answer 2

Diagnosis = time of incident
Type of stroke

Question 3

When to suspect a TIA?

Answer 3

Resolved with 24hrs
Cannot be explained by another condition

Question 4

What are the focal neurological may include for TIA?

Answer 4

Unilateral weakness
Dysphasia
Ataxia = loss of balance
Loss of vision

Question 5

What to suspect a stroke?

Answer 5

Persisted longer than 24hrs

Question 6

What are the clinical features of stroke?

Answer 6

Confusion
Headache
Unilateral weakness
Sensory loss
Ataxia
Dysphasia
Visual disturbance
Nausea/ vomiting

Question 7

What is an ischaemic stroke?

Answer 7

CLOT
Narrowing/weakening of blood vessels

Question 8

What is a haemorrhagic stroke?

Answer 8

BLEED
On brain or surface of brain

Question 9

What is a thrombotic ischaemic stroke?

Answer 9

Complication of atherosclerosis

Question 10

What is an embolic ischaemic stroke?

Answer 10

Embolus of fatty material from atherosclerotic plaque or a clot

Question 11

What are stroke risk factors?

Answer 11

Previous stroke/TIA
Previous MI
Hypertension
Atrial fibrillation
Heart failure
Age
Diabetes
Smoking
Alcohol
Poor diet

Question 12

What do you do for someone with suspected stroke?

Answer 12

Immediate emergency admission

Question 13

What must you tell the hospital about the patient?

Answer 13

Time of onset
Symptom
Evolution
Current condition
Medications

Question 14

Why do you not start anticoagulation straight away?

Answer 14

You need a brain image first to rule out it isn’t haemorrhagic stroke

Question 15

What is the 1st step of management of a stroke?

Answer 15

Ensure patent airway to avoid hypoxia

Question 16

What is the 2nd step of management of a stroke?

Answer 16

Monitor blood glucose
4-11 mmol/L

Question 17

What is the 3rd step of management of a stroke?

Answer 17

Monitor BP

Question 18

What is the 4th step of management of a stroke?

Answer 18

Urgent CT scan/MRI scan

Question 19

What is the 5th step of management of a stroke?

Answer 19

Thrombolysis
Consider if aged 18-80 years + onset of symptoms <4.5 hrs

Question 20

What is the 6th step of management of a stroke?

Answer 20

Nil by mouth until swallow is assessed

Question 21

What is the 7th step of management of a stroke?

Answer 21

Keep hydrated
BUT don’t over hydrate = risk of cerebral oedema

Question 22

What is the 8th step of management of a stroke?

Answer 22

Explain what has happened = fully communicate with patient, relatives + carers

Question 23

What is the 9th step of management of a stroke?

Answer 23

Antiplatelet agents
ONCE haemorrhagic stroke excluded

Question 24

What is the 10th step of management of a stroke?

Answer 24

Focus on secondary prevention + QoL

Question 25

What are the secondary preventative measures?

Answer 25

Arrange follow up in primary care on discharge, at 6 months Then a least annually

Question 26

When is antiplatelet therapy initiated?

Answer 26

Secondary care on diagnosis of ischaemic stroke or TIA without paroxysmal or permanent atrial fibrillation

Question 27

What is the standard treatment?

Answer 27

Clopidogrel 75mg daily

Question 28

What can be used instead of clopidogrel 75mg?

Answer 28

Aspirin 75mg with modified-release dipyridamole 2x daily

Question 29

Describe what happens in dual therapy

Answer 29

Aspirin + clopidogrel (up to 90 days) Aspirin + ticagrelor (for 30 days)

Question 30

What is the aim of statin therapy?

Answer 30

Reduce non-HDL cholesterol by more than 40%

Question 31

What are the 4 secondary prevention medications?

Answer 31

Antiplatelet therapy Statins Anti-hypertensive Anticoagulant - hold off 2 weeks

Question 32

What is an example of anticoagulation?

Answer 32

Warfarin

Question 33

Describe post-stroke driving advice

Answer 33

Single TIA = not drive for 1 month Multiple TIA = not drive for 3 month Stroke = not drive for 1 month

Question 34

Are people who have had a stroke eligible for a blue badge?

Answer 34

YES

Question 35

Describe post-stroke return to work advice

Answer 35

Discuss the need for assessment Work with rehabilitation team Person to person basis