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S2 Case 6 - stroke & anticoagulation > Pathophysiology + Treatment of Stroke > Flashcards

Pathophysiology + Treatment of Stroke Flashcards

1
Q

What is FAST?

A

Face
Arms
Speech
Time

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2
Q

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

A

Diagnosis = time of incident
Type of stroke

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3
Q

When to suspect a TIA?

A

Resolved with 24hrs
Cannot be explained by another condition

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4
Q

What are the focal neurological may include for TIA?

A

Unilateral weakness
Dysphasia
Ataxia = loss of balance
Loss of vision

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5
Q

What to suspect a stroke?

A

Persisted longer than 24hrs

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6
Q

What are the clinical features of stroke?

A

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

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7
Q

What is an ischaemic stroke?

A

CLOT
Narrowing/weakening of blood vessels

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8
Q

What is a haemorrhagic stroke?

A

BLEED
On brain or surface of brain

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9
Q

What is a thrombotic ischaemic stroke?

A

Complication of atherosclerosis

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10
Q

What is an embolic ischaemic stroke?

A

Embolus of fatty material from atherosclerotic plaque or a clot

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11
Q

What are stroke risk factors?

A

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

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12
Q

What do you do for someone with suspected stroke?

A

Immediate emergency admission

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13
Q

What must you tell the hospital about the patient?

A

Time of onset
Symptom
Evolution
Current condition
Medications

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14
Q

Why do you not start anticoagulation straight away?

A

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

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15
Q

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

A

Ensure patent airway to avoid hypoxia

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16
Q

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

A

Monitor blood glucose
4-11 mmol/L

17
Q

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

A

Monitor BP

18
Q

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

A

Urgent CT scan/MRI scan

19
Q

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

A

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

20
Q

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

A

Nil by mouth until swallow is assessed

21
Q

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

A

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

22
Q

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

A

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

23
Q

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

A

Antiplatelet agents
ONCE haemorrhagic stroke excluded

24
Q

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

A

Focus on secondary prevention + QoL

25
Q

What are the secondary preventative measures?

A

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

26
Q

When is antiplatelet therapy initiated?

A

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

27
Q

What is the standard treatment?

A

Clopidogrel 75mg daily

28
Q

What can be used instead of clopidogrel 75mg?

A

Aspirin 75mg with modified-release dipyridamole 2x daily

29
Q

Describe what happens in dual therapy

A

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

30
Q

What is the aim of statin therapy?

A

Reduce non-HDL cholesterol by more than 40%

31
Q

What are the 4 secondary prevention medications?

A

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

32
Q

What is an example of anticoagulation?

A

Warfarin

33
Q

Describe post-stroke driving advice

A

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

34
Q

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

A

YES

35
Q

Describe post-stroke return to work advice

A

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

S2 Case 6 - stroke & anticoagulation (7 decks)

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