PEVENTING A STROKE

Question 1

what is primary prevention?

Answer 1

avoiding a disease before any signs or symptoms develop

Question 2

what is secondaryy prevention?

Answer 2

avoidance of progression or later problems by treating the person who has had a stroke or TIA

Question 3

what are some non-modifiable risk factors for stroke?

Answer 3

age >55
gender woman
race - black idnividuals 
genetics/family history
personal history

Question 4

what are some modifiable risk factors of stroke?

Answer 4

hypertension
diabetes
atrial fibrillation
smoking
hyperlipidaemia
obesity
oral contraceptive
sickle cell disease
migraines with aura

Question 5

what is primary prevention of a stroke?

Answer 5

lifestyle modifications and measures to control blood pressure, cholesterol levels, diabetes mellitus, and atrial fibrillation.

Question 6

why is hypertension the biggest risk factor for stroke?

Answer 6

hypertension increases risk of damage to vessels as well as accelerating atherosclerosis

Question 7

why is diabetes a risk factor for stroke?

Answer 7

Over time, high glucose levels can damage the body’s blood vessels, increasing the chance of stroke

Question 8

why is atrial fibrillation a risk factor for stroke?

Answer 8

rapid heartbeat allows blood to pool in the heart, which can cause clots to form and travel to the brain

Question 9

why is smoking a risk factor for stroke?

Answer 9

Carbon monoxide reduces the amount of oxygen in your blood, and the nicotine makes your heart beat faster and raises your blood pressure. It can also trigger an episode of atrial fibrillation

Question 10

why is hyperlipiademia a risk factor for stroke?

Answer 10

cholesterol deposits in arteries, narrowing them

Question 11

why is the oral contraceptive pill a stroke risk factor?

Answer 11

It raises blood pressure and makes blood hypercoagulable

Question 12

what are some common reasons for young people to have strokes?

Answer 12

dissection of artery
cardioembolism e.g. from PFO
endocarditis
vasculitis
genetic causes
illicit drug use
clotting disorders

Question 13

which illicit drugs are commonly associated with stroke?

Answer 13

cocaine and amphetamine - causes hypertension surges

Question 14

how much does smoking >20 a day increase risk of stroke?

Answer 14

4 times

Question 15

how many stroke victims will have another stroke within 3 months?

Answer 15

1/5 (your risk is 15 times higher than a healthy individual)

Question 16

what is the CHADS2 score?

Answer 16

Its an assessment tool for estimating stroke risk in patients with AF
it asks about congestive heart failure history, hypertension history, >75, Dm history, previous stroke/TIA- all worth 1 point other than the last which is worth 2 points
(score of >3 is high risk)

Question 17

outline the secondary prevention a doctor prescribes after stroke in terms of lifestyle?

Answer 17

minimise sitting for long periods
individualized exercise programmes
advise to stop smoking
eat a healthy balanced diet
keep alcohol consumption within recommended limits
advise against routine dietary supplementation with B vitamins/folate, vits A, C E, selenium, calcium, vit D

Question 18

what antiplatelet medications are used in secondary prevention of a stroke?

Answer 18

clopidogrel daily
if this cant be tolerated then aspirin with modified release dipyridamole
aspirin can be used alone if the dipyridamole isnt tolerated

Question 19

when is dual antiplatelet therapy used and what is used?

Answer 19

people at high risk of TIA (e.g. ABCD2 score >4) or those with intercranial stenosis

aspirin plus clopidogrel or aspirin plus ticagrelor

Question 20

what is an ABCD2 score?

Answer 20

an assessment tool for estimating the risk of stroke after a susepected TIA

Question 21

what does the ABCD2 score measure?

Answer 21

age >60
bp >140/90
whether there was unliateral weakness or speech distubance
duration of symptoms 
history of diabetes

Question 22

what lipid modification drug is usually given after a stroke?

Answer 22

statins e.g. atorvostatin

Question 23

who should statin treatment be contradicted in?

Answer 23

primary intracerebral haemorrhage

Question 24

whats a common complaint of statins?

Answer 24

myalgia - muscle pain

Question 25

how is hypertension treated after a stroke?

Answer 25

thiazide like diuretics, long acting calcium-channel blocker, ACE inhibitor, angiotensin 2 receptor blocker

Question 26

what do you have to check before putting someone on anticoagulant drugs?

Answer 26

that the stroke is definitely not haemorrhagic

Question 27

how long is anticoagulant treatment deferred for in people with disabling ischaemic strokes?

Answer 27

at least 14 days

Question 28

what drug can you give stroke patients if you have caught it within 4.5 hours?

Answer 28

alteplase - a thrombolytic medication