Stoke

Question 1

Types of stroke

Answer 1

Ischaemic - due to ischaemia

Haemorrhagic- due to an intracranial bleed

Question 2

Causes of ischaemia

Answer 2

Thrombus 
Embolus 
Atherosclerosis 
Shock 
Vasculitis

Question 3

TIA

Answer 3

Transient neurological dysfunction secondary to ischaemia without infarction

Question 4

Crescendo TIA

Answer 4

2+ TIAs within 1 week

Question 5

Presentation of stroke

Answer 5

Face - facial weakness
Arms - unilateral arm weakness
Slurring speech - dysphasia
Time - act fast

Sudden onset visual loss
Sudden onset sensory loss

Question 6

Risk factors of stroke

Answer 6

Atrial fibrillation 
Cardiovascular disease - angina, previous MI, peripheral vascular disease 
Previous stroke or TIA 
Carotid artery disease 
HTN 
Diabetes 
Smoking 
Vasculitis 
Thrombophilia 
COCP

Question 7

ROSIER tool

Answer 7

Risk of stroke in the emergency room

Stroke is likely if score > 0

Question 8

Management of stroke

Answer 8

1. Admit to specialist stroke centre
2. Exclude hypoglycaemia
3. Immediate CT brain

After CT if ischaemic:
1. 300mg aspirin stat and continue for 2 weeks
2. Thrombolysis with alteplase within 4.5 hours
OR
Thrombectomy within 24 hours of onset

Question 9

Management of TIA

Answer 9

Start aspirin 300mg daily
Secondary prevention of cardiovascular disease e.g. atorvastatin
Referred within 24 hours to stroke specialist

Question 10

Gold standard imaging for stroke

Answer 10

Diffusion weighted MRI

Carotid USS - carotid stenosis

Question 11

Treatment for carotid stenosis

Answer 11

Endarterectomy (removes plaques) or carotid stenting

Question 12

Secondary prevention of stroke

Answer 12

Clopidogrel 75mg
Atorvastatin 80mg
Carotid endarterectomy or stenting

Treat HTN - ACEi/beta blocker
Treat diabetes

Question 13

Stroke rehabilitation

Answer 13

Stroke nurses 
SALT 
Physiotherapy 
Dieticians 
Occupational therapy 
Social services - work 
Psychology 
Orthotics 
Ophthalmology