Stroke

Question 1

What is a stroke

Answer 1

reduction in cerebral blood flow due to arterial occlusion/ stenosis/ bleeding

causing infarction of the brain

TIA has the ischaemia but no infarction (think angina to MI)

Question 2

who gets strokes

Answer 2

hypertension

age 
smoking
diabetes
hypercholesterolaemia
FH 
AF 
COC pill

Question 3

how does a stroke present

Answer 3

sudden onset typically unilateral

Facial drooping
Arm weakness
Speech problems
Time to call 999

forehead sparring so should be able to move forehead

Question 4

how do you investigate a stroke

Answer 4

non-contrast CT head
ECG if in AF

bloods:

• RF screen (increased risk in RA)
• HbA1x
• lipids
• clotting

MRI head

Question 5

how do you manage an ischaemic stroke (primary)

Answer 5

Primary:

• exclude bleeding with CT
• Antiplatelets- aspirin 300mg ASAP
• Thrombolysis- alteplase (TPA)

Question 6

what is the secondary prevention for a stroke

Answer 6

anti platelet e.g. clopidogrel 75mg daily lifelong

high dose statin e.g. 80mg atorvastatin

and antihypertensive and anticoagulant e.g. warfarin

Question 7

which artery is most commonly affected in a stroke

Answer 7

middle cerebral artery