Stroke

Question 1

Name two types of strokes

Answer 1

Ischaemic and haemorrhagic

Question 2

Name the two types of ischaemic strokes

Answer 2

Thrombotic or embolic

Question 3

Name the two types of haemorrhagic strokes

Answer 3

Intracerebral or subarachnoid

Question 4

Describe a transient ischaemic attack

Answer 4

A ‘mini stroke,’ where the symptoms resolve within 24 hours (most within 1 hour). No infarction occurs

Question 5

Define FAST

Answer 5

Face, arms, speech, time

Question 6

List 4 modifiable risk factors for strokes

Answer 6

Hypertension, diabetes, tobacco smoking, physical inactivity, dyslipidaemia, etc

Question 7

Main drug used for thrombolysis?

Answer 7

Alteplase

Question 8

Alteplase MOA?

Answer 8

A recombinant plasminogen activator. Turns plasminogen into plasmin, which degrades the fibrin mesh work of a clot

Question 9

When can aspirin be given after a stroke?

Answer 9

Within 48 hours. But not within 24 hours of alteplase administration

Question 10

Dosage of acute aspirin?

Answer 10

300mg single dose

Question 11

When can mechanism techniques / endovascular thrombectomy happen?

Answer 11

Anywhere between 4.5 hours to 24 hours after the onset of symptoms

Question 12

List some complications / consequences of a stroke

Answer 12

Reduced cognition, depression, DVT, dysphagia, seizures

Question 13

Why do you not want to reduce the BP too soon after a stroke?

Answer 13

Can compromise cerebral blood flow. Only initiate antihypertensives if the patients BP is really high (above 220+), or a few other criteria

Question 14

Long term dose of aspirin given post stroke?

Answer 14

Low dose. 75-150mg. Usually 100

Question 15

Why is clopidogrel not effective in those with no CYP2C19 function?

Answer 15

Because it is a prodrug and requires this enzyme for metabolism into active form

Question 16

Why is the aspirin + clopidogrel combination not used long term?

Answer 16

Using the combo for longer than ~3 weeks increases the risk of bleeding. After 3 weeks, patient goes to mono therapy of either aspirin or clopidogrel

Question 17

Explain the dosing regime of aspirin + dipyridamole

Answer 17

First week = only take PM dose
Second week = am and pm dose.
Titrated up to increase tolerance and reduce ADRs like headaches

Question 18

Long term intensive statin therapy is useful in preventing which type of stroke?

Answer 18

Ischaemic. Can actually increase risk of haemorrhagic stroke