Stroke

Question 1

What are the 3 types of strokes

Answer 1

Haemorrhagic
Transient Ischaemic stroke
Ischaemic

Question 2

Symptoms of stroke

Answer 2

FAST

Face drop
Arm weakness
Slurred speech
Time - act fast

Question 3

Can you give antiplatelets in stroke?

Answer 3

Yes but DONT give in haemorrhagic stroke - high bleeding risk can kill the patient

Question 4

How is haemorrhagic stroke managed

Answer 4

Surgery to remove clot and then manage hypertension

Question 5

What anticoagulant treatment do you use in stroke

Answer 5

Use Anti platelets unless they have AF, DVT/PE or thrombosis- can use DOACs

Question 6

Can you use BB in stroke

Answer 6

No because they cause bradycardia and so increase the risk of stroke

Question 7

Initial management of TIA
1st line and 2nd line

Answer 7

1- 300mg aspirin immediately and arrange for specialist review within 24 hours
Can give with PPI if they have dyspepsia

2- clopidogrel 75mg if CI to aspirin

Question 8

When do you start long treatment in TIA

Answer 8

When stroke is confirmed

Question 9

Acute Ischaemic stroke initial management

Answer 9

Alteplase within 4.5 hours then aspirin 300mg or clopidogrel 75mg within 24 hours of symptom onset for 14 days then go onto long term management if stroke is confirmed

Question 10

If a patient is admitted to hospital with an Ischaemic stroke, his symptom onset has been more than 4.5 hours whats the initial management

Answer 10

Aspirin 300mg or clopidogrel 75mg within 24hrs for 14 days then long term management if stroke is confirmed

Skip alteplase

Question 11

Whats the long term management of haemorrhagic stroke

Answer 11

Manage hypertension

Question 12

Long term management of confirmed TIA or Ischaemic stroke in non AF

Answer 12

1. Clopidogrel 75mg
2. MR dipyridamole 200mg BD + aspirin 75mg OD
3. Dipyridamole alone
4. aspirin 75mg OD

High dose: atorvostatin 20-80mg 48hrs after stroke

Question 13

Long term management of ischaemic or TIA stroke in AF, thromboembolism patients

Answer 13

DOACs or warfarin

High dose: atorvostatin 20-80mg 48hrs after stroke

Question 14

When do you start statins in stroke long term management

Answer 14

48hrs after confirmed stroke

Question 15

Monitoring in long term management of stroke

Answer 15

BP - give anti hypertensives if not managed- avoid BB unless used for coexisting condition

Lifestyle advice - weight, smoking