Stroke

Question 1

What can a stroke also be known as?

Answer 1

Cerebrovascular accident (CVA)

Question 2

How can CVAs be classified?

Answer 2

Ischaemia or infarction of brain tissue secondary to inadequate blood supply
Intracranial haemorrhage

Question 3

Disruption of blood supply can be caused by:

Answer 3

Thrombus formation or embolus, for example in patients with atrial fibrillation
Atherosclerosis
Shock
Vasculitis

Question 4

What is a TIA?

Answer 4

A stroke that resolve within 24 hours

Question 5

When do TIAs happen?

Answer 5

Transient ischaemic attacks often precede a full stroke

Question 6

What is a crescendo TIA?

Answer 6

Two or more TIAs within a week. This carries a high risk of developing in to a stroke.

Question 7

Presentation

Answer 7

Sudden weakness of limbs
Sudden facial weakness
Sudden onset dysphasia (speech disturbance)
Sudden onset visual or sensory loss

Typically asymmetrical

Question 8

Risk factors

Answer 8

Cardiovascular disease such as angina, myocardial infarction and peripheral vascular disease
Previous stroke or TIA
Atrial fibrillation
Carotid artery disease
Hypertension
Diabetes
Smoking
Vasculitis
Thrombophilia
Combined contraceptive pill

Question 9

FAST Tool for Identifying a Stroke in the Community

Answer 9

F – Face
A – Arm
S – Speech
T – Time (act fast and call 999)

Question 10

Management of stroke

Answer 10

Admit patients to a specialist stroke centre
Exclude hypoglycaemia
Immediate CT brain to exclude primary intracerebral haemorrhage
Aspirin 300mg stat (after the CT) and continued for 2 weeks

Question 11

Management of TIA

Answer 11

Start aspirin 300mg daily.

Start secondary prevention measures for cardiovascular disease.

They should be referred and seen within 24 hours by a stroke specialist.

Question 12

Gold standard diagnostic scan

Answer 12

Diffusion-weighted MRI is the gold standard imaging technique. CT is an alternative.

Question 13

Secondary prevention

Answer 13

Clopidogrel 75mg once daily (alternatively dipyridamole 200mg twice daily) - antiplatlet meds

Atorvastatin 80mg should be started but not immediately

Carotid endarterectomy or stenting in patients with carotid artery disease

Treat modifiable risk factors such as hypertension and diabetes

Question 14

When is thrombolysis used?

Answer 14

Thrombolysis is the definitive treatment in a patient with ischaemic stroke confirmed by CT head scan who has presented sooner than 4.5 hours after symptom onset