Stroke

Question 1

Types of ischaemic stroke

Answer 1

Transient ischaemic stroke
Ischaemic stroke

Question 2

Initial management of transient ischaemic stroke

Answer 2

Aspirin 300mg OD immediately until diagnosis established

Question 3

Initial management of ischaemic stroke

Answer 3

Alteplase administered within 4.5 hours
Aspirin 300mg for 14 days
Consider PPI for patients with Hx of dyspepsia associated with aspirin

Question 4

Long-term management following an ischaemic stroke

Answer 4

1st: clopidogrel 75mg OD (unlicensed in TIA)
2nd: MR dipyridamole + aspirin
3rd: Monotherapy MR dipyridamole if aspirin or clopidogrel not tolerated
4th: Monotherapy aspirin if MR dipyridamole or clopidogrel not tolerated

High-intensity statin 48 hours post-stroke
Manage hypertension to achieve <130/80mmHg
Possible PPI

Question 5

Which antihypertensive drug should be avoided post-stroke?

Answer 5

Beta-blockers unless indicated for a co-existing condition (Not to manage HTN)

Question 6

How to manage a patient who has been reveiving anticoagulation for prosthetic heart valve who experience ischaemic stroke?

Answer 6

Significant risk of haemorrhagic trasnformation
Stop anticoagulant treatment for 7 days
Subsitute with aspirin

Question 7

When would a patient receive an anticoagulant post-stroke?

Answer 7

Where AF is present

Question 8

When should a high-intensity statin be initiated post-stroke?

Answer 8

48 hours post stroke

Question 9

Treatment for haemorrhagic stroke

Answer 9

Surgical intervention may be required to remove the haematoma and relieve intracranial pressure.

Question 10

Which drug should be avoided post haemorrhagic stroke?

Answer 10

Statins unless the risk of a vascular event outweighs risk of further haemorrhage

Question 11

When should rapid blood pressure lowering treatment be avoided in the initial management of haemorrhagic stroke?

Answer 11

Where there is an underlying structural cause
If Glasgow Coma Scale is below 6
If going to have early neurosurgery to evacuate the haematoma or who have a massive haematoma with a poor expected prognosis.

Question 12

When should rapid blood pressure lowering treatment be given in the initial management of haemorrhagic stroke?

Answer 12

Present with 6 hours of symptoms with a systolic bP between 150-220mmHg
Patients who do not fit the exclusion criteria

Question 13

Systolic blood pressure target in the initial management of haemorrhagic stroke?

Answer 13

140mmHg or lower

Question 14

What is the maximum allowable magnitude drop in mmHg within one hour of starting treatment?

Answer 14

Should not drop more than 60mmHg within 1 hour of starting treatment