Stroke

Question 1

Stroke is also referred to as what?

Answer 1

cerebrovascular accident

Question 2

labels

Answer 2

answer

Question 3

Cerebrovascular accidents are either
1: ?
2: ?

Answer 3

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

Question 4

give 4 things which can disrupt the blood supply to areas of the brain

Answer 4

1: Thrombus formation or embolus, for example in patients with atrial fibrillation
2: Atherosclerosis
3: Shock
4: Vasculitis

Question 5

what is a TIA?

Answer 5

Used to be ‘stroke symptoms which resolved within 24 hours
now: transient neurological dysfunction secondary to ischaemia without infarction.

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

TIAs often precede what?

Answer 7

a full stroke

Question 8

In neurology, suspect a ________ cause where there is a sudden onset of neurological symptoms.

Answer 8

In neurology, suspect a vascular cause where there is a sudden onset of neurological symptoms.

Question 9

Stoke symptoms are typically ____________

Answer 9

Stoke symptoms are typically asymmetrical:

Question 10

give some examples of asymmetrical stroke symptoms

Answer 10

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

Question 11

give some risk factors for stroke (10)

Answer 11

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 12

what is the FAST tool?

Answer 12

used for identifying stroke in the community:
F – Face
A – Arm
S – Speech
T – Time (act fast and call 999)

Question 13

what is the ROSIER tool?

Answer 13

ROSIER is a clinical scoring tool based on clinical features and duration. Stroke is likely if the patient scores anything above 0.

Question 14

describe the management of Stroke (4)

Answer 14

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

Question 15

why do we wait until after the CT before giving aspirin for stroke?

Answer 15

CT rules out a intracranial hemorrhagic stroke.

Question 16

what must we exclude before we treat for stroke?

Answer 16

hypoglycaemia

Question 17

describe thrombolysis following stroke?

Answer 17

Alteplase used after CT. needs senior guidance.
needs to be given in a defined window of opportunity
monitor for bleeding - repeat CT scans of brain/

Question 18

describe thrombectomy?

Answer 18

Thrombectomy (mechanical removal of the clot) may be offered if an occlusion is confirmed on imaging, depending on the location and the time since the symptoms started. It is not used after 24 hours since the onset of symptoms.

Question 19

thrombectomy is not used after how many hours of stroke onset?

Answer 19

24 hours.

Question 20

how should we manage blood pressure during stroke

Answer 20

Generally, blood pressure should not be lowered during a stroke because this risks reducing the perfusion to the brain.

Question 21

how do we manage a TIA

Answer 21

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 22

what imaging should we use to aid our diagnosis of a stroke

Answer 22

aim to establish which vascular territory is affected.
Diffusion-weighted MRI is the gold standard imaging technique. CT is an alternative.
Diffusion-weighted MRI is the gold standard imaging technique. CT is an alternative.
Carotid ultrasound can be used to assess for carotid stenosis.
Endarterectomy to remove plaques or carotid stenting to widen the lumen should be considered if there is carotid stenosis.

Question 23

describe the secondary prevention of stroke

Answer 23

Clopidogrel 75mg once daily (alternatively dipyridamole 200mg twice daily)
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 24

describe stroke rehabilitation

Answer 24

Once patients have had a stroke they require a period of adjustment and rehabilitation. This is essential and central to stroke care. It involves a multidisciplinary team including:
lots of people