Stroke

Question 1

what types of cerebrovascular accidents are there

Answer 1

Ischaemia or infarction of the brain tissue secondary to a disrupted blood supply (ischaemic stroke)

Intracranial haemorrhage, with bleeding in or around the brain (haemorrhagic stroke

Question 2

what can cause ischaemic strokes

Answer 2

A thrombus or embolus
Atherosclerosis
Shock
Vasculitis

Question 3

what are TIAs

Answer 3

temporary neurological dysfunction (lasting less than 24 hours) caused by ischaemia but without infarction.
rapid onset and often resolve before the patient is seen.
TIAs may precede a stroke.

Question 4

what are crescendo TIAs

Answer 4

Crescendo TIAs are two or more TIAs within a week and indicate a high risk of stroke.

Question 5

risk factors for cerebrovascular events

Answer 5

Previous stroke or TIA
Atrial fibrillation
Carotid artery stenosis
Hypertension
Diabetes
Raised cholesterol
Family history
Smoking
Obesity
Vasculitis
Thrombophilia
Combined contraceptive pill

Question 6

initial management of TIA

Answer 6

Aspirin 300mg daily (started immediately)

Referral for specialist assessment within 24 hours (within 7 days if more than 7 days since the episode)

Diffusion-weighted MRI scan is the imaging investigation of choice.

Question 7

initial management of stroke

Answer 7

Exclude hypoglycaemia
CT brain to exclude haemorrhage
Aspirin 300mg daily for two weeks (started after haemorrhage is excluded with a CT)
Admission to a specialist stroke centre

Question 8

when is thrombolysis considered for stroke

Answer 8

within 4.5 hours of symptoms starting
using alteplase
requires strict monitoring as risk of haemorrhage

Question 9

when is thrombectomy considered

Answer 9

confirmed blockage of the proximal anterior circulation or proximal posterior circulation.

within 24 hours of the symptom onset and alongside IV thrombolysis.

Question 10

how is blood pressure management important in relation to stroke

Answer 10

with an ischaemic stroke, lowering the blood pressure can worsen the ischaemia.

Blood pressure is aggressively treated in patients with a haemorrhagic stroke.

Question 11

what are all patients with stroke/TIA investigated for

Answer 11

AF and carotid stenosis
-ECG, carotid USS/MRI

Question 12

what is secondary prevention for stroke

Answer 12

Clopidogrel 75mg once daily (alternatively aspirin plus dipyridamole)

Atorvastatin 20-80mg (not started immediately – usually delayed at least 48 hours)

Blood pressure (ACEi/CCB/BB) and diabetes control

Addressing modifiable risk factors (e.g., smoking, obesity and exercise)