Stroke

Question 1

Two main types of stroke?

Answer 1

Ischaemia (blockage of blood supply) and haemorrhage (bleed in the brain)

Question 2

4 ways ischemia to brain can occur?

Answer 2

A thrombus or embolus
Atherosclerosis
Shock
Vasculitis

Question 3

What is TIA?

Answer 3

temporary neurological dysfunction (lasting less than 24 hours)

ischaemia but without infarction

Question 4

Presentation of stroke?

Answer 4

sudden onset of neurological symptoms:

Limb weakness
Facial weakness
Dysphasia (speech disturbance)
Visual field defects
Sensory loss
Ataxia and vertigo (posterior circulation infarction)

Question 5

Risk factors of stroke?

Answer 5

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

Question 6

Management of TIA acute and secondary?

Answer 6

resolved symptoms 24hrs after onset

aspirin 300mg daily (stat)
clopidogrel 300mg daily (stat)
refer for specialist assessment in 24hrs

statin 20-80mg

then dual AP therapy

aspirin 75mg
clopidogrel 75mg
PPI

Question 7

Management of ischaemic stroke?

Answer 7

<4 hrs = thrombolysis
>6 hrs = thrombectomy

24hrs later repeat head CT
300mg aspirin
75mg clopidogrel
statin 20-80mg

DOAC after 14 days if AF

Question 8

Management of haemorrhagic stroke?

Answer 8

head CT
get BP lower than 140/90 (IV Lobetolol)

reverse anticoagulants:
warfarin = PCC and Vit K
Heparin = protamine
dabigatran = idarucizumab

Question 9

What drug is used for thrombolysis?

Answer 9

Alteplase = tissue plasminogen activator