Stroke Flashcards
What is stroke?
A life threatening condition caused by a sudden reduction of blood supply to brain tissue. Leads to brain cell damage
Types of stroke
Ishaemic stroke
Transient ischaemic attack
Haemorrhagic stroke
What causes ischaemic stroke?
Lack of blood supply to the brain
What is haemorhagic stroke?
Caused by bleeding in the brain
75% of stroke occur in what age group?
65 or older
Risk factors of stroke?
Hypertension
Diabetes
Smoking
Oral contraceptive
Atrial fibrillation
Previous stroke or TIA
Lifestyle, smoking, obesity and alcohol
What are the symptoms of stroke?
FAST!
F - Drooping of face on one side
A - arm weakness
S - speech difficulty
T - Time to call 999
What are the other symptoms of stroke?
Severe headache
Loss of consciousness
Vision problems
Types of haemorrhagic stroke?
Subarachnoid and intracerebral
What is subarachnoid haemorrhage
It is when blood vessel rupture and bleed in the space between the brain and skull
What is intracerebral haemorrhage
When blood vessel rupture and bleed within the brain tissues
What is the initial management of intracerebral haemorrhage
Surgery to remove hematoma and relieve intracranial pressure
What is the exclusion criteria for rapid bp in IH
- people with large haematoma
- underlying structural cause
- glaucoma score < 6
- undergoing early surgery to remove haematoma
When should you give rapid bp and what should you aim for in IH?
- Systolic bp is 150 -220 within 6 hours onset of symptoms
- Aim for 130-139 within one hour of trt and sustain for 7 days
Can aspirin and anticoagulants be used in intracerebral haemorrhage?
No they can’t
What should be avoided but can also be used in IH?
Statins, if the risks of vascular events outweighs IH
How long does TIA stroke last?
Last for a few mins or hours and fully resolved within 24 hours
What is the first treatment to take if TIA stroke suspected?
Aspirin unless contraindicated or have hypersensitivity to it
What is the first line treatment to give a pt with suspected TIA
Aspirin 300mg unless contraindicated or pt has hypersensitivity
What do you give people taking aspirin that develop dyspepsia?
A proton pump inhibitor
What is another alternative of aspirin if contraindicated
Anti platelet eg
clopidogrel 75mg OD
What is the long term management of TIA or ischaemic stroke without AF or paroxysmal
Clopidogrel 75mg OD
If clopidogrel is contraindicated, what do you use?
Aspirin plus dipyridamole MR 200mg BD
If aspirin and clopidogrel is contraindicated give what?
Dipyridamole 200 mr BD
If clopidogrel and Dipyridamole
Aspirin 75mg OD
What is the initial treatment of ischaemic stroke and when should it be given?
Alteplase or tenecteplase
Within 4.5hours onset of symptoms
What is thrombolysis?
A procedure to break up blood clots and prevent it from
What should pt with Ishaemic stroke get after thrombolysis
Start Antiplatelet (Aspirin) 300mg OD for 14 days
after 24hrs of thrombolysis or within 48hrs of those not receiving it or onset of symptoms
What is the dose of aspirin after thrombolysis
Aspirin 300mg OD for 14 days
When should you give dual therapy
When there is high right risk of TIA or those with intracranial stenosis
What is the dual therapy that you can give?
aspirin + clopidogrel for up to 90 days
Or
Aspirin + ticagrelor for up to 30 days
High intensity statins should be given to all patients after stroke onset regardless of serum cholesterol levels. True or False
True
When do you start statins therapy,
48 hours after stroke onset
List the high intensity statin given and what’s the aim of it? And for how long should you check reduction
- 20-80mg daily Atorvastatin
- Aim is to reduce the non HDL cholesterol by more than 40%
-3 months
When can you only give ezetimibe?
Pts who have familial hypercholesterolemia
Can beta blockers be used in management of hypertension after stroke?
No unlesss indicated for co existing condition
Anticoagulants can’t be given for long term management of recurrent stroke unless when there is AF. True or false
True
Can you use anticoagulant in acute IS in pt who are in sinus rhythm?
No
When can anticoagulants be used
Pts with AF
Pulmonary embolism
Dvt
What should not be used in acute phase of ischaemic stroke
Warfarin
When should you have your anticoagulant treatment stopped and for how long
If anticoagulant is used for prosthetic heart valve (risk of haemorrgahic transformation, disabling stroke, stop for 7 days and replace with aspirin
What is the target bp in stroke?
<130/80mmhg
Which ppi should be given in aspirin induced dyspepsia
Omeprazole 20mg OD
When can you not give anticoagulants
In acute phase of Ischaemic stroke
Acute ischaemic stroke in sinus rythmm
What should you not offer pre menstrual women with stroke or TIA
Combined oral contraceptive pills
What should you give pre menopausal women with stroke or TIA
Progesterone only eg desogestrel
Non hormonal contraceptive methods
What should you give pre menopausal women with stroke or TIA
Progesterone only eg desogestrel
Non hormonal contraceptive methods
What should you give pre menopausal women with stroke or TIA
Progesterone only eg desogestrel
Non hormonal contraceptive methods
