Stroke

Question 1

1st line imaging Ix for suspected stroke

Answer 1

non-contrast CT head to dertermine Ishaemic OR Haemorrhagic

Question 2

Thrombolysis timeframe in acute ischaemic stroke

Answer 2

within 4.5 hours from Sx onset

Question 3

Confirmed Haemorrhagic stroke Mx

Answer 3

1st line: Reverse anticoagulant effect
2nd: Nimodipine: Prevent vasospasm to ensure sufficient cerebral perfusion
2nd: Maintain BP <140/80
3rd: CT angiogram head
4th: Endovascular coiling (better prognosis)/Surgically clipping

Question 4

3 steps

Confirmed Ischaemic stroke Mx onset <4.5 hours

Answer 4

1. Thrombolysis w/ Alteplase
2. Conside throbectomy
3. Aspirin 300mg for 2/52
   24hours after thrombolysis (after CT excluding haemorrhage)

Thrombolysis increase risk of bleeding - CT head to exclude haemorrhage 24h post thrombolysis

Question 5

2 steps

Ischaemic stroke Mx onset >4.5 hours

Answer 5

1. Thrombectomy
2. Aspirin 300mg

Question 6

TIA initial Mx

Answer 6

1. stat Aspirin 300mg
2. TIA clinic within 24h

Question 7

5 drugs

Ischaemic stroke/TIA secondary prevention Mx

Answer 7

1. Aspirin 75mg
2. Clopidogrel 75mg
3. Statin 80mg
4. Anti-hypertensive e.g. ACE-i, CCBs
5. Anticoagulant e.g. DOACs or warfarin

Question 8

DVLA restrictions for TIA

Answer 8

Single TIA: Stop driving for 1/12
Multiple TIAs: Stop driving for 3/12 + notify DVLA

Question 9

Lacunar stroke affected vessels

Answer 9

perforating arteries around the
internal capsule
thalamus
basal ganglia

Question 10

Lacunar stroke clinical presentations

Answer 10

Pure motor stroke: NO sensory, visual, or higher cognitive deficits

Question 11

BP range

Thrombolysis contraindications

Answer 11

BP >180/110 mmHg

Question 12

Warfarin reverse therapy in haemorrhagic stroke

Answer 12

Vit K + Prothrombin Complex Concentrate (PCC)

Question 13

Dabigatran reverse therapy

Answer 13

Idarucizumab

Question 14

Carotid endarterectomy indications

Answer 14

symptomatic patients with at least 70% carotid stenosis

Question 15

TIA risk factors

Answer 15

1. Atrial Fibrillation (cardiac emboli)

Question 16

Duration of Aspirin 300mg Tx for ischaemic stroke

Answer 16

Continue for 2/52 from Sx onset