Stroke 2 ( Therapy)

Question 1

Why are stroke units important?

Answer 1

patients do better up to 10 years after their admission

-able to concentrate on swallowing(problems present in 50%), positioning etc

Question 2

Loss in brain in an untreated large vessel ischemic stroke

Answer 2

-1.9 million neurones
13.8 billion synapses
12km of axon fibres

Question 3

Name treatments for acute ischaemic stroke

Answer 3

• Thrombolysis; ( altepase) which breaks down blood clots
• Clot retrieval; expands in vessel , grabs and removes the clot
• carotid enderactomy

Question 4

What does thrombolysis do?

Answer 4

-dissolves the thrombus in the BV + aims to restore perfusion before necrosis offurs

Question 5

Side effects of thrombolysis + its risk factors

Answer 5

• If used >4.5 hours benefits drop
• May cause haemorrhage ( rare)

Risk factors include:

• infarct size
• vessel occlusion
• diabetes
• HBP
• Age
• Stroke severity
• tissue changes
• antiplatelets

Question 6

Investigation of stroke

Answer 6

-Hypwedense MCA

Question 7

Contraindictions to thrombolysis

Answer 7

• minor neurological deficit symptoms prior to infusion
• symptoms of ischaemic attack began >4 hours prior to referral
• seizure at oonset of strokw
• aymptoma auggestive of subarchnoid haemorrhage
• warfarin therapy
• prior stroke within 3 months
• HBP
• Age

Question 8

Hemicraniectomy

Answer 8

-indiiduals up to 60 ywars suffeirng from an acute MCA terriotry ischaemic stoke complicated by massive cerebral oedma. Decompression by hemicraniectomy should be offered within 48 hours of stroke

Question 9

What is a transient ischaemic attack ( TIA)?

Answer 9

• ‘warning stroke ‘ with stroke like symptoms less than 24 hours that clears without residual disability

Question 10

Secondary preventation

Answer 10

• clopidogrel 75mg
• aspirin 75mg + dipyridamole MR 200mg
• statin
• BP drugs even if normal
• antihypertensives