stroke

Question 1

anaphylaxis tretent?

Answer 1

Stop tPA Seek immediate medical advice Administer oxygen if sats low Give Hydrocortisone 200mg and Chlorpheniramine 10mg IV If circulatory collapse and IV access give 100micrograms (1ml) to 200micrograms (2ml) of 1 in 10,000 IV Epinephrine then review response (NB no IM epinephrine)

Question 2

hypertension treatment?

Answer 2

Stop tPA Seek immediate medical advice-recheck Bp in 5 mins if lowered –recommence Tpa BP stable if still elevated commence treatment If Systolic 185 mmHg or Diastolic  110mmHg First Line:Labetalol 10mg IV over 2 minutes. May repeat or double every 10 minutes to a total dose of 150mg Or: give initial dose then infusion at 2mg/min, titrated to 8mg/min as needed Second line: Administer GTN 10micrograms/min & titrate

Question 3

suspected bleeding?

Answer 3

–Stop tPA!
•Suspect if headache, nausea and vomiting, fall in GCS, new focal neurological signs or acute hypertension
•Check bloods for APPT, INR, FBC, group and save and clotting screen
•Arrange urgent CT scan
•If Intracerebral or life - threatening systemic bleeding give the following:
•Administer Fibrinogen Concentrate
• A standard dose of fibrinogen for an average size person would be about 4gm and then check the fibrinogen straight after the infusion.
• In addition if severe beleeding consider an anti-fibrinolytic ie tranexamic acid 500mg IV 6 hourly in the acute phase.
• If platelets below 100 and life threatening bleed or ICH administer platelets
•All available from Blood bank
• NB fibrinogen concentrate is not licensed in the UK and so would be on a named patient basis

Question 4

different areas?

Answer 4

Arterial
Ischaemic
Large vessel
Atherothromboembolic
Embolic
Vasculitic
Dissection
Compression
Small vessel
Lipohyalinosis
(Micro)Atherothrombotic
Embolic
Vasculitic
Leukoaraiosis (?)
Haemorrhagic
Primary intracerebral and intracranial haemorrhage
Secondary haemorrhage into ischaemic brain

Venous
Ischaemic
Large veins
Cerebral venous sinus thrombosis
Tumour invasion/compression
Surgical ligation
Cortical veins
- Haemorrhagic
Primary
From cavernomas and AVMs
Secondary haemorrhage into ischaemic brain
Following venous infarction

Question 5

three types of artery to consider?

Answer 5

large artery occlusion

lenticulostriate perforators

leptomeningeal perforators

Question 6

large artery?

Answer 6

Question 7

function of the brain?

Answer 7

Question 8

lenticulostriate?

Answer 8

Question 9

lenticulo and internal capsule
?

Answer 9

Question 10

leptomeningeal perforators?

Answer 10

Question 11

white matter tracts?

Answer 11

Superior longitudinal fasciculus
Inferior longitudinal fasciculus
Arcuate fasciculus
Uncinate fasciculus

Question 13

areas of brain and function

Answer 13