Stroke

Question 1

Define stroke

Answer 1

• Rapidly developing clinical symptoms AND/OR
• Signs of focal/global loss of brain function AND
• Symptoms lasting more than 24hrs OR
• Leading to death with no apparent cause other than vascular origin

Question 2

What score is used to see if a patient has had a stroke?

Answer 2

Rosier score

Question 3

Is stroke a diagnoses?

Answer 3

NO

Question 4

What are the 3 different classes of stroke?

Answer 4

Haemorrhage
Subarachnoid haemorrhage
Infarct

Question 5

What is more common, a haemorrhagic stroke or an infarct stroke?

Answer 5

Infarct

Question 6

When do infarcts tend to show up on CT?

Answer 6

24hrs after a stroke

Question 7

What is the difference between a TIA and a stroke?

Answer 7

Vascular abnormality in the brain
If it lasts <24hrs = TIA
If it lasts >24hrs = stroke

Question 8

Are TIAs based on pathology?

Answer 8

No, based on clinical presentation

Question 9

Where are patients sent if they are suspected of having a stroke?

Answer 9

Rapid access neurovascular clinic

Question 10

What assessments are carried out in patients suspected of stroke?

Answer 10

History
Carotid imaging
ECG
Bloods

Question 11

What immediate therapy do patients with stroke get?

Answer 11

Meds (statin + antiplatelet)
Carotid endarterectomy (if appropriate)

Question 12

What is the management of a stroke? (acute management only)

Answer 12

Thrombolysis/ectomy
Imaging
Swallow assessment
Nutrition/hydration
Antiplatelets
Stroke unit care
DVT prevention

Question 13

What antiplatelet is give ASAP after a stroke?

Answer 13

Aspirin

wait 24hrs if being thrombolysed

Question 14

What should you do before giving an antiplatelet after a stroke?

Answer 14

CT - to exclude bleed

Question 15

If a patient’s initial swallow screen is abnormal, who should the patient be assessed by?

Answer 15

Speech and language therapist

Question 16

What tool is used to assess malnutrition in stroke patients?

Answer 16

MUST

Question 17

What is used as secondary prevention of stroke?

Answer 17

Meds
Lifestyle
Carotid surgery

Question 18

What type of stroke is characterised by a fibrin dependent red thrombus?

Answer 18

Cardioembolic

Question 19

What type of stroke is characterised by a platelet dependent white thrombus?

Answer 19

Atheroembolic

Question 20

What is a cardioembolic stroke?

Answer 20

Has fibrin dependent red thrombus

Question 21

What is an atheroembolic stroke?

Answer 21

Platelet dependent white thrombus

Question 22

Name the 3 different types of ischaemic stroke

Answer 22

Cardioembolic
Atheroembolic
Small vessel disease

Question 23

What investigations should you order if you suspect a stroke?

Answer 23

CT scan, MRI with DWI/GRE/SWI
Carotid scan
Angiogram
ECG
24hr tape
Echo
Bubble TCD/echo
Lipid profile
BP
Glucose
Smoking

Question 24

What investigations will identify the presence of an infarct/haemorrhage?

Answer 24

CT or MRI (weighted)

Question 25

What investigations will identify the aetiology of the stroke?

Answer 25

Carotid scan
Angiogram
ECG/24hr tape
Echo

Question 26

What investigations will identify the risk factors for stroke?

Answer 26

Lipid profile
BP
Glucose
Smoking?

Question 27

What would you give a patient long term if they had a cardioembolic stroke or AF?

Answer 27

Anticoagulant e.g. warfarin

Question 28

What would you give a patient if they had a non-cardioembolic ischaemic attack longterm?

Answer 28

Antiplatelet

First line = clopidogrel

Question 29

What do you give to all stroke patients as secondary prevention?

Answer 29

Smoking advice
Statins
Manage BP
Diet & lifestyle

Question 30

How long after a stroke can you start an anticoagulant?

Answer 30

10 days after

Question 31

How long after a stroke can you start an antihypertensive?

Answer 31

10 days after

Question 32

What does the CHADS2 score assess?

Answer 32

Risk of stroke in AF