Stroke

Question 1

What is a stroke?

Answer 1

Rapidly developing clinical symptoms and/or signs of focal and at time global loss of brain function with symptoms lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin

Question 2

What are important facts to elicit in clinical assessment of a stroke?

Answer 2

Time of onset
What were/are symptoms
How did they progress

Question 3

What are some common stroke mimics?

Answer 3

Seizure
Sepsis 
Toxic/metabolic
Space occupying lesion
Pre syncope
Acute confusion/ delirium
Vestibular dysfunction 
Functional 
Dementia

Question 4

What is the rosier score?

Answer 4

If there has been a loss of consciousness or seizure activity you lose a point
Add a point for asymmetric facial, arm and leg weakness, speech disturbance and visual field defect

Question 5

What are the 3 branches of stroke?

Answer 5

Haemorrhage
Subarachnoid haemorrhage
Infarct

Question 6

What are the different types of haemorrhagic stroke?

Answer 6

Structural abnormality such as arteriovenous malformation
Hypertensive
Amyloid angiopathy

Question 7

What are the different types of infarct stroke?

Answer 7

Cardioembolic - AF
Small vessel
Atheroembolic
Other

Question 8

What is the 1st line investigation for a stroke?

Answer 8

CT head

Question 9

What should be done if there is nothing on CT but clinically a stroke is still suspected?

Answer 9

MRI - infarct which is more common than haemorrhagic takes a while to show on CT as it shows as oedema etc whereas MRI is much more sensitive

Question 10

When will a CT become insensitive to blood on the brain?

Answer 10

After 1 week - late presentation

Question 11

What is the management of a stroke?

Answer 11

Thrombolysis 
Thrombectomy
Imaging
Swallow assessment
Nutrition and hydration 
Antiplatelets
Stroke unit care
DVT prevention

Question 12

What are things to thing about before thrombolysis?

Answer 12

Age
Time since onset
Previous intracerebral haemorrhage or infarct
Atrophic changes
BP
Diabetes
Potential benefit

Question 13

What are commonly used thrombolysis drugs?

Answer 13

tPA

Alteplase

Question 14

Why MUST you do a CT head before thrombolysis?

Answer 14

If haemorrhagic - DO NOT thrombolyse. Will make it MUCH worse

Question 15

What time frame impacts the administration of IV tPA?

Answer 15

Limited to <4.5 hours from onset of symptoms

Question 16

What is the recommended antiplatelet therapy post stroke?

Answer 16

Aspirin 300mg ASAP after stroke

Wait 24 hours if been thrombolysed

Question 17

What is the recommended DVT prophylaxis post stroke?

Answer 17

Intermittent pneumatic compression

LMWH has showed little benefit that is outweighed by bleeding risk

Question 18

How is dysphagia managed?

Answer 18

Initial swallow screen
If abnormal then assessment by a speech and language therapist
May require NG tube placement ot textured diet

Question 19

What is the commonest complication post stroke?

Answer 19

Aspiration pneumonia from dysphagia

Question 20

What is a TIA?

Answer 20

A brief episode of neurologic dysfunction caused by focal brain or retinal ischaemia with clinical symptoms typically lasting less than one hour and without evidence of infarction

Question 21

What is done at the rapid access TIA clinic?

Answer 21

History
Carotid imaging
ECG
Blood test
Aspirin +/- clopidogrel
Statin

Question 22

How is a haemorrhagic stroke treated?

Answer 22

If presentation within 6 hours and there is a systolic BP above 150 mmHg then it should be treated with either IV GTN or IV labetolol

Question 23

How are anticoags reversed?

Answer 23

Vit K/ prothrombin for warfarin
Specific antidotes for DOACs
Tranexamic acid