Stroke

Question 1

How do you treat a TIA?

Answer 1

1. Aspirin 300mg STAT

2. secondary prevention + long term clopidogrel

Question 2

Initial management of an ischemic stroke

Answer 2

1. If <4.5 hours presentation give Alteplase

2. Aspirin 300mg for 2 weeks + PPI

Question 3

Why is Warfarin NOT to be given during an ischemic stroke?

Answer 3

Risk of haemorrhagic transformation

Question 4

If a stroke patient also has AF how long should they receive aspirin for before considering anticoagulation treatment?

Answer 4

2 weeks

Question 5

If a stroke patient has a prosthetic valve and is therefore being treated with Warfarin - what do you do with the anticoagulation?

Answer 5

Stop for 7 days - give Aspirin along

Question 6

Should hypertension be treated during a stroke?

Answer 6

No - risk of reducing cerebral perfusion so only initiate if patient is in hypertensive crisis

Question 7

Long term management of a stroke

Answer 7

1. Clopidogrel (if no AF) or Warfarin (if AF)
2. High intensity statin
3. antihypertensives (aim for 130/80) - avoid beta blokers
4. Lifestyle

Question 8

BP aim post stroke

Answer 8

130/80mmHg

Question 9

Initial management of intracerebral haemorrhage

Answer 9

1, Surgical intervention to remove haemotoma

2. Rapid BP lowering therapy if systolic between 150-220mmHg
3. Anticoagulation to be stopped + reversed

Question 10

Long term management of intracerebral haemorrhage

Answer 10

1. Avoid aspirin or anticoagulation
2. BP monitoring to avoid hypoperfusion
3. Avoid statins
4. Hollistics e.g. swallow function. nutritional supplements etc