Stroke and TIA

Question 1

When we think about strokes which mnemonic comes to mind

Answer 1

FAST

Question 2

What does the mnemonic FAST stand for

Answer 2

Face
Arms
Speech
Time

Question 3

What dow e need to consider if a patient has had a stroke

Answer 3

1. Patients may need a bit more help if disability profound
2. Drugs used after having a stroke can affect oral mucosa
3. Issue of capacity and informed consent is crucial

Question 4

What is a stroke

Answer 4

A sudden onset of facial neurological symptoms of a presumed vascular aetiology lasting more than 24 hours

Question 5

What is a TIA

Answer 5

They are by definition transient and an ischaemic attack

Question 6

Which organ get damaged following TIA or Stroke

Answer 6

Death of Brian tissue results

Question 7

What are most strokes caused by

Answer 7

80% ischaemic in origin

20% Haemorrhagic in origin

Question 8

Why do ischaemic strokes happen

Answer 8

Due to underlying cardiovascular disease

Question 9

What categories do risk factors fall into

Answer 9

1. Modifiable

2. Non modifiable

Question 10

List some non modifiable risk factors for stroke

Answer 10

1. Age
2. Ethnicity
3. Gender
4. Family history of heart disease
5. History of heart disease
6. PFO (hole in heart)
7. Type 1 diabetes
8. Atrial fibrillation

Question 11

List some modifiable risk factors for stroke

Answer 11

1. High blood pressure e
2. High blood cholesterol
3. Type 2 diabetes
4. Being overweight
5. Alcohol consumption
6. Smoking
7. Drug use
8. Sedentary lifestyle

Question 12

Give some long term clinical features of a stroke

Answer 12

1. Limb weakness
2. Facial paralysis
3. Speech disturbances
4. Visual defects
5. Bowel and bladder dysfunction
6. Neuropathic pain
7. Swallowing difficulties
8. Cognitive difficulties
9. Communication difficulties
10. Inability to write
11. Mobility issues
12. Inability to maintain self-care
13. Mood disturbances

Question 13

Talk through the treatment of the acute phase of a stroke

Answer 13

1. Medical emergency where time is crustal
2. Thrombolysis to bust clots
3. Supportive care
4. Thrombectomy, craniotomy, shunt placement
5. Rehabilitation

Question 14

What os the post treatment plan of a stroke dependant on

Answer 14

If it was of:

1. Ischaemic aetiology
2. Heamorrhagic aetiology

Question 15

Talk though the post treatment of a stroke of ischaemic aetiology

Answer 15

1. Lifestyle modifications
2. Anti-platelet drugs
3. Anticoagulants
4. Carotid enderterctomy
5. Rehab, continence care, nursing home support,
6. Psychological support

Question 16

Give examples of Anti-platelet drugs

Answer 16

Aspirin

Clopidogrel

Question 17

Give examples of Anticoagulants

Answer 17

Warfarin

Novel or direct oral Anticoagulants (NOACS/ DOACs)

Question 18

Talk though the post treatment of a stroke of haemorrhagic aetiology

Answer 18

Largely supportive focuses on BP management and stopping pro- haemorrhage medications

Question 19

is even stroke patient mentally compromised

Answer 19

no we need to consider every patient individually

Question 20

How can communication be challenging following a stroke

Answer 20

1. Patient may not understand you
2. Ability to talk to you may be compromised
3. You may need to find some alternative material stop help the patient understand and consent

Question 21

What things should we consider when treating a patient who has had a stroke

Answer 21

1. Emergency management of the acute stroke
2. Physical access tot eh dental surgery
3. Capacity assessment
4. Adaptations to the toothbrush
5. Difficulties with denture
6. Drooling
7. Poor OH
8. Anticoagulants and other drugs may modify your treatment plan