Stroke and TIA

Question 1

Define stroke

Answer 1

Sudden onset of neurological symptoms of vascular aetiology - lasts more than 24 hours

Question 2

2 types of stroke?

Answer 2

80% cerebral infarction - ischaemia causing death in part of brain

20% haemorrhage - bleed in brain

Question 3

How does TIA differ to stroke?

Answer 3

Same process as stroke but less than 24 hours
Symptoms resolve without leaving neurological defects

Question 4

How does an ischaemic stroke occur?

Answer 4

Atheroembolism occurs:
- blood clots blocks vessel (thrombus breaks away from atheroma)
- necrosis in part of brain
- surrounding area has diminished blood supply

Question 5

How does haemorrhagic stroke occur?

Answer 5

• Blood vessel bursts leading to bleeding inside brain
• Leaking blood compresses brain tissue, leading to neurological deficits

Question 6

How does a TIA occur?

Answer 6

Same as stroke but;
- Thrombus small enough to dislodge
- Some atherosclerotic plaques unstable and fragments can embolise away to distant sites

Question 7

Clinical presenting features of acute stroke

Answer 7

Weakness in 1+ limbs
Sudden onset facial paralysis
Speech disturbance
Acute confusion
Sudden blindness
Thunderclap headache
Coma / death

Question 8

What is management of stroke? Act?

Answer 8

F - face fallen to 1 side?
A - can raise both arms and keep them there?
S - speech slurred?
T - time to call 999

Question 9

What are the aims of acute stroke management?

Answer 9

• Limit level of disability and dependency post stroke
• Preserve life
• CT scan to differentiate ischaemic / haemorrhagic

Question 10

What are 5 tx options for stroke?

Answer 10

• Thrombolysis - dissolve clot
• Thrombectomy - surgically remove clot from vessel
• Craniotomy - remove brain from skull to expose brain
• Placement of a shunt
• Rehabilitation

Question 11

What lifestyle changes should be addressed post stroke?

Answer 11

• Diet - low fat, low salt, high fibre
• Exercise
• Smoking cessation

Question 12

Which meds can be used post-stroke?

Answer 12

• Anti-hypertensive meds (reduce BP)
• Statins (lower cholesterol) reduce further stroke 25%
• Antiplatelets e.g. Aspirin / Clopidogrel / Dipyridamole
• Anticoagulants e.g. NOACs Apixaban / Rivaroxaban / Dabigastran / Edoxaban

Question 13

What further things should be considered for a pt post stroke?

Answer 13

• Swallowing management - feed by tube, thick soft diet, speech and language therapy
• Continence care - avoid in dwelling catheters due to infection risk
• Bed bound its need pressure sore management, regular turning
• Depression screening

Question 14

What is mortality rate for stroke in 1st month to 1st year?

Answer 14

19% 0-30 days
12% up to 1 year

Question 15

What should you consider for stroke pts in oral healthcare?

Answer 15

• Depression - demotivated to maintain OH
• Memory / confusion - gaining informed consent
• Swallowing - if challenging may lead to drooling / more severely nutritional deficiencies
• Facial palsy - limit denture retention
• Mobility - access to dental surgery / transport
• Meds - anticoagulants, bleeding risk?