Stroke and TIA

Question 1

What is the definition of a stroke?

Answer 1

Sudden onset focal or generalised neurological defecit which lasts for 24 hours for which the only apparent cause is vascular

Question 2

What are the percentages for prevelance of different types of strokes?

Answer 2

Haemorrhagic strokes make up 10% and ischaemic strokes make up the rest

Question 3

How should patients be managed to tell what kind of stroke they have had?

Answer 3

they should have a CT head within one hour of arriving at the hospital to tell if it is a haemorhage

Question 4

What is the management of acute ischaemic stroke?

Answer 4

Thrombolysis can be given up until 4.5 hours after symptom onset - alteplase is used, should receive CT head 24 hours post lysis
Thrombectomy is now reccommended as a form of treatment with large vessel occlusion, done in addition to thombolysis
Patients who it is not possible to do thrombolysis or thrombectomy should be given 300mg asprin OD for 2 weeks, usually started 24 hours after thrombolysis

Question 5

What is the management for haemorrhagic stroke?

Answer 5

No specific treatment but can be treated surgically

Need to control BP and reverse any anticoagulants the patient is on

Question 6

What are the risk factors that need to be addressed in secondary prevention of stroke?

Answer 6

Risk of thrombus so give 75mg clopidogrel
ECG to look for AF which needs to be treated
Cholesterol
HbA1c
Carotid doppler for carotid artery stenosis
Smoking cessation

Question 7

How are TIAs managed?

Answer 7

Given 300mg asprin and reffered to TIA clinic where they will be given 75mg clopidogrel and screened for risk factors