Stroke and TIA

Question 1

Stroke

Answer 1

CT head within 1 hour (exclude bleed)

Thrombolysis (alteplase) if < 4.5 hours and no CI

OR

Aspirin 300mg PO OD 2w OR clopi 300mg PO STAT then 75mg OD

Question 2

Transfer to stroke ward

Answer 2

Speech and language therapy assessment
Nutritional optimisation
Early mobilisation
Treat infections and protect pressure areas
Long-term drugs
MDT rehab
Consider carotid endarterectomy

Question 3

TIA

Answer 3

Aspirin 300mg PO OD for 2 weeks OR Clopi 300mg STAT then 75mg (unless already on antiplatelets or in AF - anticoagulate)

Specialist review within 24 hours

Carotid endarterectomy, long term drugs, ECG, 24-hour tape, echo, vasculitis screen, thrombophilia screen

Question 4

Long-term drugs

Answer 4

Anti-HTN
Clopi 75mg OD (or anticoagulate if in AF but wait 2 w after stroke)
Statin - but wait 48hr after stoke

Question 5

DVLA guidance

Answer 5

No driving for 4 weeks

Need to tell DVLA if HGV driver of still symptoms after 4 weeks