Stroke and Transient Ischaemic Attack

Question 1

What are the two types of stroke and what is a transient ischaemic attack?

Answer 1

Ischaemic stroke - blockage of blood flow to brain leading to cell death
Haemorrhagic stroke - caused by bleeding in brain
Transient ischaemic attack (TIA) - ischaemic blockage lasting <24 hours

Question 2

What are the two main causes of blockage in blood flow to the brain in an ischaemic stroke and TIA?

Answer 2

Atherosclerosis and Atrial fibrillation

Question 3

What are cells deprived of during an ischaemic stroke/TIA and what does it lead to?

Answer 3

Oxygen and glucose, leading to necrosis and cell death

Question 4

What are the main presentations of a stroke/TIA?

Answer 4

Face, Arms, Speech

Question 5

What is the main method of stroke diagnosis if a stroke is suspected?

Answer 5

Brain scan (ASAP - within 1hr of arriving at hospital)
- CT and/or MRI - confirm diagnosis & whether ischaemic or haemorrhagic

Question 6

What is the initial acute drug management for an ischaemic stroke and what are the conditions for its use?

Answer 6

Alteplase (thrombolysis)

• treatment started within 4.5 hours of stroke onset AND
• intracranial haemorrhage has been excluded by appropriate imaging

Question 7

What is the dose of Alteplase and how is it administered?

Answer 7

0.9mg/kg

10% as IV Bolus, then remainder as IV infusion over 60 minutes

Question 8

What is the treatment for an ischaemic stroke If Alteplase is contraindicated or after the Alteplase dose has finished?

Answer 8

Aspirin 300mg OD for 2 weeks then Clopidogrel 75mg OD lifelong as secondary prevention
- if previous history of dyspepsia/GI bleed risk = add PPI (NOT omeprazole/esomeprazole with clopidogrel)

Question 9

What further management may be required for patients who have atrial fibrillation after an ischaemic stroke?

Answer 9

Anticoagulant (DOACs, Warfarin, Enoxaparin) after Aspirin 300mg OD for 2 weeks

Question 10

What secondary prevention is required after an ischaemic stroke? (apart from aspirin + clopidogrel)

Answer 10

Lipid management- high intensity statin 48 hours after stroke onset - Atorvastatin 80mg OD unless CI
Blood pressure control and Diabetes control
Lifestyle

Question 11

What is the initial drug management and offered secondary prevention for a transient ischaemic attack?

Answer 11

Aspirin 300mg STAT dose unless CI, then Clopidogrel 75mg OD lifelong as secondary prevention

Secondary prevention: lipid management (statin), BP control, diabetes control, lifestyle

Question 12

What is the management for a haemorrhagic stroke?

Answer 12

• Confirm diagnosis - immediate CT/MRI to confirm bleeding +/- lumbar puncture
• Possible surgery to remove haematoma / relieve intracranial pressure
• Reversal of anticoagulation ASAP
• Rapid BP lowering
• seizure control if needed

Question 13

Who is the lead singer of the strokes?

Answer 13

Julian Casablancas