Stroke management

Question 1

What medication should be given as soon as possibe?

Answer 1

Aspirin

Question 2

What needs to be exlcuded before aspirin can be given?

Answer 2

Haemorrhagic stroke

Question 3

What dose of aspirin should be given?

Answer 3

300mg orally or rectally

Question 4

What needs to be maintained within normal limitis in someone who has had a stroke?

Answer 4

Blood glucose
Hydration
Oxygen saturation
Temperature

Question 5

What would indicate that patients should be started on a statin?

Answer 5

Cholesterol is > 3.5 mmol/l

Question 6

When should anticoagulation be started in someone with AF?

Answer 6

It shouldn’t be started until not be a haemorrhage has been excluded and usually after 14 days have passed from the onset of an ischaemic stroke

Question 7

When should thrombolysis with alteplase be administered?

Answer 7

Within 4.5 hours of onset of stroke symptoms

Question 8

What needs to be exlcuded before thrombolysis with alteplase can be administered?

Answer 8

Haemorrhage

Question 9

What are the absolute contradindications of thrombolysis with alteplase?

Answer 9

• Previous intracranial haemorrhage
• Seizure at onset of stroke
• Intracranial neoplasm
• Suspected subarachnoid haemorrhage
• Stroke or traumatic brain injury in preceding 3 months
• Lumbar puncture in preceding 7 days
• Gastrointestinal haemorrhage in preceding 3 weeks
• Active bleeding
• Pregnancy
• Oesophageal varices
• Uncontrolled hypertension >200/120mmHg

Question 10

Within what time frame does thrombectomy need to be carried out?

Answer 10

Within 6 hours of symptoms

Question 11

When is thrombolysis offered with thrombectomy?

Answer 11

If patient presents within 4.5 hours

Acute ischaemic stroke and
confirmed occlusion of the proximal anterior circulation

Question 12

How can an acute ischaemic stroke and occlusion of the PAC be demonstrated?

Answer 12

Computed tomographic angiography (CTA) or magnetic resonance angiography (MRA)

Question 13

When is thrombectomy offered to someone who was last known to be well between 6 and 24 hours presvious?

Answer 13

confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA and
if there is the potential to salvage brain tissue shown by CT perfusion or diffusion-weighted MRI sequences

Question 14

When should thrombectomy with thrombolysis be considered (within 4.5 hours) for people last known to be well 24 hours previous who have had an ischaemic stroke?

Answer 14

If confirmed occlusion of the proximal posterior circulation (that is, basilar or posterior cerebral artery) demonstrated by CTA or MRA and
if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences