Stroke: Management Flashcards
1
Q
How should acute stroke be managed?
A
- Keep blood glucose, hydration, oxygen sats and tempearture within normal limits.
- BP should not be lowered unless they are either a candidate for thrombolysis or they have a concomitant medical issue (aortic dissection, MI, pre-eclampsia, end organ problems due to hypertension - kidneys, heart failure etc)
- Give Aspirin 300mg ASAP once haemorrhagic stroke is excluded.
- If AF- only start anticoagulants ~14days after the start of ischaemic stroke.
- Commence on a statin if cholesterol is >3.5mmol/l (BUT ONLY START 48 HOURS AFTER STROKE DUE TO RISK OF HAEMORRHAGIC TRANSFORMATION)
2
Q
When should thrombolysis be given?
A
- Within 4.5 hours of onset of stroke symptoms.
- Haemorrhage has been definitevely excluded.
3
Q
What thrombolytic is recommended by NICE?
A
Alteplase
4
Q
What are some absolute contraindications to thrombolysis?
A
- 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
5
Q
What are some relative contraindications to thrombolysis?
A
- Concurrent anticoagulation (INR >1.7)
- Bleeding conditions
- Active diabetic haemorrhagic retinopathy
- Suspected intracardiac thrombus
- Major surgery / trauma in preceding 2 weeks
6
Q
What antiplatelets are recommended as part of the secondary prevention strategy for stroke?
A
- First line: Clopidogrel
- Second line: Aspirin + Dipyridamole
- Third line: Dipyridamole
7
Q
When is carotid artery endarterectomy recommended?
A
-
Carotid stenosis
- >70% according to Europeans (ECT)
- >50% according to USA (NASCET)
- If stroke or TIA in the carotid territory and are not severely disabled.
