Stroke Management

Question 5

First step in management?

Wht Ix?

Look at hand out from study group!!!

Answer 5

ABCDE

Investigations -

B - urine dip (? glucose, infx), BM, ECG

B - CRP (vasc), FBC (hyperviscosity/plt), U+E, LFT, CSc (esp if on warfarin), Glucose, Lipids,

I - CT-head is key, + carotid doppler, echo,

O - EEG if epilepsy suspected

Question 6

How do you manage stroke acutely?

Look at hand out from study group!!!

Answer 6

ABCDE

Investigations -

CT head to rule out haemorrhage (infarct only visible at 24h)

Stabilise glucose, don’t reduce BP

NBM until swallow assessed

Keep hydrated ? catheter

explain fully what has happened

Refer to Neuro Reg

Question 15

Post acute management? (4)

Answer 15

Reduce risk factors - e.g.

• Carotid artery disease >> stent or endarterectomy
• Drug prophylaxis - daily anti platelets e.g clopidogrel, aspirin, statin and ACEI +- thiazides (aim
• If in AF – warfarin to INR 2-3, depending on chads score…

DC with community care - intermediate care team

GP follow-up

Question 16

What are the indications for thrombolysis?

Answer 16

Acute ischaemic stroke. Benefit if given within 4.5 h (?3)

Main risk is haemorrhage

Question 17

What are the major contraindications to thrombolysis ?

Answer 17

Haemorrhagic diathesis

Overt bleeding or haemorrhage on CT

Neoplasm with increased bleeding risk

Pregnancy

Oral anticoagulation (INR > 1.4)

Seizure at stroke onset

Systolic BP > 185 or Diastolic > 110 pre-treatment

Question 18

how manage if present beyond 4.5 hours?

What else to manage?

Answer 18

Aspirin 300mg for 2 weeks, then clopidogrel 75mg thereafter

Hyperglycaemia - insulin may be required

Don’t manage BP unless symptomatic

Treat raised temp with paracetamol

Question 19

Risk factors for stroke?

Answer 19

Non-modifiable - male, age, FH

CVD risk factor s- BP, Cholesterol, DM, previous MI

Embolus risk - AF, Valvular heart disease, Carotid stenosis

Clot risk - HRT, OCP

Question 20

What scoring system used to assess risk of stroke following TIA?

Answer 20

ABCD2 - high risk if >6, ≥5 seen in TIA clinic; >1 episode in last week needs admission

• Age >60
• BP > 140/90
• Clinical features - 2 points for unilateral weakness, 1 point if just speech, 0 if other
• Duration >60 min is 2, 10-60 is 1
• Diabetes

Question 21

What factors increase the risk of stroke in AF? (scoring system)

Answer 21

CHADS2 VASC

• > 2 needs oral anticoagulant*
• > 1 aspirin or oral anticoagulant*

Congestive heart failure

Hypertension

Age > 75 (2 points)

Diabetes

Stroke - Previous Stroke (2 points)

Vascular disease

Age 65-74

Sex (female)

Question 22

Medical management of TIA?

Answer 22

300mg aspirin loading dose

ABCD2 score

Then, aspirin and dypyridamole long term (? just clopidogrel)