stroke therapy

Question 1

what are the investigations to carry out for stroke?`

Answer 1

blood tests - FBC (platelers, RBC, WCC) lipids, 
ECG/24 hrs ECG
CT
MRI scan (less often than CT)
carotid doppler to look at vessels
echocardiogram (some times useful)

Question 2

what us an echocardiogram useful for when investigating a stroke?

Answer 2

clots in the heart

Question 3

what are the advantages of CT over MRI?

Answer 3

quick

shows up blood

Question 4

what are the advantages of MRI scan over CT?

Answer 4

long (up to 30 mins)
claustrophobic
shows ischaemia better than CT

Question 5

what is the most important thing to do in order to increase survival before treatment is started?

Answer 5

get patient to stroke unit

Question 6

what are the advantages of stroke unit over a more general ward?

Answer 6

-patients do better up to 10 years after admission
as:
-mobilided ASAP
-simples things like swallowing and positioning are concentrated on
-early therapy
-expertise is concentrated

Question 7

what is the a common respiratory complication of many strokes?

Answer 7

aspiration pneumonia

Question 8

how many neurons are lost every minute a large vessel ischaemic stroke is untreated?

Answer 8

1.9 million

Question 9

what is the aim of thrombolysis in the treatment of strokes?

Answer 9

to restore perfusion before cell death occurs (salvage penumbra)

Question 10

what is a high platelet count indicative of in stroke?

Answer 10

haemorrhage

Question 11

which type of stroke patients are more likely to aspirate?

Answer 11

patients with haemmorhage

Question 12

when is thrombolysis treatment given for strokes?

Answer 12

3-4.5 hours after event

Question 13

what are the risks of thrombolysis?

Answer 13

haemorrhage

Question 14

what are the risk factors for haemorrhage after thrombolysis treatment of stroke?

Answer 14

infarct size
vessel occlusion
diabetes
BP
age
stroke severity
tissue changes
antiplatelets

Question 15

what can be done to speed up the process of reviewing, investigating and treatment a stroke patient once they have made it to hospital?

Answer 15

pre-hospital notification (by ambulance)

Question 16

what are the interventional treatments for stroke?

Answer 16

endovascular thrombectomy

Question 17

what kind of strokes are treated with thrombectomy and IVT?

Answer 17

large vessel occlusion stroke

Question 18

which drug is used in the thrombolysis of clots in strokes?

Answer 18

recombinant tissue plasminogen activator (rTPA)

alteplase

Question 19

what are the contraindications to thrombolysis?

Answer 19

age
licence
over 80s
MI with recent bleeding or very high bp

Question 20

what treatment is given ti under 60s with middle cerebral artery stroke and massive cerebral oedema?

Answer 20

hemicraniectomy

Question 21

what other medication is often given along with rTPA?

Answer 21

aspirin

Question 22

which patients are most at risk of a secondary stroke?

Answer 22

patients with a past stroke

Question 23

what are the secondary prevention techniques for stroke patients?

Answer 23

-antiplatelets
clopidogrel 75mg
or
aspirin 75mg plus dipyridamole MR 200mg bd
-statin
-antihypertensive drugs (even if bp normal)

Question 24

what is a carotid endarterectomy?

Answer 24

operation carried out to remove atheromatous plaque from carotid artery to reduce the risk of stroke