Stroke/TIA

Question 0

What abcd2 score indicates higher risk of stroke?

Answer 0

Abcd >4 or crescendo TIA:

Specialist assessment within 24 hrs and decision on brain imaging

Abcd <3 or presenting one week after symptoms resolve:

Specialist assessment within 1 week and decision on imaging

Question 1

What does ABCD2 score assess?

Answer 1

Age: >60
BP: > 140/90
Clinical: unilateral weakness (2pts), speech disturbance w/o weak (1pts)
Duration: >60 mins (2pts), 10-59mins (1pt)
Diabetes: oral mess or insulin

Question 2

When should a referral for brain imaging be made in suspected tia?

Answer 2

Haemorrhage needs to be excluded - long duration or anticoagulants

Alt diagnosis - migraine, epilepsy is a possibility

Question 3

How is suspected TIA managed?

Answer 3

If Abcd greater than four:
Initiate daily aspirin 300mg
Or
Clopidogrel 300mg

And
Statin 40mg

And refer for specialist assessment within 24 hours

Question 4

What is the management of stroke?

Answer 4

Urgent CT to exclude ICH
Alteplase in 4.5 hours
Start on aspirin 300mg - continue for 2 weeks after symptom onset
Carotid imaging in 1 week

Question 5

When is carotid endarterectomy considered?

Answer 5

Carotid imaging carried out within 1 week of onset of symptoms

Stenosis: >50% consider endarterectomy

Refer for carotid endarterectomy within 1 week of symptom onset, undergo endarterectomy within 2 weeks of symptom onset

Question 6

What is secondary stroke prevention for stroke and TIA?

Answer 6

Make plan within 7 days
Advise on lifestyle
Regular review of Risk factors
Manage BP
Anti thrombotic treatment - aspirin and clopidogrel
Statins - all patients with TIA/stroke unless contraindicated!

Question 7

How should TIA with a low risk of stroke (Abcd

Answer 7

Arrange specialist assessment within 1 week of symptom onset

Aspirin 300 mg loading dose and 75mg thereafter

Statin 40mg daily