Stroke Treatment

Question 1

What is given to a stroke patient whose symptoms started about an hour ago?

Answer 1

Thrombolysis rTPA therapy - alteplase, tenectaplase, recteplase

Question 2

What si the likely cause of a stroke patient suffering extreme cerebral oedema? And how would it be treated?

Answer 2

Occlusion of the middle cerebral artery

Treated by decompression by hemicraniotomy

Question 3

What treatment can be given for a stroke patient who has had extensive occlusion of the anterior circulation?

Answer 3

Carotid enderectomy whereby they remove the clot which is causing the occlusion

Question 4

What is the time limit for thrombolysis?

Answer 4

Thrombolysis should be given if the onset of symptoms was less than 4.5 hours ago

Question 5

What are the side effects of thrombolysis?

Answer 5

Thrombolytics can cause haemorrhage (however it is unexpected)
Can also cause bleeding else where e.g. gut

Question 6

What is the risk of a stroke patient having a haemorrhage due to the thrombolytics affected by?

Answer 6

Risk depends on ;
the size of the infarct, the tissue damage, stroke severity, vessel occlusion, age of patient, diabetes, bp, hyp/hyperglycaemia,

Question 7

What is the secondary preventative treatment given to patients post recovery from stroke?

Answer 7

Anti platelets such as clopidogrel or aspirin + dipyradamol
Statins
Anti hypertensives such as ACEI’s, CCB, thiazides like diuretics

Question 8

What are some of the contraindications for thrombolysis therapy?

Answer 8

Age <16 or > 80 years old
Previous stroke in the last 3 months
Symptoms suggest sub arachnoid haemorrhage
Low platelet count
Hypo or hyper glucose levels
Hypertensive
On warfarin therapy or been administered heparin in the last 48 hours
Seizure at onset of stroke