TIA + stroke - clinical

Question 1

ABCD2

Answer 1

Age - 60+ (1)
BP - 140/80+ (1)
Clinical features - unilateral weakness (2), speech difficulty no weakness (1)
Diabetes (1)
Duration - <1h (1), 1h+ (2)

Question 2

TIA - management + aftercare

Answer 2

resolved symptoms:
aspirin 300 if not CI
24h review by stroke doc - ?carotid endarterectomy
carotid imaging

followup (immediate):
TIA clinic
lifestyle + BP meds
75mg clopidogrel daily (300 loading dose)
atorvastatin 20-80 daily
± carotid endarterectomy

Question 3

ischaemic stroke - acute management

Answer 3

control glucose + fever
300mg aspirin (continue 2wk ± PPI)

< 4.5h - alteplase + repeat CT at 24h (?haemorrhagic transformation)

if bleeding risk, recent surgery, >80 or woke with symptoms - no alteplase

Question 4

haemorrhagic stroke - management

Answer 4

control BP, glucose + fever
reverse any anticoagulation
urgent surgery - craniotomy + coil/clip artery

Question 5

what does ABCD2 score calculate? criteria?

Answer 5

stroke risk in 48h

6-7 - high
4-5 - moderate
1-3 - low

Question 6

stroke/TIA - investigations

Answer 6

glucose - hypo = stroke mimick (todd's)
ECG - ?AF
U+Es, FBC, LFT
stroke - CT head
TIA - carotid doppler

Question 7

SAH - presentation + investigation + mgmt

Answer 7

stroke mimic

CT head + 12h later LP
when confirmed - CT intracranial angiogram

refer neurosurgery
meantime: strict bed rest, control BP, avoid straining
21d nimodipine - prevent vasospasm

Question 8

CI to thrombolysis

Answer 8

high BROW

high BP eg diastolic > 140
Bleeding tendency
Recent surgery 
Over 80y
Woke with symptoms

Question 9

ischaemic stroke - followup therapy

Answer 9

statin if >3.5
aspirin 300mg 2 weeks
THEN clopidogrel 75mg for 1y+
control RFs eg BP, lifestyle

if AF - ?anticoagulation over clopi (after the 2wk)