Treatment and Prevention of Stroke

Question 1

What needs to be thought of when diagnosing stroke?

Answer 1

Has a stroke occurred?

What type of stroke has occurred?

How severe is the stroke?

Can it be treated?

What is the underlying cause?

Question 2

What to look out for when taking a history

Answer 2

Have these sort of symptoms happened before?

Do they have any other conditions?

Try and locate the blood vessel affected by assessing symptoms

Question 3

What is the first test to do for a suspected stroke?

Answer 3

CT scan

Question 4

Why would you do a CT scan?

Answer 4

To rule out a haemorrhage

Question 5

What do you do if the CT scan suggests there is no haemorrhage?

Answer 5

Treat the stroke as ischaemic

Question 6

Why can’t the CT scan confirm if it is a ischaemic stroke?

Answer 6

The brain injury from an ischaemic stroke cannot be picked up until at least half a day after the stroke has happened

Question 7

Can a CT scan identify a haemorrhage?

Answer 7

Yes a bleed is easily identifiable on a CT scan

Question 8

What test can confirm an ischaemic stroke?

Answer 8

MRI

As it looks at blood flow within the brain

Question 9

What is the ischaemic core?

Answer 9

The area closes to the artery that has been blocked off

<20% blood flow to this area

Neuronal cell death - necrosis happens within minutes

Very difficult to treat

Question 10

What is the ischaemic penumbra?

Answer 10

Region surrounding the ischaemic core

Some blood supply from the nearby arteries

Injury can be reversed if blood supply is repaired

Without treatment, cells die within hours

Question 11

As time goes on, what happens to the core injury?

Answer 11

It continues to expand and therefore has a bigger effect

Question 12

Treatment of ischaemic stroke

Answer 12

Given aspirin to prevent any further blood clots

Given tissue plasminogen activator

Surgical treatment may be considered if the thrombolytic doesn’t work

• MERCI Retreiver
• Suction removal

Question 13

Tissue Plasminogen Activator (TIA)

Answer 13

Activates a compound in the blood called plasminogen

Once activated this is converted to plasmin

Plasmin breaks down the blood clot

Question 14

When is TIA effective?

Answer 14

Within 3-4 hours of the stroke

Question 15

Limitations of TIA

Answer 15

Limited therapeutic time window

Risk of haemorrhage
- Can be fatal

Need to consider other health issues/medications before use

Question 16

MERCI Retriever

Answer 16

Mechanical Embolus Removal in Cerebral Ischemia

Insert a wire into the artery

Wire has a blue sheath which is retracted to reveal the wire

The wire coils up and the blood clot can be removed

Question 17

Suction removal

Answer 17

Surgeon inserts a tube into the artery

The tube has a wire in it which is used to poke the clot

Suction is then used to suck up the broken-up bits of clot

Question 18

Treatments of haemorrhagic stroke

Answer 18

Management of symptoms before considering surgical options

Goal is to reduce blood flow in the brain

Given antihypertensives to reduce blood pressure

Surgical options

• Aneurysm clipping
• Coil embolisation

Question 19

Aneurysm clipping

Answer 19

Clip down the aneurysm to stop blood flow leaking out

Question 20

Coil embolisation

Answer 20

Insert tube with a wire into the artery wall

Continue to push the wire until it fills up the aneurysm space

Eventually clots up and stops the bleed

Question 21

Non-modifiable risk factors of stroke

Answer 21

Age
Gender
Ethnicity
Family history

Question 22

How does age affect your risk of stroke?

Answer 22

The older you are the more at risk you are

Arteries become less flexible as you age and may weaken

Weakening can cause bleeding in the brain

Arteries also stiffen as you age which can cause clots

Question 23

How does gender affect your risk of stroke?

Answer 23

Women prior to menopause have less chance of having a stroke due to protective feature of progesterone

After the menopause men and women become equally likely to suffer from a stroke, due to a post-menopausal drop in progesterone

As women live longer than men, they actually have a higher lifetime risk of stroke than men

Question 24

How does ethnicity affect your risk of stroke?

Answer 24

Ethnic minorities are at a greater risk of stroke

This could be due to lifestyle factors which lead to hypertension and diabetes and are more common in ethnic minorities

Question 25

How does family history affect your risk of stroke?

Answer 25

Having a family history of stroke increases your chances of having a stroke yourself

Question 26

Modifiable risk factors of stroke

Answer 26

High blood pressure

Cardiac disease

Diabetes

High cholesterol

Lifestyle factors

TIA

Question 27

Lifestyle factors which increase your risk of stroke

Answer 27

Smoking

Unhealthy diet

Alcohol consumption

Not exercising

Question 28

How does blood pressure affect your risk of stroke?

Answer 28

When BP increases, the blood is moving quicker

This is ok in wide blood vessels but in small blood vessels there is a greater chance of the blood knocking into the vessel wall

Artery may try and compensate for this by making itself thicker

This narrows the artery, causing further pressure

This also makes it easier for blood to get trapped

High blood flow can also knock into walls and weaken them, causing ballooning

If this bursts then it can cause a haemorrhage

Question 29

How does cholesterol affect your risk of stroke?

Answer 29

Cholesterol molecules can build up where the blood vessel wall is damaged

Blood clot can then form where the plaque is and cause a blockage

Alternatively, the plaque can break off and cause a blockage in one of the smaller arteries in the brain

Question 30

Why does smoking increase your risk of a stroke?

Answer 30

The toxins from tobacco can cause damage to blood vessel walls

Question 31

How does an unhealthy diet increase your risk of stroke?

Answer 31

High levels of sugar can cause blood vessel walls damage