Treatment of Stroke Flashcards

1
Q

What are basic things stroke patients have to start working on immediately after admission?

A

Mobilise patients asap (probability of returning home decreases by 20% for each day patient is not mobilized)

Swallowing - problems present in 50% of all stroke patients

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2
Q

What is the aim of thrombolysis for the treatment of a patient suffering from stroke?

A

restore perfusion before cell death occurs

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3
Q

Give an example of a drug used in thrombolysis and when to use it

A

Alteplase - used up to 4.5 hours after symptom onset

Benefits outweighs risks when used upto 4.5 hours after symptom onset (in accordance with licence)

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4
Q

What are the ways you can ensure FAST treatment of stroke?

A

Alerting hospital team

Alerting CT/radiology team

Keeping patient/relatives informed

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5
Q

Not Learning outcome

Here is some info about clot retrieval

A

https://www.youtube.com/watch?v=7gn96se6j00

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6
Q

How does clot retrieval fit in with the therapy of Thrombolysis with alteplase?

A

Thrombolysis with rTPA benefits selected patients: the earlier the better

Clot retrieval may improve outcomes further

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7
Q

What is rTPA?

A

Residual tissue plasminogen activator

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8
Q

What is the effect of rTPA? (residual tissue plasminogen activator)

A

Enzyme, catalyses conversion of plasminogen to plasmin (major enzyme responsible for clot breakdown)

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9
Q

Do no memorise

What are contraindications to thrombolysis?

A

Minor neurological deficit or symptoms rapidly improving before start of infusion.

Symptoms of ischaemic attack began more than 4 hours prior to referral, or when time of symptom onset is unknown.

Severe stroke as assessed clinically (e.g. NIHSS>25) and/or by appropriate imaging techniques.

Seizure at onset of stroke.

Symptoms suggestive of subarachnoid haemorrhage, even if the CT-scan is normal.

On warfarin therapy, or administration of heparin within the previous 48 hours and a thromboplastin time exceeding the upper limit of normal for laboratory.

Patients with any history of prior stroke and concomitant (associated) diabetes.

Prior stroke within the last 3 months.

Platelet count of below 100,000/mm3 (if available).

Systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg, or aggressive management (IV medication) necessary to reduce BP to these limits.

Blood glucose <3 or > 20 mmol/L.

Known haemorrhagic diathesis (a tendency to suffer from a particular medical condition), manifest or recent severe or dangerous bleeding, known history of or suspected intracranial haemorrhage.

(Use is contraindicated in hemorrhagic stroke and head trauma)

—Licence currently limited to <80yr

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10
Q

What should be done for a patient who has had symptoms for more than 4.5 hours without thrombolysis?

A

Contact stroke unit for admission

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11
Q

What is hemicraniectomy used to treat?

A

Brain oedema as a result of a large middle cerebral artery stroke among elderly patients.

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12
Q

What are the benefits of hemicrainiectomy?

A

Increases chances of survival, albeit with moderate to severe disability in most patients - cause of death is mostly brain herniation

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13
Q

When should hemicrainiectomy be offered?

A

Within 48 hours of stroke onset

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14
Q

Who is most likely to suffer from a stroke?

A

Someone who has already suffered from stroke

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15
Q

Does complete clinical recovery of a TIA indicate absence of infarcted tissue?

A

No - many TIA victims may show morphological changes on CT or MRI despite complete recovery

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16
Q

What drugs are used in secondary prevention?

A

Clopidogrel 75mg

Aspirin 75mg plus dipryidamole MR 200mg bd

Statin

Blood pressure drugs even if blood pressure is on normal range

17
Q

How does the reduction of absulte risk of ipsilateral carotid ischaemic stroke and stroke and death compare between surgical treatment of 70% stenosis and 50-69% stenosis?

A

Absolute reduction in risk higher in 70% of stenosis compared to 50-69% reduction of risk

18
Q

What is NIHSS?

A

Measurement of stroke severity