L 43

Question 1

3 types of ischaemic stroke (normal 2 + another)?

Answer 1

Thrombotic, embolic

+ Transient

Question 2

2 types of haemorrhagic strokes

Answer 2

Intracerbral (ICH) and subarachnoid (SAH)

Question 3

What do these stand for: “A stroke = CVA = CVAE”

Answer 3

A stroke = cerbrovascular accident = cerebrovascular adverse event

Question 4

ACS and angina are types of … which are … … rich clots

Answer 4

ACS and angina are types of IHD which are white platelet rich clots

Question 5

DVT and PE are types of… which are … … rich clots

Answer 5

DVT and PE are types of VTE which are red fibrin rich clots

Question 6

Along with heart disease, stroke is the … cause of death and disability in NZ

Answer 6

Along with heart disease, stroke is the leading cause of death and disability in NZ.

Question 7

Around 25% of ischaemic strokes are …

Answer 7

Around 25% of ischaemic strokes are embolic

Question 8

Biggest modifiable risk factors for stroke (without history)

Answer 8

Cigarette smoking and hypertension

Question 9

Sudden stroke signs and symptoms x5

Answer 9

• Weakness/numbness of face/arm/leg on one side
• Blurred or loss of vision in one or both eyes
• Dysarthria or aphasia
• Sudden dizziness, loss of balance, difficulty controlling movements
• Headaches (more common in haemorrhagic stroke)

Question 10

Stroke complications x4

Answer 10

1. Mortality
2. Permanent loss of function
3. Long term: impaired vision/speech, hemiparesis, limb hemiplagia, dysphagia, memory loss, depression.

Question 11

Hemiparesis

Answer 11

Severe weakness on one side of body

Question 12

Hemiplegia

Answer 12

Paralysis of one side of the body

Question 13

Stroke diagnostics x6

Answer 13

• Clinical assessment
• Blood glucose
• Platelets and coagulation screen
• Head CT to rule out haemorrhagic stroke
• Head MRI to show area and extent of ischaemia
• ECG (especially if at risk of AF)

Question 14

Principles of stroke treatment x4

Answer 14

Prevention of stroke
Quick recognition, treatment, and propagation prevention
Brain recovery and rehabilitation
Secondary prevention (HTN, AF etc)

Question 15

NP treatments for stroke (similar to IHD) x6

Answer 15

• Nutritional advice
• Regular physical activity and weight loss
• Moderation of alcohol consumption
• SMOKING CESSATION!
• Surgery (reperfuse brain or repair damaged vessel)
• Brain recovery and rehab (physio, speech, occupational therapy)

Question 16

Short term treatment strategy for ischaemic stroke (4.5h-24h)

Answer 16

• Revascularisation (thrombectomy or fibrinolytics) !!!!
• IV DHP CCB only if BP >220/120 mgHg (don’t do if diastolic <80 as will be too low).
• Antiplatelets (e.g aspirin +/- clopidogrel), 24 hours after alteplase therapy.

Question 17

What does TIME IS BRAIN mean

Answer 17

Every minute that the stroke is not treated, more of the brain is getting damaged.
Long term treatment strategy for ischaemic stroke

Question 18

Reduce risk factors AND…

Answer 18

If cardioembolic warfarin (or dabigatran or rivaroxaban)
If non-cardioembolic aspirin (+ dipyridamole) or clopidogel
+ moderate/high intensity statin
+ ACEI +/- thiazide, ARB or CCB if BP >140/90mmHg

Question 19

Cardioembolic

Answer 19

Stroke due to blood clot in the heart traveling to the brain.

Question 20

Why are the treatments different for cardioembolic or non-cardioembolic strokes?

Answer 20

Because with a cardioembolic stroke, the blood will be stagnating and causing red clots, therefore you need anticoagulants not antiplatelets.

Question 21

Anticoagulants are used to treat:

Answer 21

Red clots, fibrin rich. They reduce fibrin formation to prevent clots from forming and growing.

Question 22

Antiplatelets are used to treat:

Answer 22

White clots, platelet rich. They prevent platelets from clumping together and therefore prevent white clots from forming.

Question 23

Following an ischaemic stroke, you want to get the patient’s LDL to be below …

Answer 23

2mmol/L

Question 24

Which type of stroke is more common and largely preventable?

Answer 24

Ischaemic stroke

Question 25

What is primary prevention of ischaemic stroke?

Answer 25

Management of HTN, smoking and AF.

Question 26

Treatment summary for ischaemic stroke: | PROMPT TREATMENT!

Answer 26

- Reperfursion through alteplase or mechanical reperfusion - Antiplatelet therapy lifelong + high dose statin + BP management - Brain recovery and rehabilitation