Stroke

Question 1

Classification?

Answer 1

Stroke

• Ischaemic
• Haemorrhagic (10-20%)

TIA

Question 2

define TIA

Answer 2

transient neurological deficit secondary to ischaemia, without infarction

• symptoms of stroke resolve fully within 24hrs, however duration is only up to an hr

Question 3

what is a crescendo TIA?

Answer 3

TIAs often precede a stroke, crescendo TIA is when a person has 2 or more TIAs in a week- high risk of progression to full stroke

Question 4

Risk factors?

Answer 4

• CVD
• carotid artery disease
• HT
• Diabetes
• hypercoagulable states
  
  • COCP etc
• smoking
• hypercholesterolaemia
• AF

Question 5

Presentation?

Answer 5

• always suspect vascular cause when SUDDEN ONSET neurological deficit, esp asymmetrical
• symptoms depend on area / artery territory affected
  
  • Anterior cerebral artery: arms & legs affected
  • Middle cerebral artery: hands, fingers, face affected
  • Posterior cerebral artery: vision affected
  • Basilar artery: vertigo, dizziness etc

Question 6

Ix

• stroke
• TIA

Answer 6

• stroke
  
  • Blood glucose- exclude hypoglycaemia
  • Immediate CT brain - rule out primary intracerebral haemorrhage
• TIA
  
  • Blood glucose
  • FBC & U&E
  • ECG
  • Diffusion-weighted MRI - gold standard
  • Carotid US
    
    • to see if there is carotid artery stenosis

Question 7

if there is carotid artery stenosis present, what can be done?

Answer 7

• endarterectomy - removal of plaque
• carotid senting - widening lumen

Question 8

Mx for stroke

Answer 8

• Admit to specialist stroke centre
• 300mg Aspirin stat. then continue for 2 weeks
• Thrombolysis w/ alteplase
  
  • only given after CT, once haemorrhage excluded
  • needs to be given within 4.5hrs
  • close monitoring for post thrombolysis complications ie haemorrhage
• Rehabilitation

Question 9

what aspect needs to be closely monitored during a stroke?

Answer 9

BP must not be lowered in order to ensure perfusion to contralteral side, unless there is malignant hypertension

Question 10

Mx for TIA

Answer 10

• Start 300mg Aspirin daily
• Start secondary prevention measures for stroke
• ABCD2 score

Question 11

What are secondary prevention measures?

Answer 11

• Clopidogrel 85mg daily (alternatively dipyridamole twice daily)
• Atorvastatin
• Optimise modifiable risk factors

Question 12

How does Dipyridamole work?

Answer 12

nucleoside transport inhibitor - prevents clot formation

Question 13

What is the ABCD2 tool?

Answer 13

A tool used to assess the risk of progression to stroke within the next 48h. Higher score= higher risk.

A- age (>60=1)

B- BP (>140/90=1)

C-Clinical features (unilateral weakness = 2, dysphasia without weakness= 1)

D- Duration (>60mins= 2, 10-60mins = 1, < 10 mins = 0)

D-Diabetes = 1