What is the difference between a TIA and ischaemic stroke?
o >24hrs = ischaemic stroke
o <24hrs = TIAs
What are the risk factors for ischaemic stroke?
General: • Age • HTN • Smoking • Hyperlipidaemia • DM
Cardioembolism:
• AF
What are the risk factors for haemorrhagic stroke?
- Age
- HTN
- AV malformation
- Anticoagulation therapy
What is the acute management of strokes?
- Use FAST outside hospital
- Admit patient to specialist stroke centre
- ABCDE
- Neurological examination
- ROSIER score
- NIHSS score
What basic bedside investigation do you want to do for someone with a suspected stroke and why?
Blood glucose Exclude hypoglycaemia (<3.3mmol/L)
What does the ROSIER score indicate?
Stroke likely if >0
What does the NIHSS score indicate?
Higher the score, more severe the stroke
When would you lower BP in stroke?
- Hypertensive encephalopathy
- Hypertensive nephropathy
- Hypertensive cardiac failure/MI
- Aortic dissection
- Pre-eclampsia/eclampsia
What investigations do you do for stroke and why?
Non-contrast CT
o Assess whether Ischaemic or Haemorrhagic
Carotid US
o Assess for carotid stenosis
When do you consider carotid endarterectomy?
> 70% stenosis
What is the management for an ischaemic stroke?
- Thrombolysis within 4.5hrs symptom onset
- Mechanical thrombectomy within 6hrs symptom onset
- 300mg Aspirin STAT 2 weeks then Switch to clopidogrel 75mg
Secondary prevention
- Statin 48hrs after
- HTN, DM
- AF – anticoagulate
What is the management for an haemorrhagic stroke?
- Stop/reverse anticoagulants and antithrombotics
- Rapid BP lowering therapy within 6 hrs symptom onset
- Surgical intervention to remove haematoma
What must a patient’s BP be for thrombolysis?
=<185/110
When do you delay aspirin in stroke?
If the patient has undergone thrombolysis
If clopidogrel is CI, what do you give for stroke?
aspirin + dipyridamole
When do you rapidly lower BP in haemorrhagic stroke and when is this CI?
If systolic is between 150-220mmHg
CI
- Underlying structural cause
- GCS <6
- Poor expected prognosis
What is the barthel index?
Assesses whether the patient is independent or dependent in ADL
How do you manage a TIA
- 300mg Aspirin + PPI
Secondary prevention
- Statin 48hrs after
- HTN, DM
- AF – anticoagulate
Carotid USS
If a patient is currently taking aspirin, what would you do?
Continue on current dose
What is the DVLA rules for TIA?
Car = stop for 1 month Lorry = stop for 1 year
