Stroke - Therapy

Question 1

What is the most important think to acknowledge when assessing and treating stroke patients?

Answer 1

time!

time lost = brain lost

Question 2

What is the penumbra?

Answer 2

The area surrounding an ischaemic event such as thrombotic or embolic stroke. Immediately following the event, blood flow and therefore oxygen transport is reduced locally, leading to hypoxia of the cells near the location of the original insult..

Question 3

What happens to brain cells during an ischaemic stroke?

4

Answer 3

• reduced O2 and glucose
• release of Ca2+
• cells swell (brain swells)
• apoptosis

Question 4

What is the mnemonic used to recognise stroke?

Answer 4

FACE

Facial weakness
Arm weakness
Speech impairment
Time to call 999

Question 5

What would be the first thing you would want to do for a potential stroke patient?

(3)

Answer 5

• arrange urgent head CT
• contact stroke unit
• ensure no contraindications to thrombolysis

Question 6

What are the advantages of CT over MRI?

Answer 6

• quick

- shows up blood

Question 7

What would you consider as a primary treatment measure for acute ischaemic stroke?

Answer 7

thrombolysis

Question 8

What is the aim of thrombolysis in the treatment of strokes?

Answer 8

to restore perfusion before cell death occurs (salvage penumbra)

Question 9

What drug might you use for thrombolysis?

Answer 9

alteplase

Question 10

What are the risks associated with thrombolysis?

What percentage of patients are affected by this?

Answer 10

haemorrhage

3%

It can be devastating

Question 11

What scoring system might be used to establish whether thrombolysis would be a suitable treatment plan?

Answer 11

ASPECTS

8+/10 = good score

Question 12

How does alteplase help reduce the negative effects of stroke?

Answer 12

• converts plasminogen to plasmin.

- plasmin breaks down fibrin in thrombus.

Question 13

What does the severity of stroke depend on?

Answer 13

• collateral circulation
• size of penumbra/infarct
• time

Question 14

How might a stroke appear on a head CT?

Answer 14

white = occlusion/clot in artery

black area = penumbra/infarct/increased water

Question 15

How does a stroke appear on an MRI in the acute early stages?

Answer 15

white

Question 16

When is thrombolysis treatment given for strokes?

Answer 16

<4.5 hours

Question 17

What are the risk factors for haemorrhage after thrombolysis treatment of stroke?

(7)

Answer 17

infarct size
vessel occlusion
diabetes
BP
age
stroke severity
antiplatelets (e.g. aspirin)

Question 18

What are the different types of stroke?

3

Answer 18

• TIA (mini stroke)
• ischaemic stroke
• haemorrhage stroke

Question 19

What are the contraindications to thrombolysis?

Answer 19

• age (<80)
• CVS (hypertensive, recent MI)
• recent surgery (antiplatelets)

Question 20

What are the interventional/surgical treatments for stroke?

Answer 20

endovascular thrombectomy

Question 21

What might be did for a patient who has suffered from an acute MCA territory ischaemic stroke with cerebral oedema complications?

Answer 21

hemicraniectomy

Question 22

What kind of strokes are treated with thrombectomy and IVT?

Answer 22

large vessel occlusion stroke

Question 23

How is a TIA similar to a stroke, in terms of secondary prevention measures?

Answer 23

• chance of recurring stroke is same for both

- both require essential secondary prevention measures.

Question 24

What other medication is often given along with rTPA?

Answer 24

aspirin

Question 25

Which patients are most at risk of a secondary stroke?

Answer 25

patients with a past stroke/TIA

Question 26

What are the prevention measures to prevent reoccurence? | 3

Answer 26

1. antiplatelets 2. statin 3. antihypertensives

Question 27

What antiplatelet drugs might be used for secondary prevention? What dosages?

Answer 27

aspirin (100mg/2wks) clopidogrel (75mg/day)

Question 28

What are the therapeutic effects of statins? What are the side effects?

Answer 28

lower blood cholesterol muscular pains, association with type 2 diabetes

Question 29

What are the therapeutic effects of aspirin? What are the side effects?

Answer 29

antiplatelet, antithrombosis haemorrhage, dyspepsia

Question 30

What are the therapeutic effects of clopidogrel? What are the side effects?

Answer 30

antiplatelet, antithrombosis haemorrhage, diarrhoea

Question 31

Other than a throbectomy, what would be another surgical procedure which could prevent stroke?

Answer 31

Carotid endarterectomy