Strokes ☺️

Question 1

Ischemic stroke

• types
• pathophysiology
• prevalence
• risk factors

Answer 1

Most common stroke
TIA - U24hrs
Ischemic stroke - 24hrs+
-thrombosis from large vessel
-embolus often from AF
Both block blood flow

Age
HTN
Smoking
High lipids
DM
AF

Question 2

Hemorrhagic stroke

• types
• pathophysiology
• risk factors

Answer 2

Intracerebral hemorrhage
Subarachnoid hemorrhage
Both lead to reduction in blood flow to brain

Age
HTN
AVM
AC use

Question 3

Presentation

-what additional symptoms are more common in haemorrhagic stroke

Answer 3

RAPID FUNCTION LOSS

• unilateral motor/sensory loss with forehead sparing
• homonymous hemianopia
• swallowing problems
• balance problems

Decreased in LOC
Headache
N+V

Question 4

Admission and key timeframes

Answer 4

ADMIT EVERYONE WITH SUSPECTED STROKE TO STROKE UNIT - within 4hrs of presentation

• determine symptom onset - when patient was last well if unwitnessed
• thrombolysis possible within 4.5hrs

KEY INVESTIGATION - Head CT within 1hr of hospital presentation=> is it ischemic or hemorrhagic?
MRI if still not sure

Question 5

Possible stroke mimic symptoms

Answer 5

Gradual onset, progressive, migratory
Positive symptoms
-flashing lights
-tingling, jerking, trembling
-known history of cognitive impairment
-resp, abdo signs

Question 6

Management of confirmed ischemic stroke

• definitive
• CI to thrombolysis

Answer 6

Thrombolysis + 300mg aspirin (IV alteplase)
-presentation U4.5hrs AND not CI

CI

• past intracranial bleed
• uncontrolled HTN
• pregnant

Question 7

Management of TIA

• immediate
• multiple TIA/suspected cardioembolic/carotid cause
• TIA in past wk
• TIA in past wk+

Answer 7

Immediate 300mg aspirin

Carotid endarterectomy assessment with duplex US - 50-99%

TIA within 1wk => urgent assessment within 24hrs
TIA within 1wk+ => urgent assessment within wk

Question 8

Management of hemorrhagic stroke

Answer 8

NEUROSURGERY REFERRAL

Mainly supportive

• Reverse AC
• Lower BP

Question 9

Secondary management of strokes

• lifestyle
• medication

Answer 9

Increased physical activity
Smoking cessation
Reduce alcohol
Diet optimisation for CVD
T2DM, HF

Clopidogrel
Atorvastatin
HTN management