Stroke as a drug target

Question 1

Define stroke

Answer 1

a cerebrovascular event - a clinical syndrome caused by disruption of blood supply to the brain characterised by rapidly developing neurological signs lasting 24 hours

Question 2

What are 3 types of stroke

Answer 2

• ischaemic (cardiac embolic stroke)
• thrombotic (plaque rupture)
• hemorrhagic (has the worst outcomes)

Question 3

Name 3 risk factors of ischaemic stroke

Answer 3

• older age
• hypertension
• obesity

Question 4

Name 3 risk factors of hemorrhagic stroke

Answer 4

• age 45-70
• family history
• smoking

Question 5

What are the three blood supplies to the brain

Answer 5

• anterior cerebral arteries
• middle cerebral arteries
• posterior cerebral arteries

Question 6

Where do anterior circulation strokes occur and what are the signs and symptoms

Answer 6

occur in the anterior and/or middle cerebral arteries

Signs and symptoms:

• one-sided weakness
• loss of sensation
• speech disturbance
• problems with eye movements

Question 7

Where do posterior circulation strokes occur and what are the signs and symptoms

Answer 7

occur in the posterior cerebral arteries

Signs and symptoms:

• in the brainstem there is signs of facial weakness, eye movements
• in the cerebellum there are signs of ataxia

Question 8

What would be done if someone was suspected of having a stroke

Answer 8

• CT head scan
• specialist bloods to assess clotting, cholesterol, diabetes, infection markers
• MRI
• ECG/Echo

Question 9

How is acute stroke managed

Answer 9

• ABCDE approach
• bleed ruled out on CT
• If symptoms developed within 4.5 hour window with no contraindications to thrombolysis > thrombolyse (alteplase)
• if symptoms developed after 4.5 hours then patient is given 300mg of aspirin
• if there is a bleed on CT then they are referred to neurosurgeon

Question 10

Name some secondary prevention measures of stroke

Answer 10

1. antiplatelet therapy to prevent further ischemia
2. anticoagulation therapy if they have atrial fibrillation
3. control BP if hypertensive
4. Improve blood sugar control if diabetic
5. statin therapy to improve cholesterol
6. exercise and weight loss
7. reduce alcohol
8. smoker cessation

Question 11

What are the main treatments for ischaemic stroke

Answer 11

antiplatelet or anticoagulation therapy (if the patient has atrial fibrillation)