Stroke Guidelines (NICE)

Question 1

What scan should you consider for patients who have had a TIA after specialist assessment?

Answer 1

MRI same day
NOT CT

Question 2

What should everyone who has had a TIA and could be a candidate for carotid endarterectomy have?

Answer 2

Carotid imaging (doppler?)

Question 3

What scan is done for patients with acute stroke?

Answer 3

Non-contrast CT

Question 4

What scan is done after non-contrast CT in patients who are candidates for thrombectomy?

Answer 4

CT angiography

Question 5

What needs to be excluded before giving thrombolysis and how is this done?

Answer 5

Haemorrhage
Non-contrast CT

Question 6

What is the time limit from symptom onset to giving thrombolysis?

Answer 6

4.5 hours

Question 7

When should thrombectomy aim to be performed?

Answer 7

Within 6 hours of stroke onset

Question 8

Should you give both thrombolysis and thrombectomy?

Answer 8

Yes

Question 9

What area of the circulation needs to be blocked for thrombectomy to be appropriate?

Answer 9

Proximal anterior circulation

Question 10

From 6-24 hours after symptom onset, when should thrombectomy be carried out?

Answer 10

If there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume

Question 11

What medication should be offered to people as soon as possible after stroke?

Answer 11

Aspirin 300mg

Question 12

How long should aspirin continue after acute stroke?

Answer 12

2 weeks

Question 13

What is the initial management of acute cerebral venous sinus thrombosis (including secondary haemorrhage)?

Answer 13

Full-dose anticoagulation treatment (initially full-dose heparin and then warfarin [international normalised ratio 2 to 3])

Question 14

For people with acute stroke and AF, what is the medical management?

Answer 14

Aspirin 300mg two weeks before considering anticoagulation

Question 15

Management for stroke with symptomatic DVT or PE

Answer 15

Anticoagulation treatment in preference to treatment with aspirin unless there are other contraindications to anticoagulation

Question 16

Should you immediately treat a stroke with a statin?

Answer 16

No
Continue with statin if already on it

Question 17

When should patients with acute intracerebral haemorrhage have rapid blood pressure lowering?

Answer 17

If within 6 hours of onset and systolic BP 150-220
OR
After 6 hours with systolic BP >220

Question 18

Should BP be routinely lowered for patients with acute ischaemic stroke?

Answer 18

No

Only if hypertensive crisis

If undergoing thrombolysis consider lowering to below 185/110mg

Question 19

What is the preferred long term anti-platelet management for ischaemic stroke or TIA?

Answer 19

Clopidogrel 75mg daily

Question 20

What is the second line long term anti-platelet management for ischaemic stroke or TIA if clopidogrel cannot be tolerated?

Answer 20

Modified–release dipyridamole (200 mg twice a day) combined with low dose aspirin

Question 21

Acute TIA medical management

Answer 21

300mg aspirin

Question 22

Should lipid lowering be done on patients who have had a stroke or TIA?

Answer 22

Yes high dose statin

Question 23

Do you give clopidogrel long term for patients with stroke with associated AF?

Answer 23

No

Question 24

What anticoagulants do you give for stroke in a patient with AF and when?

Answer 24

14 days after stroke
DOAC

Question 25

What degree of stenosis can be considered for carotid endarterectomy (2 different guidelines)?

Answer 25

> 70% according ECST criteria
50% according to NASCET criteria