BNF

Question 1

what is a Transient ischaemic attack (TIA) ?

Answer 1

“mini stroke”
-blood supply to your brain is temporarily disrupted
Oxygen dep - ox rich blood vessel = blocked
blood clot formed in systemic body = travel to brain OR fatty material OR air bubbles

S:
-face dropping on 1 side,
-not being able to lift your arms
- speech problems

Question 2

Difference between TIA and Stroke?

Answer 2

duration - TIA = few mins - hours and resolve within 24 hours

Question 3

TIA treatment primary

Answer 3

attack suspected?
- Aspirin
if intolerant or hypersensitive
+PPI OR alternative antiplatelet

…. diagnosis to receive secondary prevention / long term management of Ischaemic stroke.

Question 4

What is a Ischaemic stroke

Answer 4

most common

blood clot blocks flow of blood/oxygen to brain
- blocks = narrowed arteries or plaques over time (atherosclerosis)

risk factors of ^
age
smoking
HT
Obesity
DM2
Excessive alcohol intake
AF ( result in clots in heart - break into vessels)

Question 5

Ischaemic stroke initial management

Answer 5

Alteplase

1.Alteplase (fibrinolytics)
activate plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.

Initially 900 micrograms/kg (max. per dose 90 mg), treatment must begin within 4.5 hours of symptom onset, to be given over 60 minutes, the initial 10% of dose is to be administered by intravenous injection and the remainder by intravenous infusion.

2.1 EXCLUDE intracranial haemorrhage

2.2 Aspirin within 24 hours of symptom onset (PPI or alt anticoagulant )

3.1 Sinus rhythm = Anticoagulants are not recommended as an alternative to antiplatelet drugs

3.2 but parenteral anticoagulants may be indicated in patients who are symptomatic of, or at high risk of developing, deep vein thrombosis or pulmonary embolism

Warfarin sodium DO NOT give in acute phase of IS

4. IS and AF = give aspirin for 2 weeks before considering anticoagulant treatment
5. Patients already receiving anticoagulation for a prosthetic heart valve who experience a disabling ischaemic stroke and are at significant risk of haemorrhagic transformation, should have their anticoagulant treatment stopped for 7 days and substituted with aspirin.
6. HT treatment in IS = can result in reduced cerebral perfusion only ok in HT emergency or pt. considered for thrombolysis.

Question 6

Alteplase class of drug?

Answer 6

fibrinolytics =plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi )

Question 7

why PPI and aspirin?

Answer 7

dyspepsia (intolerance)

Question 8

Ischaemic stroke / TIA long-term management

Answer 8

…reduce the risk of further cardiovascular events

1.1 (NO AF) = clopridgrel long term

or modified-release dipyridamole in combination with aspirin

or just modified-release dipyridamole

or just aspirin

1.2 AF = long-term anticoagulant treatment
apixaban OR vitamin K antagonist such as warfarin sodium

Aspirin not recommended

2. Artivostatin 80mg (HIGH DOSE) initiated 48 hours after stroke symptom onset
3. Diet and Lifestyle

Question 9

what to avoid starting after IS/TIA

Answer 9

BB for Bp control unless indicated for a co-existing condition

Question 10

Intracerebral haemorrhage initial Management

Answer 10

STOP ANY ANTICOAGULANTS UNLESS PT symptomatic of deep vein thrombosis or pulmonary embolism; placement of a caval filter is an alternative in this situation.

may need Surgical intervention to relieve haematoma and relieve intracranial pressure.

Do not give rapid BP-lowering treatment to pt who have an underlying structural cause, have a score on the Glasgow Coma Scale of below 6

consider rapid BP-lowering treatment to pt present within 6 hours of symptom onset with systolic blood pressure between 150 and 220 mmHg and who do not fit any exclusion criteria.
Target BP = 140 mmHg or lower, ensuring that the magnitude drop does not exceed 60 mmHg within 1 hour of starting treatment

Rapid blood pressure lowering should also be considered on a case-by-case basis for patients who do not fit any exclusion criteria and who present beyond 6 hours of symptom onset or who have a systolic blood pressure greater than 220 mmHg. Seek specialist paediatric advice if considering blood pressure lowering in patients aged 16 or 17 years

Question 11

Intracerebral haemorrhage long-term Management

Answer 11

Specialist - aspirin not recommended.

BP management try to avoid hypoperfusion

Avoid statins BUT can be used in caution of CV risk outweighs further risk of haemorrhage damage.