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Flashcards in Neuro - Stroke/TIA Deck (17)
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As a quick exam to check for stroke/TIA, what (2) do you get patients to do?

Facial Droop: Have Patient Smile

Arm Drift: Close Eyes & Hold Out Both Arms


Emergency Rx for stroke (Code Stroke)

1. Urgent triage and high priority for stroke patient

2. Mobilise the stroke team

3. IV - glucose, routine biochemistry, FBE

4. ECG

5. Accurate clinical diagnosis – exclude mimics 6. Urgent CT


(4) Clinical features that help predict stroke

• exact time of onset

• patient could recall exactly what they were doing at symptom onset

• well in the last week

• definite focal symptoms or signs, worse NIHSS


(5) clinical features that help predict mimics of stroke

• known cognitive impairment

• lost consciousness or seizure at onset

• patient could still walk

• no lateralising symptoms

• confusion, non-vascular or no neurological signs


3 major stroke types

• Ischemic stroke (cerebral infarction)

• Intracerebral hemorrhage (ICH)

• Subarachnoid hemorrhage (SAH)


5 subtypes of ischaemic stroke

1. Large artery thromboembolism

2. Cardiogenic embolism (e.g. AF)

3. Small vessel (lacunar) infarction

4. Rarer causes

5. Unclassified or cryptogenic


2 subtypes of intracerebral haemorrhage

1. Deep hypertensive location

2. Lobar


3 subtypes of subarachnoid haemorrhage

1. Aneurysm

2. Arteriovenous malformation

3. Other


(4) Areas commonly affected in deep ICH

Putamen, thalamus, brainstem, cerebellum

• Usually due to hypertension and rupture of deep penetrating arteries


General area commonly affected in lobar ICH
- Causes?


• Often secondary to amyloid angiopathy, tumour, arteriovenous malformation, aneurysm


Describe primary prevention of stroke

In those who have never had strokes before

• Main modifiable risk factors are smoking, hypertension, diabetes and obesity
• Encourage smoking cessation, weight loss, increased physical activity and a healthy diet
• Antihypertensive drugs reduce the risk of primary stroke by up to 40%
• There is NO clear indication for antiplatelet treatment in low risk, or intermediate risk (uncomplicated diabetes, hypertension or hypercholestrolaemia) of stroke
• In high risk of cardiovascular disease consider aspirin


What is dabigatran?

A Direct Thrombin Inhibitor (NOAC)


What is Rivaroxaban?

Factor Xa Inhibitors (NOAC)


What is Apixaban?

Factor Xa Inhibitors (NOAC)


How do you assess stroke risk in non-valvular AF?

CHADS2 score

(score 1 for each risk factor of heart failure, hypertension, age >75, and diabetes, score 2 for previous stroke of TIA).

• If score zero, can undertake a more comprehensive risk assessment e.g. VASc

• CHADS2 score of one or more recommends an oral anticoagulant

• Oral anticoagulants reduce the risk of stroke by about 60% in people with AF


Describe secondary prevention of stroke

In those who have had a previous stroke

• Blood pressure lowering
• Cholesterol and statins
• Antiplatelet therapy – which strategy?
• Atrial fibrillation and anticoagulation
• Carotid revascularization endarterectomy and stenting

Lowering blood pressure and cholesterol at any level equally effective in secondary stroke prevention

High-risk patients benefit from BP, cholesterol lowering regardless of baseline

Antiplatelet therapy routine if patient not anticoagulated


How do you assess the risk of having another stroke in stroke patients?

ABCD2 score

- Age >60
- BP: SBP >140, DBP>90
- Clinical: e.g. focal weakness, speech impaired w/o focal weakness
- Duration
- Diabetes

Total out of 7

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