stroke Flashcards
(5 cards)
what are the types of stroke?
ischaemic (BLOCKAGE) (87%)
- clots, fatty plaque, smoking, alcohol, diabetes, dyslipidemia, hypertension
haemorrhagic (RUPTURE) (13%)
- hypertension, aneurysms, blood thinners, head trauma, bleeding disorders
ischaemic stroke diagnosis?
can be done in community
F - face - can they smile
A - arm - can they raise both arms
S - speech - can they speak clearly
T - time - call 999
on admission use ROSIER tool to diagnose properly
ischaemic stroke management
initial:
- alteplase - administer once haemorrhagic excluded within 4.5hrs
- aspirin 300mg OD for 2 weeks after onset of symptoms
long term: advice against supplements e.g. B vitamins or folate
1st line - clopidogrel 75mg OD (lifelong)
2nd line - if clopi c/i aspirin 75mg OD + MR dipyridamole 200mg BD
3rd - MR dipyridamole alone
4th- Aspirin alone
PPI - lansoprazole not omep
start high intensity statin as soon as can swallow (atorva 20-80mg) - aim is to reduce non-HDL by >40%
manage hypertension systolic <130
- ACEi/ARB or CCB or TLD
haemorrhagic stroke management
surgery to remove haemotoma and relieve intracranial pressure
stop and reverse anticoagulation treatments
rapid BP lowering - in acute intracerebral haemorrhage
- within 6 hrs of symptoms
- who have systolic 150-220
risk with statins not determined
- consider benefit vs risk before initiating statin
how to treat suspected TIA?
immediate aspirin 300mg
if already on aspirin 75 - continue on that no need for 300mg
long term management same as stroke
if at high risk of TIA:
DAPT
aspirin + clopi - 90 days
aspirin + ticagrelor - 30 days
