Stroke

Question 1

TIA resolution time

Answer 1

Usually symptoms persist for < 24 hours

Question 2

Diagnosis

Answer 2

CTH and CTA if considering thrombolectomy
BEFAST

Question 3

Thrombolytics initiation timeframe

Answer 3

Within 4.5 hours of symptoms (9 hours off-label)

Question 4

When are thrombolytics considers?

Answer 4

For every patient regardless of stroke severity is used within the timeframe

Question 5

What is the NIHSS score used for?

Answer 5

Helps to determine treatment for stroke

Question 6

NIHSS score for a stroke to be deemed a TIA?

Answer 6

<5

Question 7

Acute ischaemic stroke treatment

Answer 7

Aspirin 300mg for 14 days (started 24 hours after thrombolysis or within 24 hours of symptom onset)

Question 8

Long-term management of acute ischaemic stroke

Answer 8

Clopidogrel monotherapy (Aspirin if clopi contra-inidicated)

Question 9

Acute treatment of TIA/minor stroke?

Answer 9

Aspirin and Clopidogrel 300mg stat, followed by DAPT 75mg for 21 days OR Ticagrelor 180mg and Aspirin 300mg stat, followed by ticagrelor 90mg BD and Aspirin 75mg for 30 days.

Question 10

Long-term management options of TIA/minor stroke

Answer 10

Clopidogrel life-long (If cannot be used NICE suggests Dipyramidole AND aspirin or Aspirin monotherapy)

Question 11

Management if patient has stroke on anticogulation?

Answer 11

Stop anticoagulation and replace with Aspirin for 7 days

Question 12

Treatment for subarrachnoid haemorrhage?

Answer 12

Nimodipine 60mg every 4 hours

Question 13

When should rapid lowering of blood pressure not take place in intracerebral haemorrhage?

Answer 13

If GCS <6
If underlying structural cause
If large haematoma withpoor prognosis
If early neurosurgery to evacuate haematoma

Question 14

When should rapid blood pressure lowering be considered in intracerebral haemorrhage?

Answer 14

If can be done within 6 hours of onset and SBP 150-220
If >220 and presents outside of 6 hour window- consider

Question 15

BP target if undergoing rapid blood pressure lowering for the treatment of intracerebral heamorrhage?

Answer 15

130-139 SBP in an hour- maintained for 7 days (Initial drop should not exceed >60 in the first hour)

Question 16

When should statins be avoided in stroke?

Answer 16

In intracerebral haemorrhage- unless VTE risk outweighs risk of further haemorrhage

Question 17

Lipid modifciation stargets post stroke?

Answer 17

Fasting LDL <1.8
Non-HDL <2.5

Question 18

BP target in stroke if severe bilateral carotid artery stenosis?

Answer 18

140-150 SBP