Stroke

Question 1

What are ischaemic strokes and cause

Answer 1

Blockage

Blood clots
Fatty plaque
Diabetes
Smoking
Alcohol
Dyslipidaemia
Hypertension

Question 2

What are haemorrhagic strokes and causes

Answer 2

Rupture

Hypertension
Aneurysms
Blood thinners
Head trauma
Brain tumours
Bleeding disorders

Question 3

Ischaemic stroke diagnosis and on admission

Answer 3

F - face
A - arm
S - speech
T - time

Use ROSIER tool to diagnose

Question 4

What is initial management plan of ischaemic stroke

Answer 4

Alteplase within 4.5hrs onset and excluded haemmorhagic

Aspirin 300mg until 2 weeks after onset of stroke

Question 5

What is long term management of ischaemic stroke 1st 2nd line and other supporting meds

Answer 5

1st clopidogrel 75mg
2nd aspirin 75mg

PPI
Statin
Manage HT - TLD, CCB, ACEi/ARB

Question 6

What is initial management plan for haemorrhagic stroke

Answer 6

Surgery to remove haematoma RELIEVE INTRACRANIAL PRESSURE

Stopping/reversing anticoagulants

Question 7

When to avoid management plan of HIGH BP in acute intracerebral haemorrhage

Answer 7

Within 6hrs of symptoms
Systolic 150-220mmhg

Do not lower BP in pts with structural cause, GCS<6, neurosurgery to evaluate haematoma, very large haematoma with poor prognosis

Question 8

What is transient ischaemic attack

Answer 8

Temporarly loss of blood supply to brain

Lasts few mins and resolves within 24 hrs

Question 9

What is initial treatment plan for transient ischaemic attacks

Answer 9

Aspirin 300mg
If already on asp 75mg no need to add

Question 10

What is long term management for transient ischaemic attack

Answer 10

Same as ischaemic stroke
1stClop 75 2ndasp 75
PPI
Statin
Control HT

Question 11

If at high risk of TIA again, what is treatment plan

Answer 11

Before starting long term treatment:

1. DAPT - asp + clopi up to 90 days

2.DAPT - asp + tica up to 30 days