Flashcards in Stroke Deck (29)
What are the causes of an ischaemic stroke?
Cerebral thrombosis from atherosclerotic disease
Distal embolism from cardioembolic disease
In haemorrhagic stroke, in which two places can the bleed take place in?
Intracerebral - rupture of small vessel
Subarachnoid - rupture of aneurism in subarachnoid space
What are the symptoms of stroke?
Arm or leg weakness
Time - call 999 if any of symptoms present
Men at higher risk of stroke and more men die of it than women. True or false?
False - higher risk men but more women die
What are the modifiable risk factors of stroke?
What are the non-modifiable risk factors of stroke?
What type of scan is done to investigate stroke?
CT scan - will identify whether or not there is a bleed. If no bleed then can initiate treatment for ischaemic stroke
After patient gets admitted to hospital and CT scan identifies ischaemic stroke, what would patient be given?
What type of drug is alteplase?
How soon after onset of symptoms should alteplase be given?
Within 3 hours of symptoms onset - licensed for up to 4.5hrs but more effective if given sooner
If patient with ischaemic stroke cannot be thrombolysed, what drug is given instead?
If aspirin is given instead of alteplase how long should it be continued for?
up to 14 days
If patient has been thrombolysed, are they given aspirin?
Yes, wait 24hrs before offering aspirin, CT scan repeated to ensure no bleed (haemorrhagic transformation) then aspirin started for 2 weeks
What is the acute treatment option for haemorrhagic stroke?
Neurosurgical intervention sometimes necessary if on-going bleed
Anti-coagulants stopped and reversed if INR >1.4
How can anticoagulants be reversed?
Prothrombin complex concentrate
What lipid lowering treatment is given in ischaemic stroke?
High intensity (atorvastatin 20-80mg) as soon as patient can swallow safely
What would you do if patient has high blood pressure and needs to be thrombolysed?
BP needs to be reduced before thrombolysis initiated if BP >185/110 mmHg
Is BP always controlled with meds in acute stroke?
Fluctuations of BP common after acute stroke - only manage high BP if hypertensive crisis, complications of hypertension arise e.g. MI or patient has high BP and and needs thrombolysis
What are the long-term treatments for ischaemic stroke. For example, patient has been on aspirin for 2 weeks, what are they given to prevent further stroke?
All patients start clopidogrel
If clopidogrel not tolerated, what can patients be given long-term instead?
Aspirin plus MR dipyridamole
If aspirin and clopidogrel not tolerated, what can patients be given long-term?
What type of drug is clopidogrel?
Which drug cannot be given in AF?
If patients experience GI side effects with clopidogrel, what drug can also be given?
PPI e.g. omeprazole
In which cases are anticoagulants given in long-term treatment?
Ischaemic embolic stroke
Name an anticoagulant that can be initiated as long-term treatment for an ischaemic embolic stroke
Which antihypertensives can be given long-term?
If patient >55yrs, CCB e.g. diltiazem
If patient <55yrs, ACEI e.g. lisinopril
Which patients are given statins as long-term treatment?
All ischaemic stroke patients - atorvastatin mainly