Strokes

Question 1

What symptoms would you expect from Total Anterior Circulation Syndrome?

Answer 1

Hemiplegia involving at least two of face, arm and leg +/- hemisensory loss

Homonymous Hemianopia

Cortical signs (dysphasia, neglect etc)

Question 2

What does ABCD2 stand for and what is the significance of the score?

Answer 2

Age- over 60= 1 point

Blood pressure- over 140/90= 1 point

Clinical Features- Unilateral weakness= 2 points

Speech disturbances without the weakness= 1 point

Duration of symptoms- over 1 hour= 2 points

between 10 minutes and an hour= 1 point

Diabetes- yes= 1 point

Question 3

when would a stroke patient be thrombolysed?

Answer 3

After CT/MRI has excluded haemorrhage

if patient is between 18-80

and onset of symptoms is <4.5 hours

Question 4

after CT/MRI what other investigations should be done?

Answer 4

Full Lipid Profile

• Blood Pressure
• Carotid Scan
• ECG
• Consider

– 24 Hour ECG (or longer)

– Echo Cardiogram

Question 5

what is the secondary prevention of a stroke?

Answer 5

Aspirin- 300mg per day for 2 weekks then 75mg

Warfarin- if cardioembolic cause. Aim for INR of 2.5-3.5. Bigger risk of bleeding with warfarin. Can use aspirin instead

Control of risk factors- statins, BP control, smoking

Carotid endarterectomy