Stroke Treatment & Prevention

• What is the clinical definition of stroke?

  • Sudden onset
  • Neurological symptoms
  • Vascular origin
  • Lasting >24 hours or interrupted by death
• What is the response time for a Category 2 call to stroke treatment?

  8-10 mins
• What does "TIME is BRAIN" imply in stroke treatment?

  Time lost equals brain lost
• What are the classifications of stroke by area of the brain affected?

  • TACS
  • PACS
  • LACS
  • POCS
• What is the initial imaging technique used in stroke?

  CT head
• What does the CT head differentiate in stroke cases?

  Bleed vs infarct
• What is the time frame for thrombolysis after stroke onset?

  Within 4.5 hours
• What are the risks associated with thrombolysis?

  Bleeding in various locations
• What are the inclusion and contraindications for tPA thrombolysis?

  Inclusion:

  • Within 4.5 hours of symptoms

  Contraindications:

  • BP >185/110 unresponsive to treatment
  • Recently damaged brain
  • Stroke >4.5 hours and <3 months ago
  • Major surgery in last 14 days
  • GI or urinary bleeding in last 21 days
  • Clotting disorder
  • Platelets <100
  • INR >1.7 or NOAC within 24-48 hours
• How long should it take from arrival to delivery of thrombolysis?

  20-30 minutes
• What is the time frame for mechanical thrombectomy?

  Less than 6 hours
• What is the NNT for various treatments mentioned?

  • Antihypertensives to prevent death: 625
  • PCI to prevent death in MI: 50
  • Thrombolysis for a good outcome: 10
  • Thrombectomy: 5
• What new trends are mentioned in stroke treatment?

  Use of AI and image-based treatment
• What is the purpose of investigating the cause of a stroke?

  To identify underlying conditions
• What are the common causes investigated for stroke?

  • Atherosclerosis
  • Blood pressure issues
  • Lipids
  • Renal function
  • Carotid ultrasound
  • Embolism from heart
• What are rarer causes investigated for stroke?

  • Blood clotting disorders
  • Inflammatory disorders (vasculitis)
  • Dissection of blood vessels
  • Hereditary disorders
• What is the goal of secondary prevention in stroke?

  • Reduce/prevent recurrent events
  • Implement lifestyle measures
  • Use pharmacological treatment
• What special circumstances are considered in secondary prevention?

  • Atrial fibrillation: use anticoagulants
  • Carotid stenosis: potential surgical options
• What is the summary of stroke management?

  • Stroke is a medical emergency
  • Requires treatment on an Acute Stroke Unit
  • Eligible patients may receive hyperacute treatments
  • High risk of recurrence can be reduced by secondary prevention