stroke – acute hemiplegia. history sandeep patel is a 75 year old retired lawyer who has been...
TRANSCRIPT
History
Sandeep Patel is a 75 year old retired lawyer who has been admitted to MAU following a sudden onset of left sided weakness 2 hours ago.
What factors in the history would you seek to identify?
1. Timing
2. Anatomy
3. Headache
4. Stroke aetiology
5. Risk factors
What would you seek from the examination?
1. General examination
2. Cardiovascular examination
3. Neurological examination
4. Check for complications
How would you investigate?
1. Blood tests including clotting profile
2. ECG
3. Neuroimaging
4. Further imaging1. Echo
2. Carotid dopplers
How might you manage this patient pharmacologically in
the acute phase of their illness?1. Haemorrhagic stroke
2. Thromboembolic ischaemic stroke
Thromboembolic stroke
Are they suitable for thrombolysis?
May reduce those dead or with major disability if administered within 3 hours.
How would you manage this patient pharmacologically after they have
recovered from the acute illness?
How would you manage this patient pharmacologically after they have
recovered from the acute illness?
Risk reduction!
1. Aspirin
2. Warfarin if AF
3. Statins whatever the cholesterol
4. BP control
General Advice
• Stop smoking – 33% reduction in further CVA
• Alcohol – drink a small amount
• Exercise
• Can drive after 1 month if they have made a recovery
TIA risk scoreRisk factor Category Score
A Age Age > 60
Age < 60
1
0
B BP SBP > 140 or DBP > 90
Other
1
0
C Clinical features
Unilateral weakness
Speech disturbance alone
Other
2
0
D Duration > 60 mins
10 – 59 mins
< 10 mins
2
1
0
E Diabetes Yes
No
1
0
Total
Score 4 or over – 30% chance CVA within 7 days
Score 5 or 6 – 50% chance of CVA within 7 days