Neurology16 UKMLA questions
Stroke — UKMLA Revision Notes
Stroke is a clinical syndrome of rapidly developing focal neurological deficit lasting more than 24 hours (or leading to death), caused by a vascular event. Ischaemic stroke (85%) is most common; haemorrhagic stroke (15%) carries higher mortality. Rapid assessment and treatment are essential — 'time is brain'.
Key Facts
- FAST: Face drooping, Arm weakness, Speech difficulty, Time to call 999
- Ischaemic stroke: thrombolysis with alteplase within 4.5 hours of onset
- CT head: first investigation to exclude haemorrhage before thrombolysis
- Atrial fibrillation is the most common cardioembolic cause
- Secondary prevention: antiplatelet therapy, statin, BP control, anticoagulation if AF
Investigations
- CT head (non-contrast): exclude haemorrhage — performed immediately
- CT angiography: identify large vessel occlusion for thrombectomy
- MRI brain: more sensitive for early ischaemia, posterior fossa
- ECG: identify AF
- Echocardiogram, carotid Doppler: identify cardioembolic/carotid source
Management
- Ischaemic stroke: IV alteplase within 4.5 hours (NICE NG128)
- Mechanical thrombectomy: large vessel occlusion within 24 hours
- Aspirin 300mg: within 24 hours of ischaemic stroke (not haemorrhagic)
- Admit to stroke unit: reduces mortality and disability
- Secondary prevention: clopidogrel, statin, antihypertensives, anticoagulation if AF
NICE Guideline: NICE NG128 — Stroke and transient ischaemic attack in over 16s (2019)
Related UKMLA Conditions
Atrial FibrillationHypertensionTIACarotid Artery Stenosis