1. Stroke – acute hemiplegia

2. 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.

3. What differential diagnosis would you consider for this patient?

4. What factors in the history would you seek to identify?

5. 1.Timing 2.Anatomy 3.Headache 4.Stroke aetiology 5.Risk factors

6. What would you seek from the examination?

7. 1.General examination 2.Cardiovascular examination 3.Neurological examination 4.Check for complications

8. How would you investigate?

9. 1.Blood tests including clotting profile 2.ECG 3.Neuroimaging 4.Further imaging 1.Echo 2.Carotid dopplers

10. Imaging

11. Imaging 2

12. Call the neurosurgeons!

13. Pharmacological management (acute)

14. How might you manage this patient pharmacologically in the acute phase of their illness?

15. 1.Haemorrhagic stroke 2.Thromboembolic ischaemic stroke

16. Thromboembolic stroke Are they suitable for thrombolysis?

17. Thromboembolic stroke Are they suitable for thrombolysis? May reduce those dead or with major disability if administered within 3 hours.

18. Thromboembolic stroke Decreases mortality at 1 month by 1 %

19. How would you manage this patient pharmacologically after they have recovered from the acute illness?

20. Risk reduction! 1.Aspirin 2.Warfarin if AF 3.Statins whatever the cholesterol 4.BP control

21. Typical drug chart

22. What monitoring will he require?

23. 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

24. TIA risk score Risk factorCategoryScore AAgeAge > 60 Age < 60 1010 BBPSBP > 140 or DBP > 90 Other 1010 CClinical features Unilateral weakness Speech disturbance alone Other 2020 DDuration> 60 mins 10 – 59 mins < 10 mins 210210 EDiabetesYes No 1010 Total Score 4 or over – 30% chance CVA within 7 days Score 5 or 6 – 50% chance of CVA within 7 days

25. Any questions?