Clinical Conversations: Acute Stroke Treatments and Secondary Stroke Prevention | Part One

Prof Bruce Campbell

writer

Prof Bruce Campbell

Neurologist; Head, Neurology and Stroke, Royal Melbourne Hospital; Professor of Neurology, Department of Medicine, Royal Melbourne Hospital

 

Never before has it been so important to educate our patients about the importance of calling triple zero promptly if they have symptoms that could be a stroke as this will result in far better outcomes. The F.A.S.T. test should be displayed in all medical waiting rooms and hospitals. Professor Bruce Campbell explains the newest technology and medications used in acute stroke and secondary stroke prevention. This is part one of a two-part article.

This is part one of this series. Read Part 2 >>

Practice points

• The first message we promote are the most common signs of stroke. So F is for face droop, A is for arm, if the arm is weak, S is for speech, if it is slurred or incomprehensible, T is for time to call triple zero.
• Do not try to give a stroke patient anything orally, do not to give them aspirin as it could be a haemorrhage, do not treat hypertension.
• If you get a focal deficit that is sudden onset (the average duration is about ten minutes,), the patient needs exactly the same workup as a stroke.
• Look at the carotid arteries, look for atrial fibrillation, start anti-platelet therapy really quickly. Brain imaging is very worthwhile, such as a CT scan to exclude a bleed; an MRI should be normal in a TIA.
• Endovascular thrombectomy, physically removing the clot via an angiogram, is of major benefit for patients with a large artery occlusion, such as the middle cerebral carotid territory or the vertebral artery, within six hours of onset.
• The proportion of stroke patients who benefit from active management does drop off rapidly with time.

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Prof Bruce Campbell

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Prof Bruce Campbell

Neurologist; Head, Neurology and Stroke, Royal Melbourne Hospital; Professor of Neurology, Department of Medicine, Royal Melbourne Hospital

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