Articles / Clinical Conversations: Acute Stroke Treatments and Secondary Stroke Prevention | Part Two
writer
Neurologist; Head, Neurology and Stroke, Royal Melbourne Hospital; Professor of Neurology, Department of Medicine, Royal Melbourne Hospital
This is part two of this series. Read Part 1 >>
Practice points
• 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.
• GPs need to ensure patients have adequate and appropriate secondary stroke prevention therapy.
• Look hard for atrial fibrillation, as anti-platelet therapies will not prevent stroke recurrence if the emboli are atrial in origin. It is definitely worth feeling the pulse every time you see the patient as a single Holter monitor has pretty low sensitivity.
• If you have a patient who’s had a normal Holter monitor, but you are suspicious that they really have had an embolic event, you can certainly take advice from your local stroke team.
• Dual anti-platelet therapy (aspirin and clopidogrel) is used for ischaemic stroke/TIA for three weeks and then clopidogrel is continued.
• The evidence is that we need to reduce the LDL to a target of less than 1.8 mmol/L.
• Reduce the blood pressure as low as you can get it without making the patient feel horrible, certainly a systolic consistently less than 140 mmHg.
Based on this educational activity, complete these learning modules to gain additional CPD.
Managing Prostate Cancer Treatment Update
RSV, Respiratory Viral Infections and the Heart – Exert Panel
Thyroid Disease in Pregnancy
writer
Neurologist; Head, Neurology and Stroke, Royal Melbourne Hospital; Professor of Neurology, Department of Medicine, Royal Melbourne Hospital
Strongly support
Somewhat support
Neither support nor oppose
Somewhat oppose
Strongly oppose
Listen to expert interviews.
Click to open in a new tab
Browse the latest articles from Healthed.
You have completed the Educational Activities (EA) component of this activity.
Select ‘Confirm & claim CPD‘ to confirm you have engaged with this activity in its entirety and claim your CPD.
You will be taken to explore further CPD learning available to you.