Acute stroke

• referred urgently for specialist care

• same day admission

Stroke thrombolysis

• present within 4.5hrs may be cadidates

Brain imaging

• all patients should have urgent brain CT or MRI

  • immediately where availbale

  • within 24hrs

• exclude intracerebral haemorrhage

  • allow appropriate secondary prevention treatments to be initiated rapidly

  • TIA = low risk of ICH

Long term benefits

Lifestyle

• smoking

• improving diet

• increase regular exercise

Blood pressure lowering

• all patients - regardless of bp - should receive new blood pressure lowering

• most direct evidecne use of ACEi

• all excpet b-blocker evidecne for

antiplatelet

• aspirin + clopidogrel not recommended

Anticoagulation therapy

• not routinely unless AF or cardioembolic and no contraindicaiton

• in TIA - once CT/MRI has excluded intracranial haemorrhage as cause of current event

• after ICH

  • individual risk of future thromboembolic events and risk of recurrent ICH

    • greatest risk:

      • lobar ICH

    • less with

      • deep ‘hypertensive ICH’

        • bp control optimised

    • thromboembolism risk greatest with AF and patients with previous ischaemic events

cholesterol lowering

• ischeamic

• not routinely with intracerebral haemorrhage

Diabetes

Carotid surgery

• non-disabling carotid artery territory ischaemic strok or TIA with ipsilateral carotid stensosis

  • 70-99%

  • low rates (\<6%) of peri-operative mortality/morbidity

• consider

  • symptomatic 50-69%

  • asymptomatic >60%

    • if very low complication rates (\<3%)

• surgery within 2 weeks