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      // ── TITLE ──────────────────────────────────────────────
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      // ── 1. DEFINITION ─────────────────────────────────────
      h1('1. DEFINITION'),
      para('A stroke (cerebrovascular accident, CVA) is the sudden onset of a focal neurological deficit due to either ischaemia (87%) or haemorrhage (13%) involving a region of brain supplied by a specific artery. A transient ischaemic attack (TIA) is a brief episode of similar symptoms lasting <24 h with no evidence of infarction on imaging.'),

      // ── 2. EPIDEMIOLOGY ───────────────────────────────────
      h1('2. EPIDEMIOLOGY'),
      bullet('Second leading cause of death worldwide; leading cause of adult disability.'),
      bullet('Ischaemic stroke accounts for ~87% of all strokes; intracerebral haemorrhage ~10%; subarachnoid haemorrhage ~3%.'),
      bullet('Incidence doubles with each decade after age 55.'),
      bullet('Risk of stroke after TIA: ~10–15% in the first 3 months; highest risk in the first 48 h.'),

      // ── 3. RISK FACTORS ───────────────────────────────────
      h1('3. RISK FACTORS'),
      h2('Modifiable'),
      bullet('Hypertension (most important modifiable risk factor)'),
      bullet('Atrial fibrillation (most important cardiac cause of embolic stroke)'),
      bullet('Diabetes mellitus'),
      bullet('Dyslipidaemia (elevated LDL, low HDL)'),
      bullet('Tobacco smoking'),
      bullet('Obesity & physical inactivity'),
      bullet('Oral contraceptive pill / hormone replacement therapy'),
      bullet('Excess alcohol'),
      bullet('Obstructive sleep apnoea'),
      h2('Non-modifiable'),
      bullet('Age (doubles per decade after 55)'),
      bullet('Male sex'),
      bullet('Family history / genetics'),
      bullet('Ethnicity (higher in Black and South Asian populations)'),
      bullet('Prior stroke or TIA'),

      // ── 4. CLASSIFICATION ─────────────────────────────────
      h1('4. CLASSIFICATION'),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          tableRow(['Type', 'Subtype', 'Frequency', 'Key Mechanism'], true),
          tableRow(['Ischaemic', 'Large-vessel atherothrombosis', '~20%', 'Atherosclerotic plaque with in-situ thrombosis or artery-to-artery embolism']),
          tableRow(['Ischaemic', 'Cardioembolic', '~25%', 'AF, valvular disease, recent MI, cardiomyopathy']),
          tableRow(['Ischaemic', 'Small-vessel (lacunar)', '~20%', 'Lipohyalinosis of perforating arteries; hypertension']),
          tableRow(['Ischaemic', 'Cryptogenic', '~30%', 'No definite cause found after full work-up']),
          tableRow(['Ischaemic', 'Other determined cause', '~5%', 'Dissection, hypercoagulability, vasculitis, CADASIL']),
          tableRow(['Haemorrhagic', 'Intracerebral haemorrhage (ICH)', '~10%', 'Hypertension, amyloid angiopathy, AVMs']),
          tableRow(['Haemorrhagic', 'Subarachnoid haemorrhage (SAH)', '~3%', 'Ruptured aneurysm, AVM']),
        ],
      }),
      para(''),

      // ── 5. PATHOPHYSIOLOGY ────────────────────────────────
      h1('5. PATHOPHYSIOLOGY'),
      h2('A. Ischaemic Stroke — Ischaemic Cascade'),
      para('Acute occlusion of an intracranial vessel reduces cerebral blood flow (CBF). The magnitude of reduction depends on collateral supply, occlusion site, and systemic BP.'),
      bullet('CBF = 0: brain death within 4–10 minutes'),
      bullet('CBF <16–18 mL/100 g/min: neuronal death (infarct core)'),
      bullet('CBF 18–20 mL/100 g/min: neuronal dysfunction (ischaemic penumbra) — salvageable with timely reperfusion'),
      para('The ischaemic cascade includes:'),
      bullet('ATP depletion → failure of Na⁺/K⁺-ATPase → cellular depolarisation', 1),
      bullet('Glutamate excitotoxicity → NMDA/AMPA receptor activation → Ca²⁺ influx', 1),
      bullet('Mitochondrial dysfunction → free radical generation → lipid peroxidation', 1),
      bullet('Activation of caspases → apoptosis; inducible NOS activation → NO toxicity', 1),
      bullet('Inflammatory cytokine release (TNF-α, IL-1β) → blood-brain barrier breakdown → cerebral oedema', 1),
      h2('B. Haemorrhagic Stroke'),
      para('Primary intracerebral haemorrhage (ICH) results from rupture of small penetrating arteries damaged by chronic hypertension (lipohyalinosis). Blood forms a haematoma causing mass effect, raised ICP, and herniation. Secondary ICH can result from haemorrhagic transformation of an ischaemic infarct or from amyloid angiopathy (lobar haematomas in elderly).'),

      // ── 6. STROKE SYNDROMES ───────────────────────────────
      h1('6. STROKE SYNDROMES (Vascular Territory Deficits)'),
      h2('Anterior Circulation (Carotid System)'),
      h3('Middle Cerebral Artery (MCA) — Most Common'),
      para('Proximal MCA occlusion (complete):'),
      bullet('Contralateral hemiplegia + hemianesthesia (face, arm > leg)'),
      bullet('Homonymous hemianopia (contralateral)'),
      bullet('Gaze deviation toward the side of the lesion (ipsilateral)'),
      bullet('Dominant hemisphere → Global aphasia'),
      bullet('Non-dominant hemisphere → Anosognosia, constructional apraxia, hemispatial neglect'),
      para('Superior division MCA:'),
      bullet('Broca\'s (expressive) aphasia + right hemiparesis (arm > face)'),
      para('Inferior division MCA:'),
      bullet('Wernicke\'s (receptive) aphasia + contralateral superior quadrantanopia'),
      h3('Anterior Cerebral Artery (ACA)'),
      bullet('Contralateral hemiparesis/sensory loss — leg > arm'),
      bullet('Abulia, personality change (frontal lobe involvement)'),
      bullet('Urinary incontinence'),
      h3('Internal Carotid Artery (ICA) Occlusion'),
      bullet('Variable — may be silent if good collaterals via Circle of Willis'),
      bullet('Transient monocular blindness (amaurosis fugax) — ophthalmic artery'),
      bullet('If complete: MCA + ACA territory infarct → massive hemiplegia'),
      h2('Posterior Circulation (Vertebrobasilar System)'),
      h3('Posterior Cerebral Artery (PCA)'),
      bullet('Contralateral homonymous hemianopia with macular sparing'),
      bullet('Thalamic syndrome (sensory loss, thalamic pain)'),
      bullet('Dominant: alexia without agraphia (left PCA + splenium)'),
      h3('Basilar Artery'),
      bullet('Locked-in syndrome (bilateral pontine infarcts): quadriplegia, unable to speak, only vertical eye movements preserved'),
      bullet('Coma, cranial nerve palsies, ataxia'),
      bullet('Top-of-basilar syndrome: somnolence, visual hallucinations, oculomotor disturbances'),
      h3('Vertebral Artery / PICA — Lateral Medullary (Wallenberg) Syndrome'),
      bullet('Ipsilateral: facial pain/numbness (CN V), Horner\'s syndrome, ataxia, dysphagia/dysarthria (CN IX, X), nystagmus'),
      bullet('Contralateral: loss of pain & temperature sensation (spinothalamic)'),
      bullet('Mnemonic: PICA = Ipsilateral Cerebellar & Horner\'s, Contralateral Spinothalamic loss'),
      h3('Small-Vessel (Lacunar) Strokes — Classic Syndromes'),
      new Table({
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        rows: [
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          tableRow(['Pure Motor Hemiparesis', 'Face + arm + leg weakness, no sensory loss', 'Posterior limb internal capsule / pons']),
          tableRow(['Pure Sensory Stroke', 'Hemisensory loss, no motor deficit', 'Ventral thalamus (VPL)']),
          tableRow(['Ataxic Hemiparesis', 'Ipsilateral ataxia + mild contralateral hemiparesis', 'Ventral pons / internal capsule']),
          tableRow(['Dysarthria-Clumsy Hand', 'Slurred speech + unilateral hand clumsiness', 'Ventral pons / genu internal capsule']),
          tableRow(['Sensorimotor Stroke', 'Combined motor + sensory deficit', 'Posterior limb IC + thalamus']),
        ],
      }),
      para(''),

      // ── 7. CLINICAL PRESENTATION ──────────────────────────
      h1('7. CLINICAL PRESENTATION'),
      para('The hallmark is SUDDEN onset of focal neurological deficit. Key symptoms:'),
      bullet('Sudden weakness or numbness (face, arm, leg — one side)'),
      bullet('Sudden speech disturbance (dysarthria, aphasia)'),
      bullet('Sudden visual disturbance (monocular/binocular, hemianopia)'),
      bullet('Sudden severe headache ("thunderclap") → suggests SAH or ICH'),
      bullet('Sudden dizziness, loss of balance, incoordination'),
      bullet('Sudden confusion or altered consciousness'),
      para('FAST mnemonic: Face drooping, Arm weakness, Speech difficulty, Time to call emergency.'),
      para('Features suggesting haemorrhage over ischaemia:'),
      bullet('More depressed level of consciousness'),
      bullet('Marked hypertension at onset'),
      bullet('Headache, vomiting, neck stiffness'),
      bullet('Worsening after onset (ischaemia is typically maximal at onset)'),

      // ── 8. INVESTIGATIONS ─────────────────────────────────
      h1('8. INVESTIGATIONS'),
      h2('Immediate (Emergency)'),
      bullet('Non-contrast CT brain — FIRST and URGENT; rules out haemorrhage; detects acute ischaemic changes (hypodense area) after 6–24 h'),
      bullet('Serum glucose (fingerprick) — exclude hypoglycaemia mimicking stroke'),
      bullet('ECG — detect AF, MI'),
      bullet('FBC, coagulation (PT/INR/aPTT), electrolytes, renal function'),
      bullet('Blood cultures if infective endocarditis suspected'),
      h2('Imaging'),
      bullet('MRI DWI (diffusion-weighted imaging) — most sensitive for acute ischaemic stroke within minutes; shows restricted diffusion (bright on DWI, dark on ADC map)'),
      bullet('CT/MR angiography — identifies large vessel occlusion (LVO) — essential if considering thrombectomy'),
      bullet('CT/MR perfusion — identifies penumbra (salvageable tissue) vs. infarct core; guides treatment decisions beyond 4.5 h window'),
      bullet('Carotid Doppler USS — screens for extracranial carotid stenosis'),
      bullet('Trans-thoracic/trans-oesophageal echocardiogram — detects cardiac sources (thrombus, valvular disease, PFO)'),
      bullet('24–72 h ambulatory ECG (Holter) — detects paroxysmal AF'),
      h2('Biochemistry / Haematology'),
      bullet('Fasting lipids, HbA1c'),
      bullet('Thrombophilia screen (if young, cryptogenic): protein C, S, antithrombin III, APS antibodies, Factor V Leiden, MTHFR'),
      bullet('ESR/CRP — vasculitis, infective endocarditis'),
      bullet('Haemoglobin electrophoresis — sickle cell disease'),
      h2('Lumbar Puncture'),
      bullet('Rarely required; indicated if SAH suspected clinically but CT brain is normal (xanthochromia in CSF)'),

      // ── 9. DIAGNOSIS & SCORES ─────────────────────────────
      h1('9. DIAGNOSTIC SCORING'),
      h2('NIHSS (NIH Stroke Scale)'),
      para('11-item neurological examination scale assessing level of consciousness, gaze, visual fields, facial palsy, motor arm/leg, limb ataxia, sensory, language, dysarthria, and extinction/neglect. Scored 0–42. Higher score = more severe deficit. Guides thrombolysis and thrombectomy decisions.'),
      h2('ABCD² Score — Risk of Stroke After TIA'),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          tableRow(['Parameter', 'Score'], true),
          tableRow(['Age ≥60 years', '1']),
          tableRow(['BP ≥140/90 mmHg at presentation', '1']),
          tableRow(['Clinical features: Unilateral weakness', '2']),
          tableRow(['Clinical features: Speech disturbance without weakness', '1']),
          tableRow(['Duration ≥60 min', '2']),
          tableRow(['Duration 10–59 min', '1']),
          tableRow(['Diabetes mellitus', '1']),
          tableRow(['Total', '0–7']),
        ],
      }),
      para(''),
      bullet('Score 0–3: Low risk (~1% 2-day stroke risk)'),
      bullet('Score 4–5: Moderate risk (~4%)'),
      bullet('Score 6–7: High risk (~8%)'),
      bullet('Score ≥4 → urgent evaluation and hospital admission recommended'),

      // ── 10. MANAGEMENT ────────────────────────────────────
      h1('10. MANAGEMENT'),
      h2('A. Acute Ischaemic Stroke — General Measures'),
      bullet('ABCs: Airway, Breathing, Circulation'),
      bullet('Treat hypoglycaemia immediately; avoid hyperglycaemia (target glucose 7.8–10 mmol/L)'),
      bullet('Blood pressure: Do NOT lower acutely unless BP >220/120 mmHg (or >185/110 if thrombolysis planned); maintain perfusion pressure'),
      bullet('Avoid hyperthermia; treat fever aggressively'),
      bullet('Aspiration precautions; SALT assessment before oral feeding'),
      bullet('DVT prophylaxis: subcutaneous LMWH + pneumatic compression stockings'),
      bullet('Early physiotherapy, speech therapy, occupational therapy'),
      bullet('Admit to a dedicated Stroke Unit (reduces mortality and dependency by 25–30%)'),
      h2('B. IV Thrombolysis — Alteplase (tPA)'),
      boldPara('Dose:', 'Alteplase 0.9 mg/kg IV (maximum 90 mg); 10% as bolus, remainder over 60 min.'),
      boldPara('Time window:', 'Within 4.5 hours of symptom onset (or last-known-well time). Earlier is better — "time is brain" (~1.9 million neurons/minute lost during ischaemia).'),
      h3('Inclusion Criteria'),
      bullet('Ischaemic stroke causing measurable neurological deficit'),
      bullet('Symptom onset <4.5 h (up to 3 h for older trials; extended to 4.5 h by ECASS-3)'),
      bullet('Age ≥18 years'),
      h3('Absolute Contraindications to tPA'),
      bullet('Intracranial haemorrhage on CT'),
      bullet('BP >185/110 mmHg (untreatable)'),
      bullet('Recent (<3 months) intracranial surgery, serious head trauma, or prior stroke'),
      bullet('Active internal bleeding or bleeding diathesis'),
      bullet('Platelet count <100,000/μL'),
      bullet('Anticoagulant use: INR >1.7, aPTT elevated, direct thrombin/Xa inhibitors within 48 h'),
      bullet('Blood glucose <50 mg/dL (<2.8 mmol/L)'),
      bullet('CT showing >⅓ of MCA territory hypodensity'),
      bullet('Subarachnoid haemorrhage symptoms'),
      bullet('Active infective endocarditis'),
      para('Note: Tenecteplase (0.25 mg/kg single IV bolus, max 25 mg) is now used in many centres as a simpler alternative with comparable efficacy.'),
      h2('C. Endovascular Thrombectomy (EVT/MT)'),
      para('Mechanical removal of thrombus from large intracranial vessels using stent retriever or aspiration catheter.'),
      boldPara('Indications:', 'Ischaemic stroke due to large vessel occlusion (LVO) of the ICA, M1/M2 MCA, basilar artery.'),
      boldPara('Time window:', 'Up to 24 h from symptom onset in selected patients with favourable imaging (evidence from DAWN, DEFUSE-3 trials).'),
      boldPara('Evidence:', 'Five landmark RCTs in 2015 (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, THRACE) demonstrated superiority over medical therapy alone.'),
      bullet('Significant benefit: NNT ≈ 2.6 to prevent dependency (mRS shift)'),
      bullet('Can be combined with IV thrombolysis ("bridging therapy")'),
      bullet('Requires: NIHSS, CT angiography confirming LVO, low ASPECTS score on CT (ASPECTS ≥6)'),
      h2('D. Antithrombotic Treatment'),
      boldPara('Aspirin:', '300 mg orally within 24–48 h of ischaemic stroke onset (after haemorrhage excluded and tPA window has passed). Continue aspirin 75–100 mg daily long-term.'),
      boldPara('Dual antiplatelet (DAPT):', 'Aspirin + clopidogrel for 21 days after minor ischaemic stroke or high-risk TIA (POINT, CHANCE trials). Then single antiplatelet long-term.'),
      boldPara('Anticoagulation:', 'NOT used acutely in most ischaemic strokes. For cardioembolic stroke (AF): start anticoagulation after 2–14 days depending on infarct size. DOACs (rivaroxaban, apixaban, dabigatran) preferred over warfarin for NVAF.'),
      h2('E. Blood Pressure Management After Acute Phase'),
      bullet('Target <130/80 mmHg long-term for secondary prevention'),
      bullet('ACE inhibitors and thiazide diuretics have strongest evidence (PROGRESS trial)'),
      bullet('SPRINT trial data: systolic <120 mmHg reduces stroke + MI by 43% vs <140 mmHg'),
      h2('F. Haemorrhagic Stroke — Intracerebral Haemorrhage (ICH)'),
      bullet('Immediate reversal of anticoagulation: Vitamin K + PCC (prothrombin complex concentrate) if on warfarin; andexanet alfa for anti-Xa agents; idarucizumab for dabigatran'),
      bullet('Blood pressure reduction: Target <140 mmHg systolic (INTERACT-2, ATACH-2 trials)'),
      bullet('Surgical evacuation: Controversial for supratentorial ICH; evidence of benefit for: cerebellar haematoma >3 cm (with brainstem compression), superficial lobar ICH in young patients with clinical deterioration'),
      bullet('ICP management: Head elevation 30°, osmotherapy (mannitol), avoid hypotension'),
      bullet('No antifibrinolytics routinely; haemostatic therapy with tranexamic acid under investigation'),

      // ── 11. SECONDARY PREVENTION ──────────────────────────
      h1('11. SECONDARY PREVENTION'),
      h2('Antiplatelet Therapy'),
      bullet('Aspirin 75–100 mg/day: standard for non-cardioembolic ischaemic stroke'),
      bullet('Aspirin + dipyridamole (modified-release 200 mg BD): ESPRIT trial — superior to aspirin alone'),
      bullet('Clopidogrel 75 mg/day: alternative to aspirin; equivalent efficacy (CAPRIE trial)'),
      bullet('DAPT (aspirin + clopidogrel): for minor stroke/high-risk TIA for 21 days, then mono-therapy'),
      h2('Anticoagulation — Cardioembolic Stroke (AF)'),
      bullet('DOACs first-line: Apixaban, rivaroxaban, dabigatran, edoxaban'),
      bullet('Warfarin if DOAC contraindicated (target INR 2.0–3.0)'),
      bullet('CHA₂DS₂-VASc score guides anticoagulation in AF: treat if score ≥2 (men) or ≥3 (women)'),
      h2('Statins'),
      bullet('All patients with ischaemic stroke: high-intensity statin (atorvastatin 40–80 mg)'),
      bullet('Target LDL <70 mg/dL (1.8 mmol/L); SPARCL trial: atorvastatin 80 mg reduced recurrent stroke by 16%'),
      h2('Carotid Endarterectomy (CEA) / Stenting (CAS)'),
      bullet('Symptomatic carotid stenosis 70–99%: CEA within 2 weeks (reduces 5-year stroke risk from 26% to 9% — NASCET)'),
      bullet('Symptomatic stenosis 50–69%: CEA beneficial in selected patients'),
      bullet('Asymptomatic stenosis >60%: CEA or CAS in appropriate surgical candidates'),
      bullet('CAS as alternative to CEA in high surgical-risk patients'),
      h2('Patent Foramen Ovale (PFO) Closure'),
      bullet('In young patients (<60 y) with cryptogenic stroke and PFO: percutaneous closure reduces recurrence (CLOSE, REDUCE, RESPECT trials)'),
      h2('Lifestyle Modifications'),
      bullet('Stop smoking (reduces stroke risk by 50% within 1 year)'),
      bullet('Reduce alcohol to safe limits'),
      bullet('Regular aerobic exercise (≥150 min/week moderate intensity)'),
      bullet('Healthy diet (Mediterranean diet)'),
      bullet('Weight reduction if obese'),
      bullet('Tight glucose control in diabetes (target HbA1c <7%)'),

      // ── 12. TIA ───────────────────────────────────────────
      h1('12. TRANSIENT ISCHAEMIC ATTACK (TIA)'),
      para('TIA = transient episode of neurological dysfunction from focal brain/retinal ischaemia, with symptoms typically resolving within 1 h, with no infarction on imaging.'),
      para('If infarction is seen on DWI-MRI, it is classified as stroke regardless of symptom duration.'),
      bullet('10–15% risk of stroke within 3 months; risk is highest in first 48 h'),
      bullet('ABCD² score stratifies short-term risk (see Section 9)'),
      bullet('Urgent evaluation and treatment: brain imaging, ECG, vascular imaging, cardiac monitoring'),
      bullet('Immediate aspirin 300 mg; then DAPT for 21 days if ABCD² ≥4'),
      bullet('Carotid imaging: urgent carotid duplex/CTA if hemispheric TIA'),
      bullet('Hospital admission recommended for high-risk TIA (ABCD² ≥4)'),

      // ── 13. COMPLICATIONS ─────────────────────────────────
      h1('13. COMPLICATIONS OF STROKE'),
      h2('Early (Days)'),
      bullet('Cerebral oedema and herniation (massive MCA infarcts) — "malignant MCA syndrome"'),
      bullet('Haemorrhagic transformation of ischaemic infarct'),
      bullet('Seizures (early: 2–23%; late epilepsy in ~10%)'),
      bullet('Aspiration pneumonia (most common cause of early death post-stroke)'),
      bullet('DVT/pulmonary embolism'),
      bullet('Hypo-/hyperglycaemia; hyponatraemia'),
      h2('Late (Weeks–Months)'),
      bullet('Post-stroke depression (~30%)'),
      bullet('Vascular dementia / cognitive impairment'),
      bullet('Spasticity, contractures, shoulder subluxation'),
      bullet('Central post-stroke pain (thalamic pain syndrome)'),
      bullet('Pressure ulcers, urinary tract infections'),

      // ── 14. REHABILITATION ─────────────────────────────────
      h1('14. REHABILITATION'),
      bullet('Early mobilisation within 24–48 h (once medically stable) reduces complications'),
      bullet('Multidisciplinary stroke unit care: physiotherapy, occupational therapy, speech & language therapy, nursing, psychology'),
      bullet('Motor rehabilitation: constraint-induced movement therapy, task-specific training'),
      bullet('Dysphagia management: SALT assessment; NGT/PEG if needed'),
      bullet('Aphasia: speech therapy; intensive aphasia therapy'),
      bullet('Spasticity: baclofen, botulinum toxin injections'),
      bullet('Depression: SSRIs (fluoxetine shown to improve motor recovery — FLAME trial)'),
      bullet('Goal: maximise independence and quality of life; return to work/community'),

      // ── 15. PROGNOSIS ─────────────────────────────────────
      h1('15. PROGNOSIS'),
      bullet('~25% die within 1 year of first stroke'),
      bullet('~50% survivors have permanent disability'),
      bullet('Haemorrhagic stroke has higher short-term mortality (~40–50% at 30 days for ICH)'),
      bullet('Best outcomes with: early stroke unit admission, rapid thrombolysis, successful thrombectomy'),
      bullet('Lacunar strokes generally have better prognosis than cortical strokes'),
      bullet('Modified Rankin Scale (mRS) used to assess functional outcome: 0 = no symptoms, 6 = death'),

      // ── 16. IMPORTANT TRIALS ──────────────────────────────
      h1('16. KEY CLINICAL TRIALS (Exam-Relevant)'),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          tableRow(['Trial', 'Topic', 'Key Finding'], true),
          tableRow(['NINDS (1995)', 'IV tPA ≤3 h', 'tPA improved outcomes at 3 months; ↑ICH risk (6.4% vs 0.6%)']),
          tableRow(['ECASS-3 (2008)', 'IV tPA 3–4.5 h', 'Extended window to 4.5 h; benefit maintained']),
          tableRow(['MR CLEAN (2015)', 'EVT (thrombectomy)', 'Thrombectomy superior to medical Rx for LVO']),
          tableRow(['DAWN/DEFUSE-3', 'EVT 6–24 h window', 'Selected patients benefit up to 24 h with perfusion imaging']),
          tableRow(['CAPRIE (1996)', 'Clopidogrel vs aspirin', 'Clopidogrel marginally superior to aspirin (RRR 8.7%)']),
          tableRow(['CHANCE/POINT', 'DAPT after TIA/minor stroke', 'Aspirin + clopidogrel 21 days reduces recurrence']),
          tableRow(['SPARCL (2006)', 'Atorvastatin 80 mg', 'Reduced recurrent stroke by 16% in prior stroke/TIA']),
          tableRow(['NASCET (1991)', 'Carotid endarterectomy', 'CEA in 70–99% symptomatic stenosis: 5-yr stroke risk 9% vs 26%']),
          tableRow(['PROGRESS (2001)', 'Perindopril ± indapamide', '28% relative risk reduction in recurrent stroke']),
          tableRow(['INTERACT-2', 'BP in ICH', 'Target SBP <140 mmHg in acute ICH improves functional outcome']),
          tableRow(['CLOSE/REDUCE (2017)', 'PFO closure', 'PFO closure reduces recurrence in young cryptogenic stroke']),
        ],
      }),
      para(''),

      // ── 17. MIMICS ────────────────────────────────────────
      h1('17. STROKE MIMICS & DIFFERENTIAL DIAGNOSIS'),
      bullet('Hypoglycaemia (most common mimic — always check glucose first)'),
      bullet('Todd\'s paralysis (post-ictal focal weakness)'),
      bullet('Migraine with aura (hemiplegic migraine)'),
      bullet('Brain tumour / abscess (more gradual onset usually)'),
      bullet('Hypertensive encephalopathy / PRES'),
      bullet('Subdural haematoma'),
      bullet('Functional neurological disorder (conversion disorder)'),
      bullet('Multiple sclerosis relapse'),
      bullet('Wernicke\'s encephalopathy (confusion, ataxia, ophthalmoplegia — not unilateral)'),

      // ── SUMMARY TABLE ─────────────────────────────────────
      h1('18. QUICK REVISION SUMMARY'),
      new Table({
        width: { size: 100, type: WidthType.PERCENTAGE },
        rows: [
          tableRow(['Domain', 'Key Points'], true),
          tableRow(['Definition', 'Sudden focal neurological deficit due to ischaemia or haemorrhage']),
          tableRow(['Most common type', 'Ischaemic (87%)']),
          tableRow(['#1 Risk factor', 'Hypertension']),
          tableRow(['#1 Cardiac cause', 'Atrial fibrillation (cardioembolic stroke)']),
          tableRow(['Most common stroke syndrome', 'MCA territory (contralateral hemiplegia, face+arm>leg, aphasia/neglect)']),
          tableRow(['Emergency imaging', 'Non-contrast CT brain first']),
          tableRow(['Most sensitive imaging', 'MRI DWI (within minutes of onset)']),
          tableRow(['IV thrombolysis', 'Alteplase 0.9 mg/kg within 4.5 h; max 90 mg']),
          tableRow(['Thrombectomy window', 'Up to 24 h for LVO with penumbral imaging']),
          tableRow(['Aspirin timing', '300 mg within 24–48 h (after haemorrhage excluded)']),
          tableRow(['AF anticoagulation', 'DOAC; start 2–14 days post-ischaemic stroke']),
          tableRow(['Statin target', 'LDL <70 mg/dL; atorvastatin 80 mg']),
          tableRow(['Best TIA prophylaxis', 'DAPT (aspirin + clopidogrel) × 21 days']),
          tableRow(['Haemorrhagic stroke BP', 'Target SBP <140 mmHg acutely']),
          tableRow(['Prognosis', '25% die at 1 yr; 50% permanent disability']),
        ],
      }),
      para(''),
      new Paragraph({
        children: [new TextRun({ text: 'Sources: Harrison\'s Principles of Internal Medicine 22E (2025) | Goldman-Cecil Medicine International Edition', italic: true, size: 18, color: '888888', font: 'Calibri' })],
        alignment: AlignmentType.CENTER,
        spacing: { before: 400 },
      }),
    ],
  }],
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