16. Emergency in cerebrovascular disorders Flashcards
Stroke definition
Blood flow to the brain is reduced and persist > 24 hours (not TIA)
Types of stroke
Ischemic (80%)
- Thrombotic (atherosclerosis)
- Embolism (due to AF/CHF)
Hemorrhagic 20%
- Intracerebral (15%)
- Subarachnoid (5%) bleeding
Initial work-up when suspected stroke
- ICU if theres altered conciousness or focal symptoms are worsening/severe
- Intubation if bulbar reflexes are absent/patient in coma
- Mechanical ventilation if saturation < 90% or pCO2 > 50 mmHg
- IV access
- MRI/CT + angio
Most common acute cerebrovascular disorder
Ischemic stroke (80%)
General complications of cerebrovascular disorders
- Fever
- AMI
- Hypertension
- Increased b. glc.
- Dysphagia
- DVT (immobilisation after stroke), give LMWH as prophylaxis
- Neural complications
Hypertension in cerebrovascular disorders
Reducing BP in acute phase of ischemic vscular event may be very harmful, since the hypertension is a compensatory mechanism for maintaining perfusion to the brain.
Dysphagia in cerebrovascular disorders
In large hemispheric infarctions, brainstem disorders it’s increased risk of aspiration pneumonia and malnutrition. Insert nasogastric tube and give H2 blockers.
Treatment of cerebrovascular disorders
Thrombolysis, endovascular thrombectomy, anticoagulant
Thrombolysis in cerebrovascular disorders
- rt-PA alteplase/reteplase 0,9mg/kg (max 90mg)
- Give 10% as bolus, then the rest 90% over 1 hour
- Worsening of condition: stop trhombolysis, do a CT
- Indications of thrombolysis: within 4 hours and high NIHSS
- If BP above 185: give IV labetalol before thrombolysis
- Thrombectomy if more than 4 hours has passed
- Antiplatelets given only after 24h
Contraindications of thrombolysis
- Large artery occlusion in MCA
- Surgery in the last 2 weeks
- Previous intracranial hemorrhage
- INR above 1,7
- Severe thrombocytopenia
