A. 16 - 16. Emergency in cerebrovascular disorders Flashcards
how long does it take for the symptoms to deteriorate after acute cerebrovascular disorder?
within the first 24-48h
whatis is necessary if there is altered consciousness or if focal symptoms are severe/worsening?
ICU
when is it necessary to intubate?
Intubation is necessary if bulbar reflexes are absent/patient is in coma
what are the general complications in case of Emergency in cerebrovascular disorders?
Fever
AMI
Hypertension
Blood glucose level increase
Dysphagia
Urosepsis risk increases (in case of catheter use)
DVT
fever as General complication in cerebrovascular disorders emergency?
○ In most cases a sign of pneumonia
○ Give broad spectrum antibiotics and antipyretic tx ASAP
○ Increases the metabolic demand of the brain, leading to enlargement of infarct
AMI as General complication in cerebrovascular disorders emergency?
mainly increased risk in right hemispheric lesions:
○ Probably due to increased release of catecholamines from brain → arrhythmias
(both depolarizing and repolarizing changes can be seen)
Hypertension as General complication in cerebrovascular disorders emergency?
○ Most important risk factor of cerebrovascular disorders
○ Reducing blood pressure in the acute phase of ischemic vascular events may be harmful, as the elevation is a compensatory mechanism for maintaining perfusion to the brain.
After stabilization of general condition the blood pressure decrease is spontaneous in
most cases.
○ In some cases a spontaneous lowering is not expected (hypertensive encephalopathy, AMI, ARF, aortic dissection), and anti-HTN tx is needed:
■ Oral ACE inhibitors, i.v. labetalol (or i.v. sodium-nitroprusside)
Hyperglycemia as General complication in cerebrovascular disorders emergency?
○ Cerebral ischemia in diabetic patients are associated with very high blood glucose levels.
Also usually increased in non-diabetic patients
○ Mechanism: in anaerobic conditions glucose is transformed to lactate → damage to BBB → cerebral edema.
○ Glucose is contraindicated in cerebral ischemia (except in hypoglycemia).
○ Insulin should be given if glucose levels > 15 mmol/L (target: 7,8-10 mmol/L)
Dysphagia as General complication in cerebrovascular disorders emergency?
○ In large hemispheric infarctions, brainstem disorders, vascular pseudobulbar paralysis and in diseases affecting nucleus ambiguus
→ increased risk of aspiration pneumonia.
→ malnutrition
○ Nasogastric/nasoduodenal tube should be inserted
○ H2 blockers are recommended
DVT as General complication in cerebrovascular disorders emergency?
○ Immobilisation secondary to cerebrovascular disorders results in DVT in 50% of cases, whereas PE is the cause of death in 10% of stroke patients.
○ Standard heparin or LMWH is given as prophylactic therapy:
■ Started 1st day in case of ischemic stroke
■ Started 3rd day in case of hemorrhagic stroke
○ If heparin is CI compression stockings and/or oral aspirin is given
Neural complications in cerebrovascular disorders emergency?
○ Ischemia → cerebral edema, maximum at 3rd day
■ Reduced by osmodiuretics like mannitol or glycerol
■ Loop diuretics reduce production of CSF
■ In severe cases:
1. Controlled hyperventilation (decreased pCO2 will reduce ICP)
2. Barbiturate narcosis (EEG/plasma level monitoring)
3. Last solution is decompressive craniectomy
○ In occlusive hydrocephalus, e.g. blockage of the 4th ventricle, temporary drainage of CSF is indicated