Acute Stroke Flashcards
What are the steps in the management of an acute stroke?
- Protect airway
- Maintain homeostasis
- Screen swallow
- CT head
- Anti-platelets
- Thrombolysis
- Thrombectomy
What is involved in maintaining homeostasis in acute stroke?
- Keep blood glucose 4-11
- Only treat hypertension if hypertensive emergency or thrombolysis is considered
What BP should be aimed for if it’s treated in acute stroke?
180/110
What should be done until a swallowing screen is performed in acute stroke?
Keep patient NBM, but keep hydrated
How quickly should CT be done in acute stroke?
Within 1 hour if certain conditions, 24 hours otherwise
Under what conditions should CT head be done within 1 hour in acute stroke?
- Thrombolysis considered
- High risk of haemorrhage
- Unusual presentation
What features show high risk of haemorrhage in acute stroke?
- Decreased GCS
- Signs of raised ICP
- Severe headache
- Meningism
- Progressive symptoms
- Bleeding tendency
- Anticoagulated
What is considered to be an unusual presentation with stroke?
- Fever
- Fluctuating consciousness
What is the advantage of CT in acute stroke?
Rules out haemorrhage
What is the advantage of MRI in acute stroke?
More sensitive for acute infarct
When should anti-platelets be given in acute stroke?
As soon as haemorrhagic stroke ruled out
What does of aspirin should be given in acute stroke?
300mg
How long should aspirin be continued for in acute stroke?
2 weeks (then start definitive anticoagulation)
When should thrombolysis be considered in acute stroke?
When haemorrhage is excluded
When are best results seen with thrombolysis?
Within 90 mins
What is the absolute latest time you can do thrombolysis?
4.5 hours after symptom onset
What are the contraindications to thrombolysis?
- Blood glucose <3 or >22
- Known clotting disorder
- Anticoagulants, or INR >1.7
- Platelets <100
- History of clotting disorder
What can the contraindications to thrombolysis be divided into?
- Factors relating to acute stroke
- PMH
- Clotting problems
- Glucose
What are the contraindications to thrombolysis that relate to features of the acute stroke?
- Haemorrhage seen on CT
- Mild/non-disabling deficit
- Rapidly improving symptoms >180/105
- BP >180/105
- Seizures at presentation
What are the contraindications to thrombolysis that relate to PMH?
- Recent surgery, trauma, or artery/vein puncture at non-compressible site
- Previous CNS bleeds
- AVM/aneurysm
- Stroke or serious head injury in last 3 months
- GI/urinary tract haemorrhage in last 21 days
- Severe liver disease, varices, or portal hypertension
- History of intracranial neoplasm
What are the contraindications to thrombolysis that relate to clotting problems?
- Known clotting disorder
- Anticoagulants, or INR >1.7
- Platelets <100
- History of clotting disorder
What blood glucose is a contraindication to thrombolysis?
<3 or >22
What is the agent of choice for stroke thrombolysis?
Alteplase
What follow up needs to be done after thrombolysis?
CT 24 hours post-lysis
When does thrombectomy provide additional benefit?
For those with large artery occlusion in proximal anterior circulation
Can you do thrombectomy and thrombolysis together?
Yes (if within respective time frames)
Within what time frame should thrombectomy be done?
6 hours
