Australian Stroke Guidlines Flashcards
All patients with a TIA with anterior circulation symptoms should undergo what imaging?
Early carotid imaging with CT angiography, carotid US or MR angiography
Secondary stroke prevention
Antihypertensives - if BP >140/90
Anticoags if AF
Antiplatelets if not on anticoags
Statin therapy - high intensity
Consideration of carotid endartectomy
DM management
Cease any HRT
Lifestyle factors- Mediterranean diet, physical activity, smoking and ETOH cessation
Patients with acute ischemic stroke and eligible for IV thrombolysis should have their BP lowered to:
below 185/110 before treatment and first 24 hours after treatment
When to start or intensify antihypertensive treatment in a patient who has had a stroke or TIA
BO >140/90
Recommended antihypertensives for secondary stroke prevention
ACE, ARB, CCB, thiazide
BB not to be used as first line unless IHD
Recommended antiplatelets for secondary stroke prevention
Low dose aspirin, clopidogrel, combined low dose aspirin and mod. release dipyramidole
Commenced ASAP once imaging has excluded hemorrhage - unless thrombolysis has been given, in which case commence after 24 hour brain imaging has excluded hemorrhagic transformation
When is carotid endarterectomy considered
Recent <3mo non disabling carotid artery territory ischemic stroke or TIA with ipsilateral carotid stenosis at 70-90% (consideration if from 50%-90%)
Ideally performed within 2 weeks after ischemic event
Patients with acute ischemic stroke secondary to cervical artery dissection should be treated with?
Antithrombotic therapy
Management of cerebral venous sinus thrombosis
SC LMWH or dose adjusted IV heaprin followed by warfarin regardless of intracerebral hemorrhage
Duration of therapy is determined in consultation with hematologist
If using a CT to identify hyperdense thrombus what modality should be used
Thin slice <2mm should be used rather than standard 5 mm slices to improve diagnostic sensitivity
What are some high risk indicators of TIA
Crescendo TIA
Current/ suspected AF
Current use of anticoags
Carotid stenosis
High ABCD2 score
When to administer IV thrombolysis for potentially disabling ischemic stroke?
Within 4.5 hours of onset
Timeframe for endovascular therapy
Within 24 hours
indications for endovascular therapy
Disabiling deficit due to large vessel occlusion in: ICA, porximal MCA, basilar
Pts not having reperfusion therapy should have what ?
Antiplatelets once hemorrhage is r/o: aspirin plus clopidogrel within 24hours used in first 3 weeks in minor ischemic or high risk TIA
HTN effects on stroke
Acute ischemic stroke - increases risk of cerebral edema
Intracerebral hemorrhage- hematoma expansion
Target BP in acute intracerebral hemorrhage
130-140 within 1 hour of commencing treatment
When is a hemicraniectomy considered
Pts <60yo with: malignant MCA infarction
large life threatening space occupying brain edema
Done within 48 hours of stroke onset
What glucose abnormality needs to be monitored in the firs 72 hours following admisison for stroke
Hyperglycemia
Frequency of temperature moniotring post stroke
At least 4 times a day for 72 hours
