Hyperacute Stroke Flashcards
What are the three models of hyperacute stroke management?
Drip and ship - Supportive care and transport to get thrombolysis
Mothership - Straight to a center that can do thrombolysis
MSU - Travel to patient having stroke
What is needed in hyperacute stroke management?
- Urgent imaging
- Thrombolysis/thrombectomy
- BP lowering
- Stroke unit care
- Swallow assessment, nutrition & hydration
- Secondary preventative care
- DVT prevention
What step before reaching the hospital is key in hyperacute stroke management?
Pre-hospital assessment over the phone to a stroke consultant
Where does the patient get taken first in the hospital in a hyperacute stroke?
CT scanner
What is a thrombectomy used for?
If there is a large artery occluded by a clot
How is the type of stroke determined?
CT
How is it decided if there is a large vessel occlusion in stroke?
CT or MR angiogram
What are some examples of posterior stroke symptoms?
Ataxia
Diplopia
How long after stroke symptoms is thrombolysis licensed for?
4.5 hours after symptom onset
What is the most common drug used in thrombolysis?
Alteplase
How does thrombolysis work?
The breakdown (lysis) of a clot by a tissue plasminogen activator (alteplase)
What is a contraindication to thrombolysis?
- Previous brain hemorrhage
- Recent infarct
- BP >185/110
- On anti-coagulants (warfarin ok if INR low enough)
1) if taken DOAC in last 24 hrs - Platelets <100, severe anemia
What are some potential complications of thrombolysis?
Hemorrhage
- Intra-cranial OR extra-cranial
Anaphylaxis
- Very rare
Angioedema
- Patients on ACEi at higher risk
What are the two types of primary intracerebral haemorrhage?
Lobar - More related to cerebral amyloid angiopathy
Deep - More related to effect of BP
What treatment is given for intracerebral hemorrhage?
- Lowering BP
- Neurosurgery where appropriate
- Reversal of anticoagulant
- Critical care
