Ischemic stroke management

Question 1

What is the NIH stroke scale?

Answer 1

standardized scale that quantifies stroke deficits

maximum is 42. The higher the number the worst

Question 2

What is a Tissue plasminogen activator (tPA)?

Answer 2

PlasminogenàPlasmin = Degrades Thrombin, lyses clot

Question 3

What is te criteria for a tPA?

Answer 3

• CT brain: no hemorrhage
• <3 hrs. from symptom onset (4.5 hrs. in select cases)
• NIHSS 5-22
• Exclusion criteria
• IV infusion over an hour
• +/- Interventional procedures

Question 4

What are the criteria for a Endovascular Thrombectomy?

Answer 4

• Proximal Anterior Circulation Occlusion (Internal Carotid, Middle Cerebral)
• CT Perfusion (No large infarct)
• 4.5-12 hours from symptom onset
• IV tPA then interventional thrombectomy improved outcomes vs IV tPA alone