Management of STROKE Flashcards
A typical patient loses how much neuron every minute in which stroke is untreated
1.9 million neuron
Stroke Diagnosis
Profound Weakness
➕
CT Brain: To assess Hemorrhage
(OR)
DWMRI: Hyperintensity ➡️ Infarct ➡️ Stroke
T2W MRI shows STROKE minimum after
4-6 days
Cerebral Blood Flow
✨ < 10 ml/mg/min
✨ 10-22 ml/mg/min
✨ > 22 ml/mg/min
✨ < 10 ml/mg/min
🎯 Infarcted Area ➡️ NOT SALVAGEABLE
✨ 10-22 ml/mg/min
🎯 ISCHEMIC PENUMBRA
✨ > 22 ml/mg/min
🎯 NORMAL
Penumbra
Peripheral region of Infarct in the brain
Penumbra can be detected by
Perfusion Weighted MRI
ADC
⭐ Use
Apparent Diffusion Coefficient
⬇️
USE: Shows HYPOINTENSITY in ACUTE INFARCT
Hyperintensity in DWMRI (White)
➕
Hypointensity in ADC (Black)
Means?
Acute INFARCTION
Hypointensity in DWMRI (White)
➕
Hyperintensity in ADC (Black)
Means?
Chronic Infarct
Golden Hour of Stroke
4.5 hrs (4-5 hrs)
✨ Thrombolysis can be done
Thrombolysis in Stroke is INEFFECTIVE, if patient presents
After 5 hrs
💊💉 MANAGEMENT of STROKE
Small Inaccessible Vessel:
1. Thrombolysis
Large Vessel or 1st Order Branches:
2. MR angiography ➕ Endovascular Clot Retrieval & Stenting
Indications for THROMBOLYSIS
- LESION in 2nd & 3rd Order VESSELS & patient present within 4.5hrs
- Clinical diagnosis of Stroke ➕ NORMAL CT ➕ No Endovascular intervention ➕ patient present within 4.5hrs
🚫 CONTRAINDICATION of THROMBOLYSIS
- Age < 18 yrs
- Platelet count < 1 lakh/mm³
- Blood Sugar < 50 & > 400 mg/dl
- H/O of Surgery in last 14 days or GI bleeds in last 21 days
- BP < 185/110 with (OR) without drugs
- Edema in > ⅓rd of MCA territory
Drug used for THROMBOLYSIS in STROKE
Alteplase
0.9mg/kg IV
✨ 10% as IV Bolus
✨ 90% as IV infusion over 1 hr