Management of STROKE Flashcards

1
Q

A typical patient loses how much neuron every minute in which stroke is untreated

A

1.9 million neuron

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2
Q

Stroke Diagnosis

A

Profound Weakness

CT Brain: To assess Hemorrhage
(OR)
DWMRI: Hyperintensity ➡️ Infarct ➡️ Stroke

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3
Q

T2W MRI shows STROKE minimum after

A

4-6 days

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4
Q

Cerebral Blood Flow
✨ < 10 ml/mg/min
✨ 10-22 ml/mg/min
✨ > 22 ml/mg/min

A

✨ < 10 ml/mg/min
🎯 Infarcted Area ➡️ NOT SALVAGEABLE

✨ 10-22 ml/mg/min
🎯 ISCHEMIC PENUMBRA

✨ > 22 ml/mg/min
🎯 NORMAL

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5
Q

Penumbra

A

Peripheral region of Infarct in the brain

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6
Q

Penumbra can be detected by

A

Perfusion Weighted MRI

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7
Q

ADC
⭐ Use

A

Apparent Diffusion Coefficient
⬇️
USE: Shows HYPOINTENSITY in ACUTE INFARCT

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8
Q

Hyperintensity in DWMRI (White)

Hypointensity in ADC (Black)
Means?

A

Acute INFARCTION

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9
Q

Hypointensity in DWMRI (White)

Hyperintensity in ADC (Black)
Means?

A

Chronic Infarct

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10
Q

Golden Hour of Stroke

A

4.5 hrs (4-5 hrs)

✨ Thrombolysis can be done

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11
Q

Thrombolysis in Stroke is INEFFECTIVE, if patient presents

A

After 5 hrs

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12
Q

💊💉 MANAGEMENT of STROKE

A

Small Inaccessible Vessel:
1. Thrombolysis

Large Vessel or 1st Order Branches:
2. MR angiography ➕ Endovascular Clot Retrieval & Stenting

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13
Q

Indications for THROMBOLYSIS

A
  1. LESION in 2nd & 3rd Order VESSELS & patient present within 4.5hrs
  2. Clinical diagnosis of Stroke ➕ NORMAL CT ➕ No Endovascular intervention ➕ patient present within 4.5hrs
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14
Q

🚫 CONTRAINDICATION of THROMBOLYSIS

A
  1. Age < 18 yrs
  2. Platelet count < 1 lakh/mm³
  3. Blood Sugar < 50 & > 400 mg/dl
  4. H/O of Surgery in last 14 days or GI bleeds in last 21 days
  5. BP < 185/110 with (OR) without drugs
  6. Edema in > ⅓rd of MCA territory
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15
Q

Drug used for THROMBOLYSIS in STROKE

A

Alteplase
0.9mg/kg IV
✨ 10% as IV Bolus
✨ 90% as IV infusion over 1 hr

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16
Q

Anti platelet to be given in STROKE

A

Aspirin 300 mg stat Dose followed by 150 mg Maintainance

17
Q

Double Anti-Platelet therapy
Indications

A
  1. Pt with TIA who can develo Stroke
  2. Minor STROKE
  3. Developed Stroke while on Single Anti-Platelet
18
Q

Anticoagulation INDICATIONS in STROKE

A

CARDIOEMBOLIC stroke
✨ Atrial Fibrillation with Mitral Stenosis
✨ Post Mitral Valve Replacement