Neuro Emergencies: Ischemic Stroke Flashcards
What % of all strokes are ischemic?
87%
Risk factors for ischemic stroke include?
Older age
HTN
DM
HLD
African American or Asian descent
HRT disease
Smokers
Drug abuse
Previous TIA
Coag d/os (protein C or S deficiency, antiphospholipid antibody syndrome, antithrombin III deficiency)
Ischemic Stroke Prevention
Primary Prevention includes?
BP control
smoking cessation
DM control
Statins
A fib- anticoagulation / antiplatelet therapy
CEA/CAS w/ 60-70% stneosis
OC may be harmful
Diet and Exercise
A-fib anticoagulation/antiplatelet therapy
Scores to calculate when patient has CHF, HTN, AGE, sex, DM, Prior stroke TIA, Vascular disease?
CHADS2 score
CHA2DS2-VASc Score
A-fib anticoagulation/antiplatelet therapy
Scores to calculate when patient has HTN, abnormal renal function, abnormal liver function, stroke, bleeding, labile INR, elderly >65, alcohol or drug use?
HAS-BLED
Possible Differential Diagnosis for pts experiencing stroke like symptoms
Tumors
SDH
Cerebral abscess
Todd’s paresis or paralysis
Hypoglycemia
Encephalitis
Conversion D/O
Migrainous aura
focal seizure
periveral nerve lesions
Cincinnati Prehospital Stroke Sale components include?
Facial droop
Arm drift
Speech
FAST components include?
Face
Arm
Speech
Time
Clinical Manifestations for MCA stroke
Hemiparesis
Hemiplegia
Hemianesthesia
Hemianopia
Aphasia
Neglect
Gaze deviation
!
Clinical Manifestations for Anterior Cerebral artery stroke
Lower extremity hemiplegia
Primitive reflexes
confusion
abulia
behavioral changes
disturbance in memory
Clinical Manifestations for Vertebral and basilar artery stroke
Decreased LOC
Vertigo
Dysphagia
Diplopia
Ipsilateral CN findings
Contralateral (or bilateral) sensory and motor deficits
Initial Evaluation
10 min or sooner from arrival
Evaluation by physician
Initial Evaluation
</= 15 min
Stroke or neurologic expertise contacted
Initial Evaluation
</= 20 min
NCCT or MRI
Initial Evaluation
</= 45 min
interpretation of neuroimaging
Initial Evaluation
</= 60 min
initiation of IV alteplase
Initial Evaluation
What should be assessed?
ABCs
Time of Onset
Circumstances surrounding onset of neuro symptoms
Hx
Neuro eval (NIHSS)
Labs and ECG
STAT Head CT
Vascular imaging
Initial Evaluation
Exclude stroke mimics such as
Psychogenic
Seizures
Hypoglycemia
Migraine
HTN encephalopathy
Wernicke’s encephalopathy
CNS abscess
CNS tumor
Drug toxicity
Initial Evaluation
All patients need
Non-Con CT (NCCT)
MRI
Blood glucose
Cardiac monitoring
EKG
Troponin
BMP, CBC, PT/INR/aPTT
Maintain O2 sats > 94%
Initial Evaluation
All patients need
For patients with suspected LVO in which MT is being considered, what should be obtained?
noninvasive vascular imaging
CTA with CTP
MRA with DW-MRI w/ or w/o MR perfusion
Initial Evaluation
Selected Patients
TT, Ecarin clotting time or direct factor Xa activity assay
Hepatic function test
Toxicology screen
Blood alcohol level
Pregnancy test
ABG
CXR
EEG (if seizures are suspected)
Initial Evaluation
Selected Patients
if SAH is suspected and CT is negative for blood what should be performed?
Lumbar puncture
Initial Evaluation
Selected Patients
If seizures are suspected what should be performed?
Electroencephalogram (EEG)
Emergent Management of Ischemic Strokes
ABCs
avoid hypotension, hypoxia and hypovolemia
Emergent Management of Ischemic Strokes
Supplemental O2 for sats of?
> 94%
Emergent Management of Ischemic Strokes
Antipyretic medications for temp of?
> 38 C
Emergent Management of Ischemic Strokes
monitoring?
cardiac monitoring
cautious BP treatment