Stroke 2 Flashcards
What is the window the FDA has approved for recombinant tissue plasminogen activator (rTPA)
three hours after onset. Most hospitals use 4.5
What is the only FDA approved treatment for acute stroke
TPA
Specific exclusion criteria for TPA
- no recent surgery involving a non-compressible site
- INR > 1.7
- Blood sugar 400
- BP > 185/110, (give labetolol IVP 10 mg twice)
- platelet count < 100,000
- No history of intercranial hemorrhage
Intra-arterial TPA???
delivery of tPA directly into the clot through the artery. Has the benefit of decreasing dose, and expanding time window to 6 hrs. However it is not FDA approved, and only a limited number of hospitals are able to provide it. Its also invasive and can only be done if clot is visible in a large vessel. Not helpful for lacunar strokes
what is a penumbra
tissue that can potentially be rescued. think fried egg. the penumbra is the tissue that surrounds the infarct that can be potentially rescued.
What kind of of penumbra can be rescued?
only ischemic
how to treat penumbra
endovascular treatment
A possible option for someone with malignant MCA edema (80% mortality rate)
decompressive hemicraniectomy
What tests should you order to work up stroke?
carotid doppler=to evaluate carotids as the source of thrombosis or emboli
Echo (preferable TEE) = to look for cardioembolic etiology particularly left atrium
MRI and MRA= can easily dif new strokes from old
Blood tests such as A1c for diabetes, lipid profile, syphilis serology must be obtaines, drug screen
How to treat carotid stenosis
carotid endarterectomy (indicated when stenoisis >70%)
can also place a stent if severe. actually a less invasive procedure
when to use anticoagulants
a-fib cardiac thrombus hypercoagulable state venous throbosis carotid dissections
How to prevent
keep BP < 130/85, reduce cholesterol, DM control, weight reduction, stop smoking
