Stroke Guidlines TIA and AF Flashcards
(38 cards)
A patient came in with 4/5 weakness of the UE and slurring of speech. GCS 15 comfortable.
Based on stroke definition this patient has what stroke severity?
Mild
Mild stroke any or combi of the following
- Mild pure motor weakness 3-4/5
- Pure sensory deficit
- Slurred but intelligible speech
- Vertigo with incoordination
- Visual field deficits
NIHSS score 0-5
How is moderate stroke defined?
Significant motor/sensory/ language/ visual defect *and/or
Disoriented, drowsy, light stupor with purposeful response to painful stimuli
NIHSS 6-21
*** basically a patient that is not GCS 15 but not in deep coma
How do you define severe stroke?
Depp stupor or coma
NIHSS >22
NIHSS score for
Mild stroke
Moderate stroke
Severe stroke
0-5
6-21
> 22
Based on the local Philippines guideline what is the time frame for resolution of clinical symptoms of TIA?
Last less than an hour
Risk of having stroke after a TIA is highest within what time frame?
Within 48 hours 25-50% will have stroke
10-15 % will have stroke within 3 months
A 66 yo, diabetic female patient claimed that he had left sided weakness 2 days ago but resolved spontaneously. Should you hospitalize the patient or advise opd monitoring?
Yes
ABCD2 score is >/= to 3
A age > 60 = 1 B BP > 140/90 = 1 C Clinical feat -> unilat weakness = 2 -> language disturbance w/o weakness = 1
D diabtes = 1 D duration -> >60 min = 2 -> 10-59 = 1 -> <10 = 0
Patient score 2+ 1+ 1 = 4
What is the imaging modality of choice for suspected TIA patients?
MRI icluding DWI if not avialble CT scan should be done
- patients with TIA should ideally have neuroimaging within 24 hours
First choice antiplatelet for TIA
Aspirin
True or false aspirin and clopidgrel combination is recommended for stroke prevention?
False
For patients who are candidates for Carotid endarterectomy when is the best time to perform the procedure after a TIA event?
Within 2 weeks
Leading cause of embolic stroke?
AF
Accounts for 15% of all strokes
CHA2DS2VASc score means?
C - CHF H - Hypertension A - Age > 75 (2) D - Diabetes S - Stroke/ TIA (2) V - Vascular disease A- Age 65-74 Sc- Sex (Female)
All have one point except the 2s
Management for INR >9 without significant bleeding?
Hold drug
Give vitamin K one dose oral 2.5-5 mg
Repeat INR daily
Resume warfarin once INR is <3 but decrease dose by 10-20%
CHA2DS2VASc score to start anticoagulation?
2 or greater
CHADS2 score of > 2 start warfarin
Target INR for high risk patients such as those with prosthetic valves?
INR 2.5-3.5
Calss IB indication drug alternative for warfarin?
Dabigatran
For TIA and ischemic stroke patients precipitous drop in bp is avoided. How much is the safe range for lowering BP?
Not >15% of baselin MAP
For TIA patients with non-cardioembolic cause ASA is given for how long in the early phase?
14 days at 160-325 mg/day
You treat with BP lowering medications for ischemic stroke patients if MAP is?
> 130 mmHg
When is O2 support given for ischemic stroke patients?
O2 saturation < 95%
Further workup using CT with contrast, Ct angiogram, MRA or CTA is warranted for what group of patients?
< 45 yo Normotensive Lobar ICH Uncertain cause of ICH Suspected AVM
For mild stroke how soon can rehab be initiated?
72 hrs post stroke once clinically stable
For severe Hemorrhagic stroke supportive management with 20% mannitol is warranted. How much is the dose?
0.5-1 g/kg q 4-6 x 3-7 days