Stroke - Neurological

Question 1

Although treatment of hypertension in ischemic stroke is not routinely undertaken, what is the target BP for a patient with ischemic stroke who is eligible for thrombolytic therapy?

Answer 1

Target < 180/105 but above 160/95

Question 2

Extreme blood pressure in a patient with an ischemic stroke (ie. systolic >220 or diastolic >120) should be treated cautiously to reduce the BP by what percentage?

Answer 2

Approx. 15%, and not more than 25%

Question 3

With acute intracerebral hemorrhage (ICH) what is the target SBP?

Answer 3

Target SBP of 140 mmHg

Question 4

In a patient presenting with an acute intracerebral hemorrhage what is the first-line medication for acute blood pressure management?

Answer 4

Labetalol

Question 5

In a patient with an acute intracerebral hemorrhage management of anticoagulation is important - what is recommended for a patient on Warfarin?

Answer 5

PCC - preferred due to fast onset of action

FFP & Vit K - good alternative if PCC not available

Question 6

In a patient with an acute intracerebral hemorrhage management of anticoagulation is important - what is recommended for a patient on the NOAC Dabigatran only?

Answer 6

Idarucizumab (5g over 10 min)

Question 7

In a patient with an acute intracerebral hemorrhage management of anticoagulation is important - what is recommended for a patient on the NOACs rivaroxaban or abixaban?

Answer 7

PCC

Question 8

With both ischemic and hemorrhagic stroke you should consider early intubation if the GCS is < what?

Answer 8

Equal to or less than GCS 8

Question 9

As per the Ornge stroke MDSO herniation syndrome is diagnosed as a combination of GCS <9 and one of these three findings:

Answer 9

1. Abnormal pupils (fixed/dilated, non-reactive)
2. Abnormal motor exam (flaccidity or posturing)
3. Cushing’s reflex (bradycardia, irregular respirations, widening pulse pressure)

Question 10

If a patient is presenting with cerebral herniation what are the ETCO2 goals?

Answer 10

ETCO2 32-35

Question 11

If a patient is presenting with cerebral herniation what are the 2 medications to patch for?

Answer 11

Hypertonic saline (3 percent), 3 mL/kg IV if MAP <80 mmHg
and/or
Mannitol, 1g/kg IV if MAP >80 mmHg