Strokes

Question 1

Reverse anticoagulation treatments with ICH or Hemorrhagic stroke TX: (3)

Answer 1

o Warfarin? then Vitamin K IVPB KCentra and FFP
oDabigatran? then Praxbind (idarucizumab)
oRivaroxaban or apixaban? then Prothrombin complex

Question 2

BP Goal and drugs w/ ICH or Hemorrhagic stroke TX: (2)

Answer 2

o BP goal: 160/90 (MAP~110)

w/ Nicarpine or hydralazine

Question 3

DX test and imaging findings for ICH or Hemorrhagic stroke:

Answer 3

CT scan w/o contrast
oNew blood: white (hyperdense)
oOld blood: dark grey (hypodense)

Question 4

Spontaneous hemorrhage associated w/ ICH MC occurs secondary to:

Answer 4

poorly controlled HTN secondary to chronic damage causing microaneurysm

Question 5

ICH locations of the brain affected: (5)

Answer 5

basal ganglia
cerebrum
cerebellum
pons 
thalamus

Question 6

Specific measures to reduce ICP and prevent herniation in ICH: (4)

Answer 6

1- Decompressive craniectomy: most definitive
2- mannitol/hypertonic saline
3- hypothermia
4- hyperventilation (transient cerebral vasoconstriction)

Question 7

TPA Exclusion Criteria: (10)

Answer 7

1- Stroke hx w/in 3 mos. 
2- Surgery Intracranial and Intraspinal
3- Heparin use in the last 48 hrs
4- Anticoagulation w/ INR>1.7
5- Head trauma w/in 3 mos.
6- AVM/Aneurysm/Intracranial neoplasm
7- Hx of ICH/SAH
8- Arterial puncture @ noncompressible site in past days
9-Hypoglycemia/HTN>185/110
10- Active internal bleed/bleeding diathesis
- also never TPA if pt getting better

Question 8

TX for large vessel dz secondary prevention w/ stroke:

Answer 8

90 days DAPT and ASA indefinite

Question 9

TX for small vessel dz secondary prevention w/ stroke:

Answer 9

ASA indefinite