Treatment of Stroke Flashcards
What are basic things stroke patients have to start working on immediately after admission?
Mobilise patients asap (The probability of returning home decreases by 20% for each
day the patient is not mobilized)
Swallowing - swalowing problems are present in 50% of all stroke patients
What is the aim of thrombolysis for the treatment of a patient suffering from stroke?
To restore perfusion before cell death occurs
Give an example of a drug used in thrombolysis and when to use it
Alteplase - not for use after 4.5 hours of the onset of symptoms
Benefit of using alteplase outweighs the risk when used up to 4.5 hours after the onset of symptoms in accordance with the licence
What are the ways you can ensure FAST treatment of stroke?
Alerting hospital team
Alerting CT/radiology team
Keeping the patient/relatives informed
Here is some info about clot retrieval
https://www.youtube.com/watch?v=7gn96se6j00
How does clot retrieval fit in with the therapy of Thrombolysis with alteplase?
Thrombolysis with rTPA benefits selected patients: the earlier the better
Clot retrieval may improve outcomes further
What is rTPA?
Residual tissue plasminogen activator
What is the effect of rTPA? (residual tissue plasminogen activator)
As an enzyme, it catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown.
What are contraindications to thrombolysis?
Minor neurological deficit or symptoms rapidly improving before start of infusion.
Symptoms of ischaemic attack began more than 4 hours prior to referral, or when time of symptom onset is unknown.
Severe stroke as assessed clinically (e.g. NIHSS>25) and/or by appropriate imaging techniques.
Seizure at onset of stroke.
Symptoms suggestive of subarachnoid haemorrhage, even if the CT-scan is normal.
On warfarin therapy, or administration of heparin within the previous 48 hours and a thromboplastin time exceeding the upper limit of normal for laboratory.
Patients with any history of prior stroke and concomitant (associated) diabetes.
Prior stroke within the last 3 months.
Platelet count of below 100,000/mm3 (if available).
Systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg, or aggressive management (IV medication) necessary to reduce BP to these limits.
Blood glucose <3 or > 20 mmol/L.
Known haemorrhagic diathesis (a tendency to suffer from a particular medical condition), manifest or recent severe or dangerous bleeding, known history of or suspected intracranial haemorrhage.
(Use is contraindicated in hemorrhagic stroke and head trauma)
Licence currently limited to <80yr
What should be done for a patient who has had symptoms for more than 4.5 hours without thrombolysis?
Contact stroke unit for admission
What is hemicraniectomy used to treat?
Brain edema as a result of a large middle cerebral artery stroke among elderly patients.
What are the benefits of hemicrainiectomy?
Increases the chances of survival albeit with a moderate to severe disability in most patients - cause of death is mostly brain herniation
When should hemicrainiectomy be offered?
Within 48 hours of stroke onset?
Who is most likely to suffer from a stroke?
Someone who has already suffered from stroke
Does complete clinical recovery of a TIA indicate absence of infarcted tissue?
No - many TIA victims may show morphological changes on CT or MRI despite complete recovery
