Acute ischemic stroke
Management
A, B, C
Ct scan : look for hemorrhage, thrombus, penumbra salvageable with thrombolysus
NIHSS - high risk TIA / NIHSS < 3 is DAPT 21, mono lifelong
blood glucose and BP - for thrombolysis 180/110 and not for thrombolysis 220/110 for 24 hours
BP- for next 72 hours - not less than 130 / 85 mmhg
if BP > 220 mmhg - labetolol / nifedipine
Wake up stroke
unsure when it happen
last since well > 4.5 hours - MRI - DWI perfusion mismatch shows salvageable tissue
IV thrombolysis
on warfarin
not recommended for thrombolyis
INR < 1.7, higher give vitamin K
INR < 1.7 and within 4.5 hours - ok to thrombolyse
on DAPT
ok to thrombolyse if less than 4.5 hours
DOAC
not recommended IVT
on ESRD regular dialysis
APTT normal - thrombolyse
Alzheimer
thrombolyse
discuss with fam
mRankin score
> 1 ( wheelchair bound etc )
dfiscuss with fam
Contraindications for thrombolysis
CT aspect score - predict outcome of stroke
subcortical area ( internal capsule, lenticules nucleus, thalamus )
M1, M2, M3, Posterior - M4, M5, M6
higher score - better functional neurological outcome
