Stroke. Core Rounds Mark Y. Wahba Preceptor: Dr. Ian Rigby Oct. 16th, 2003. WHO definition: Stroke. “a neurological deficit of sudden onset accompanied by focal dysfunction and symptoms lasting more than 24 hours that are presumed to be of a non-traumatic vascular origin”.
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Mark Y. Wahba
Preceptor: Dr. Ian Rigby
Oct. 16th, 2003
HemorrhagicWhat are the types of stroke?
From carotid system
Supplies 80% of brain
From vertebral system
Supplies 20% of brainCerebral Blood Supply
Guidelines for the Early Management of Patients With Ischemic Stroke. A Scientific Statement From the Stroke Council of the American Stroke Association. Adams HP et al Stroke. 2003;34: 1056-1083.
“in general, the diagnosis of stroke is straightforward”
Post-ictal paresis (Todd’s paresis)
Malignant hypertensionDifferential Diagnosis
Brain CT attack
aPTTImaging and Lab - All patients should have:
Tox screen and EtOH (if uncertain about hx)
ABG (if hypoxic)
CXR (if lung pathology suspected)
LP (if suspecting SAH and CT is negative)
EEG (suspecting seizures )Selected Patients
MRI vs CT
Are we doing the right thing?
Assessment and Emergency Management (Part II)
6 grade-one multi-center RCTs of thrombolytics for acute stroke demonstrated lack of benefit or worse outcomes with treatment
3 trials of streptokinase were halted prematurely because of an excess of poor outcomes or deaths (level I)
the NINDS trial is the only published RCT of intravenous thrombolytic therapy that has been positive in favor of thrombolysis
Position Statement on Thrombolytic Therapy for Acute Ischemic Stroke, The CAEP Committee on Thrombolytic Therapy for Acute Ischemic Stroke http://www.caep.ca/002.policies/002-01.guidelines/thrombolytic.htmTo date:
Position Statement on Thrombolytic Therapy for Acute Ischemic Stroke:
SAH appropriate neurological and neuro-imaging resources that are capable of administering treatment within 3 hoursHigh attenuation is seen diffusely within the sulci on a noncontrasted head CT. High attenuation collections are also present within the occipital horns of the lateral ventricles. Moderate hydrocephalus is present
Among patients undergoing angiography for atherosclerotic stroke:
Level of Consciousness-3 appropriate neurological and neuro-imaging resources that are capable of administering treatment within 3 hours
LOC of questions-2
LOC of Commands-2
Motor Arm: L and R-4 each
Motor Leg: L and R-4 each
Extinction and Inattention-2NIHSSscore out of 42