Ischemic Stroke: Treatment

by Carlo Raj, MD

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    Now, what about the treatment for ischemic stroke? Well, in ABCs, you always want to make sure that you’re able to take care of the airway, the breathing, and circulation. That’s always going to be the issue with stroke. Now, with your blood pressure control, you want to keep in mind with systolic blood pressure between, let’s say, 180 and 220. And then if it’s a diastolic blood pressure, you may be approximately 140 to about 120. You want to be less than that so that you’re able to manage your patient who has suffered a stroke. Antiplatelet therapy, aspirin. Anticoagulation. If, if, the patient luckily is the hospital, heparin has to be instituted and helps and hurts, only used in atrial fib and dissection. So be careful. If your patient is already in a state of vulnerability, is already in the state of maybe bleeding, and if your patient is not suffering from atrial fibrillation or dissection, then be really careful with heparin. It’s rapidly acting, works through antithrombin III. And it might actually hurt the patient, may result in a hemorrhagic stroke, so be careful with heparin, please. Also, thrombolytics. I’m going to walk you through tPA, very, very important. And I want to walk you through this. I’m going to walk you through a great detail as to the contraindications for TPA that you must know for your boards. And then rehab. I promised you that we’d come back to the indications for tissue plasminogen activator. Remember that the physiology behind your tPA is the fact that plasmin is an “enzyme” that breaks down your fibrin clot very, very quickly. In other words, it’s a thrombolytic agent physiologically or homeostatically. And of course, we used this to our advantage in which we can then try to break...

    About the Lecture

    The lecture Ischemic Stroke: Treatment by Carlo Raj, MD is from the course Stroke (Cerebrovascular Accident). It contains the following chapters:

    • Treatment of Ischemic Stroke
    • Tissue Plasminogen Activator - tPA
    • Secondary Prevention
    • Ischemic Stroke: Summary

    Included Quiz Questions

    1. Time elapsed during the transfer of the patient to hospital.
    2. Age of the patient does not fit the criteria for tPA administration.
    3. He is a IV drug abuser.
    4. CT findings does not support administration of tPA.
    5. Clinical diagnosis was ischemic stroke.
    1. The PT must be monitored regularly to achieve desired therapeutic range
    2. Heparin is used in strokes caused due to dissection of the blood vessels.
    3. Heparin is used in the strokes caused due to atrial fibrillation.
    4. Heparin can complicate ischemic strokes by causing hemorrhage.
    5. Heparin is a rapidly acting natural anticoagulant.
    1. 12 weeks since the patient had a previous stroke.
    2. 8 weeks since the patient had a previous myocardial infarction.
    3. 4 weeks since the patient underwent arthroplasty.
    4. 4 weeks since the patient had a bout of hemetemesis
    5. 4 weeks since the patient underwent lumbar puncture at non compressible site.
    1. Patient had a myocardial infarction 8 months ago.
    2. Patient having an arterio-venous malformation.
    3. Patient had a stroke in the past 12 weeks.
    4. Patient had a major road traffic accident 2 weeks ago
    5. Patient had genito-urinary bleed 2 weeks ago
    1. Platelets - 40000 cells/cumm
    2. PT-16 seconds and aPTT -40 seconds
    3. Glucose - 80gm/dl
    4. NIHSS - 10
    5. Systoiic blood pressure- 126mm/Hg and diastolic blood pressure -88mm/Hg
    1. Antifibrinolytics drugs
    2. Thromboxane A2 inhibitor drugs
    3. GP IIb/IIIA complex inhibitor drugs
    4. Phosphodiesterase enzyme inhibitor drugs
    5. Anticoagulant drugs

    Author of lecture Ischemic Stroke: Treatment

     Carlo Raj, MD

    Carlo Raj, MD

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    Decent but flesh out the management
    By Hamed S. on 16. March 2017 for Ischemic Stroke: Treatment

    I enjoyed the series on ischaemic stroke but it would have been great to discuss in more depth the secondary management of stroke in particular blood pressure targets and agents with the most supportive evidence for use (e.g ACE-I). I also note that there was an omission about the best way to manage BP in the acutely hypertensive patient post stroke. Despite theses as always good taster of the topic. I appreciate the challenge of work that goes into producing these contents