Stroke: Complications

by Roy Strowd, MD

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    00:01 So let's step back and look at what's happening in the brain and to the patient who's undergoing an acute stroke, or patients present suddenly with an acute fixed deficit, and that presentation is suggestive of an acute infarct.

    00:15 Those patients present to the hospital, often to the ER for early evaluation of those symptoms.

    00:22 Patients who present early within 3 to 4.5 hours of their last known normal are candidates for IV tPA.

    00:30 This is tissue plasminogen activator, it's a clot busting medication, with the goal being to bust up the clot that is reducing perfusion to an area of the brain.

    00:39 Outside of that window, we can consider thrombectomy and increasingly thrombectomy as utilized in the early management of patients with an acute ischemic infarct.

    00:49 We consider thrombectomy or other interventions within 3, 4.5 hours, 6 hours and sometimes out to 24 hours particularly for patients with posterior circulation strokes.

    01:01 Patients are then admitted for further monitoring and evaluation and that first 24-48 hours is a critical period of time when the goal is to prevent evolutionary expansion of the ischemic infarct and manage those patients.

    01:15 Initially, after an ischemic event, there's cytotoxic edema or swelling within the cells as the cells lose their sodium potassium ATPase function.

    01:25 And so the cells swell and we see cytotoxic edema within the first 24-48 hours.

    01:31 Then moving forward 3-5days after the stroke, we see vasogenic edema.

    01:35 And the peak edema after the stroke where increased water is moving outside of the blood vessels and into the brain.

    01:43 This increases the total amount of volume within the brain and we can see swelling, herniation and other catastrophic events that can occur after a stroke.

    01:52 And so patients are monitored during that 3-5 day period for swelling or edema after the stroke.

    01:58 The larger the stroke, the more of the edema, and the longer we'll monitor and evaluate those patients.

    02:04 During that period of time where there could be breakdown of the blood vessels, there's a risk of bleeding and we worry about bleeding during that initial week after the stroke.

    02:13 Ultimately, the risk of recurrence is earliest within a month or up to 3 months after stroke.

    02:18 And secondary prevention which is prevention of the stroke is critical during that window and then we look for recovery.

    02:26 And we really measure recovery after stroke, not in hours or days.

    02:29 But in weeks, months and even out to a year.

    02:32 We see patients recover after their stroke up to 3 months, 6 months and even continue to recover 12 months out from a stroke.

    02:40 Early intervention with rehabilitation is important, but we also want to continue those rehabilitative efforts during that entire recovery window.

    About the Lecture

    The lecture Stroke: Complications by Roy Strowd, MD is from the course Stroke and Intracranial Hemorrhage.

    Included Quiz Questions

    1. Less than 4.5 hours since last known normal
    2. Less than 12 hours since last known normal
    3. Less than 24 hours since last known normal
    4. Less than 48 hours since last known normal
    1. 24 hours
    2. 6 hours
    3. 12 hours
    4. 18 hours
    5. 48 hours
    1. 3–5 days
    2. 24–48 hours
    3. 7–10 days
    4. 2–3 weeks
    5. First 24 hours

    Author of lecture Stroke: Complications

     Roy Strowd, MD

    Roy Strowd, MD

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