initial stroke management
- related: Neurology
- tags: #literature
Stroke Notes
Initial management
Code Stroke
- CT head wo to rule out bleed
- MRI after 24 hours if no bleed
- Call neurosurgery and repeat CT head in 24 hours if hemorrhagic stroke
Tier 1
- tPA within 3-4 hours
- Observation in ICU for 24 hours then transfer to floor
- BP goal: <180 in 1st 24 hours, then normotension once on floor
- After 24 hours: statin only, repeat CT, then add antiplatelet or anticoagulation
Tier 2
- Thrombectomy within 24 hours
- BP goal: <180 in 1st 24 hours, then normotension once on floor
- Antiplatelet and anticoagulation?
No intervention
- Permissive HTN 160-180 in first 48 hours, then normotension
Types of Strokes
- Small vessel disease
- Usually from process of atherosclerosis
- Risk stratification: lipids, A1C, TSH
- Imaging: CTA, MRA
- Large vessel disease
- From carotid plaques
- Imaging: CTA, MRA, carotid US, transcranial doppler
- Cardioembolic
- From arrythmia or DVT with cardiac shunt
- Telemetry, EKG, TTE with bubble to look for shunt, lower extremity doppler if shunt present, ziopatch on discharge
- Others
- Cerebral amyloid angiopathy
- Embolic stroke of undetermined source (ESUS)
- Cryptogenic
Routine workup: CT head, then CTA/MRA, transcranial doppler with carotid US, TTE with bubble, lipid profiles, A1C, TSH
Antiplatelet and anticoagulation
- ESUS: ASA only
- Intracranial disease s/p stenting: DAPT
- 1 vessel disease or TIA: DAPT for 21 days, then ASA only
- Afib with new stroke: AC
- Cardioembolic: AC