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Old 09-08-2011
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Neuro Management of Ischemic Stroke!

I started neurology, this is a summary for management of ischemic stroke, please guys add or correct me. Thanks.

Ischemic stroke: Only 15% would make it to the ER in < 3 Hrs, of beginning of symptoms & 85% after 3 Hrs. the management, is different. If you get the patient with the first 3 hrs, you need to do first CT without contrast, to role out hemorrhage, then give tPA.

If you get the patient after 3 Hrs, the same way do CT scan without contrast, tPA is going to help, give aspirin. If you get a patient, who had a stroke in the past & on aspirin, you may consider switching to Clopidogrel, or adding Dipyridamole.
For secondary prevention we use aspirin, 24 Hrs after tPA. If there is history of aspirin allergy we can use Clopidogrel or Dipyridamol.
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Old 09-09-2011
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Remember: Patients come with sudden numbness & weakness. Diagnostic tests you need to do:
      • CT without contrast to role out bleeding.
      • Echo: to look for clots & valvular lesions (AS or MS)
      • EKG: to look for A Fib.
      • Telemetry/Holter: to look for A Fib.
      • Carotid Duplex : > 70% stenosis + Stroke : endarterectomy.
INR 2 to 3 : A Fib, pulmonary embolism, DVT, any clot any where. The only indication, for INR more than that is Metallic valve 3-4.
The board may mention atrial flutter, instead of A Fib, the management is the same regarding clotting.
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Old 09-09-2011
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Stroke in young person < 50, what you do different in evaluation: Look for vasculitis & Hypercoagulable state:
  • SLE 2.
  • Lyme disease,
  • Hypercoagulable state like factor 5 Leiden.
  • PAN.
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Old 09-09-2011
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Control of risk factors for stroke:
1. Diabetes to Hb A1C less than 7%.
2. HTN.
3. LDL less than 100.
4. Stop smoking.
Remember IF Hemorrhagic stroke: No treatment, surgical drainge will not help.
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Old 09-09-2011
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if patient recieved aspirin, tPA can be given after it..but if tPA has been given firat for some reason than asipirn can ONLY be given after 24 hrs..

in case of ICH..
control BP but dont lower it too much..also give calcium channel blocker(nimodipine)
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