Acute Ischemic Stroke

When was the patient last seen normal?

What are the patient's symptoms? Hemiparesis, aphasia, visual field deficits?

What is the patient's baseline function (including occupation & important hobbies)?

Any contraindication to thrombolytics?

- These important questions, along with the CT head and score on this NIH stroke protocol, will help guide whether a patient is a candidate for thrombolytic therapy

- Systemic tPA provides the most benefit early (< 3 hours) but can be used up to 4.5 hours in certain cases. The major benefit is reduced disability at 3 months (NNT 8), at the risk of increased intracranial bleeding (NNT 17). Check out these two landmark trials to see the difference in outcome and exclusion criteria based on the different time cut-offs (NINDS and ECASS-III). Every minute counts!

 

 - Malignant MCA syndrome is the consequence of increased cerebral edema with large MCA strokes. In younger patients there is evidence that a hemicraniectomy performed early significantly improves mortality and disability

Here is a great review article on acute ischemic stroke!