Acute Ischemic Stroke Management Overview

20 Questions

Match the following medications with their uses in stroke care:

Tranexamic acid (TXA) = Treatment for hemorrhagic conversion after tPA administration Diphenhydramine = Treatment for angioedema caused by tPA administration Famotidine = Treatment for gastrointestinal ulcers Warfarin = Anticoagulation for cardioembolic causes of stroke

Match the following procedures with their uses in stroke care:

Mechanical thrombectomy = Treatment for large vessel occlusions within 6 to 24 hours of last known well time Carotid revascularization via endarterectomy = Treatment for carotid stenosis over 70% Hemicraniectomy = Treatment for increased intracranial pressure due to cerebral edema CT scan = Diagnostic tool for brain or body bleeding before tPA administration

Match the following complications with their associations in stroke care:

Hemorrhagic conversion = Complication of tPA administration requiring immediate intervention and reversal Angioedema = Allergic reaction to tPA administration requiring antihistamines and IV steroids Cerebral edema = Complication of large hemispheric infarcts leading to increased intracranial pressure Seizures = Common complication of stroke

Match the following terms with their definitions in stroke care:

Penumbra = Salvageable ischemic tissue around a core infarct in the brain Time is tissue = Principle of stroke care emphasizing timely intervention to salvage ischemic tissue ABCs = Essential components of acute stroke care before initiating tPA or thrombectomy Last known well time = Time at which the patient was last known to be normal

Match the following conditions with their associations in stroke care:

Diabetes = Risk factor for stroke that can be modified Hypercoagulable states = Contraindication to tPA administration Hypertension = Risk factor for stroke that requires blood pressure control Hyperlipidemia = Risk factor for stroke that can be modified with treatment

Match the following causes of acute ischemic stroke with their descriptions:

Global hypoperfusion = Caused by carotid stenosis leading to low blood pressure Thrombotic causes = Caused by cardiac emboli or left atrial thrombi Embolic causes = Caused by significant cardiogenic shock or acute respiratory failure Vasculitis = Caused by large vessel blockage like internal carotid artery

Match the following types of emboli with their descriptions:

Arterial to arterial emboli = Originates from a thrombus in the heart Cardiac emboli = Formed in the carotid artery and travels to the brain Paradoxical emboli = A blood clot that forms in the legs and travels to the brain Left atrial thrombi = A type of cardiac emboli that forms in the left atrium

Match the following syndromes with their affected vascular territories:

MCA syndrome = Affects the posterior cerebral artery PCA syndrome = Affects the middle cerebral artery Lacunar syndrome = Affects the lenticulostriate arteries Anterior choroidal syndrome = Affects the anterior cerebral artery

Match the following diagnostic tests with their purposes:

Stat CT scan = Evaluates for intracerebral hemorrhage Coagulation studies = Determines point-of-care glucose CBC = Evaluates cardiac function MRI = Confirms the type and location of stroke

Match the following treatment options with their criteria:

Administering tPA = For patients with intracerebral hemorrhage Supportive care = For patients with neuro deficits and no intracerebral hemorrhage Thrombectomy = For patients within the treatment window of less than 4.5 hours Anticoagulation therapy = For patients with atrial septal defect

Which type of ischemic stroke is often associated with hypertension, diabetes, and hyperlipidemia?

Thrombotic stroke

What is a common location for thrombotic causes of acute ischemic stroke?

Internal carotid artery

What is a potential complication of untreated carotid stenosis?

Global hypoperfusion

What is a critical factor in determining eligibility for tPA administration?

All of the above

What is the primary purpose of obtaining a stat CT scan in acute ischemic stroke?

To rule out intracerebral hemorrhage

What is the standard tPA dosage for acute ischemic stroke?

1.0 milligrams per kilogram with 25% given as a bolus

What are the contraindications for tPA administration in acute ischemic stroke?

Uncontrolled hypertension, presence of neural deficits, active bleeding

What is the standard blood pressure requirement for administering tPA in acute ischemic stroke?

Less than 185 over 110

What is the first-line treatment for large vessel occlusions within 6 to 24 hours post-stroke onset?

Mechanical thrombectomy

What is the potential complication of tPA administration that may necessitate fibrinogen level monitoring and intervention?

Hemorrhagic conversion

Study Notes

Video discusses acute ischemic strokes, emphasizing the importance of understanding the causes and pathophysiology.
Causes of acute ischemic stroke are categorized into global hypoperfusion, thrombotic causes, embolic causes, and other rare causes like vasculitis, dissection, and hypercoagulable states.
Global hypoperfusion can be caused by significant cardiogenic shock, acute respiratory failure, or carotid stenosis leading to low blood pressure.
Thrombotic causes often involve large vessels like the internal carotid artery or middle cerebral artery, as well as small vessels like lenticulostriate arteries.
Risk factors for thrombotic strokes include hypertension, diabetes, hyperlipidemia, smoking, and obesity.
Embolic causes can be arterial to arterial emboli, cardiac emboli (left atrial thrombi, left ventricular thrombi), or paradoxical emboli (through atrial septal defect).
Clinical features of acute ischemic strokes depend on the vascular territory affected and can include specific syndromes like MCA syndrome or PCA syndrome.
Diagnosis involves obtaining a stat CT scan, point-of-care glucose, coagulation studies, CBC, and potentially MRI and echo to confirm the type and location of stroke.
Treatment may involve administering tPA if the patient meets criteria like having neuro deficits, no intracerebral hemorrhage, and being within the treatment window (typically less than 4.5 hours from symptom onset).
Contraindications to tPA include active bleeding, low glucose levels, and uncontrolled hypertension.
Other considerations for treatment include managing blood pressure and addressing any underlying risk factors like diabetes or hypercoagulable states.- Standard blood pressure for administering tPA is less than 185 over 110
Contraindications for tPA include neural deficits, absence of brain or body bleeding, and well-documented last known well time
Standard tPA dosage is 0.9 milligrams per kilogram, with 10% given as a bolus and the rest over an hour
Post-tPA, blood pressure goals are crucial, and a CT scan should be obtained within 24 hours
Mechanical thrombectomy is an interventional radiology procedure for large vessel occlusions within 6 to 24 hours of the last known well time
Time is tissue in stroke care – the goal is to salvage ischemic tissue before it infarcts
Penumbra refers to salvageable ischemic tissue around a core infarct in the brain
ABCs (Airway, Breathing, Circulation) are essential in acute stroke care before initiating tPA or thrombectomy
Blood pressure control is crucial post-stroke, with different goals based on tPA administration or not
Anticoagulation is considered for cardioembolic causes, with DOACs or warfarin commonly used
Carotid revascularization via endarterectomy or stenting is indicated for carotid stenosis over 70%, especially in symptomatic patients
Antiplatelet therapy is important post-stenting or in cases of plaques to prevent thrombosis
Modifying risk factors like hypertension, diabetes, hyperlipidemia, smoking, and obesity can reduce stroke risk
Complications of tPA may include hemorrhagic conversion, requiring immediate intervention and reversal if fibrinogen levels are low- Tranexamic acid (TXA) is given as a treatment for stroke, with a bolus of one gram followed by another gram later. Cryoprecipitate containing fibrinogen may also be administered, along with a possible platelet transfusion.
Post-administration of tissue plasminogen activator (TPA), potential complications include angioedema, which may require antihistamines like diphenhydramine and famotidine, IV steroids, and a low threshold for intubation.
Cerebral edema and increased intracranial pressure (ICP) can occur in cases of large hemispheric infarcts, leading to midline shift and potential need for surgical interventions like a hemi craniectomy or medical management with hypertonic saline solutions like 23.4% saline or mannitol.
Seizures are a common complication of cortical infarcts near the cerebral cortex, often requiring treatment with anti-epileptic drugs or sedative medications like propofol in severe cases.
Aspiration pneumonia can develop post-stroke due to dysphagia, leading to secretions entering the lungs and causing infection. Prevention methods include speech evaluations, possible feeding tubes, and antibiotic treatment if infection occurs.
Treatment for infection due to aspiration pneumonia involves broad-spectrum antibiotics until culture results are available to narrow down the appropriate antibiotic choice.
Overall, the text covers acute ischemic stroke management, emphasizing the importance of recognizing and addressing potential complications promptly to optimize patient outcomes.

Explore the causes, clinical features, diagnosis, treatment options, and potential complications of acute ischemic strokes in this comprehensive overview. Learn about risk factors, thrombolytic therapy, mechanical thrombectomy, post-treatment care, and more.

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