Questions and Answers
If SAH is suspected but non con CT is normal What is required? VSWhat is required for DEFINITIVE DIAGNOSIS?
REQUIRED= LP definitive diagnosis- catheter based angiography
What intervention is recommended for subarachnoid hemorrhage patients with the presence of hydrocephalus on neuroimaging?
Neurosurgical placement of an external ventricular drain
What is the most common cause of intracerebral hemorrhage that affects deep structures of the brain, and what is the mainstay of prevention for this condition?
Hypertension; control of blood pressure
What is the only thrombolytic agent approved for use in acute ischemic stroke?
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When is alteplase most effective when administered in acute ischemic stroke?
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What is the significant outcome associated with early administration of alteplase in acute ischemic stroke?
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What is the role of MRI in selecting patients for IV alteplase administration in acute ischemic stroke?
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In patients with acute ischemic stroke, what is the significance of unclear time of onset?
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What is the time window for IV alteplase administration in patients with acute ischemic stroke who awake with stroke symptoms?
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What are the main risk factors for symptomatic hemorrhage in stroke patients?
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What are the key considerations for IV alteplase administration in acute ischemic stroke?
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What is the significance of catheter-based angiography in the diagnosis of aneurysms and subarachnoid hemorrhage?
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What should be the maximum blood pressure reading before treatment with alteplase in patients with acute ischemic stroke?
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Why should nitrates be avoided in patients with acute ischemic stroke before treatment with alteplase?
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What are the main risk factors for symptomatic hemorrhage in stroke patients?
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What specific examination and radiologic findings are required for recommending endovascular therapy within 24 hours of stroke onset?
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What noninvasive vessel imaging techniques are recommended for patients considered for endovascular therapy?
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What is the recommended primary method for endovascular therapy within 24 hours of stroke onset?
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In a recent trial, what medications were compared within 24 hours of stroke onset, and what was the outcome?
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What is the NIHSS score range for the patient population that has been the focus of recent trials of antiplatelet therapy?
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What is the recommended systolic blood pressure target for acute treatment of patients with intracerebral hemorrhage?
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Why should IV nitrates and nitroprusside be avoided in patients with intracerebral hemorrhage?
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What is the primary predictor of early hematoma expansion in acute intracerebral hemorrhage?
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What is the systolic blood pressure threshold for initiating treatment in patients with intracerebral hemorrhage?
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What is the preferred intervention over medical therapy when elevated intracranial pressure and hydrocephalus result in decreased level of consciousness in intracerebral hemorrhage?
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What type of therapy is ineffective in reducing cerebral edema in intracerebral hemorrhage and should not be routinely administered?
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Which two substances may temporarily reduce intracranial pressure in intracerebral hemorrhage when used as short-term bolus osmotherapy?
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What is the purpose of catheter-based angiography in the diagnosis of aneurysms and subarachnoid hemorrhage?
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In patients with symptoms suggestive of SAH and normal noncontrast head CT findings, what procedure is required to evaluate for the presence of blood or xanthochromia?
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What should be done if SAH is confirmed in a patient?
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Study Notes
Subarachnoid Hemorrhage (SAH)
- If SAH is suspected but non-contrast CT is normal, a lumbar puncture is required to evaluate for the presence of blood or xanthochromia.
- For definitive diagnosis of SAH, LP or CT angiography is required.
Hydrocephalus and SAH
- In SAH patients with hydrocephalus on neuroimaging, ventriculostomy is recommended.
Intraparenchymal Hemorrhage
- Hypertension is the most common cause of intracerebral hemorrhage that affects deep structures of the brain.
- Blood pressure control is the mainstay of prevention for this condition.
Alteplase in Acute Ischemic Stroke
- The only thrombolytic agent approved for use in acute ischemic stroke is alteplase.
- Alteplase is most effective when administered within 3-4.5 hours of acute ischemic stroke.
- Early administration of alteplase is associated with improved outcomes, including independence and reduced mortality.
- MRI is used to select patients for IV alteplase administration in acute ischemic stroke.
Patient Selection for Alteplase Administration
- Patients with unclear time of onset of stroke are not eligible for alteplase administration.
- The time window for IV alteplase administration in patients with acute ischemic stroke who awake with stroke symptoms is within 4.5 hours of waking.
- Key considerations for IV alteplase administration include time of onset, patient age, and stroke severity.
Catheter-Based Angiography
- Catheter-based angiography is significant in the diagnosis of aneurysms and subarachnoid hemorrhage.
Blood Pressure Management
- The maximum blood pressure reading before treatment with alteplase in patients with acute ischemic stroke is 185/110 mmHg.
- Nitrates should be avoided in patients with acute ischemic stroke before treatment with alteplase due to risk of hypotension.
Endovascular Therapy
- Specific examination and radiologic findings, including large vessel occlusion, are required to recommend endovascular therapy within 24 hours of stroke onset.
- Noninvasive vessel imaging techniques, including CTA or MRA, are recommended for patients considered for endovascular therapy.
- The recommended primary method for endovascular therapy within 24 hours of stroke onset is mechanical thrombectomy.
Intracerebral Hemorrhage
- The recommended systolic blood pressure target for acute treatment of patients with intracerebral hemorrhage is 140 mmHg.
- IV nitrates and nitroprusside should be avoided in patients with intracerebral hemorrhage due to increased risk of increased intracranial pressure.
- The primary predictor of early hematoma expansion in acute intracerebral hemorrhage is Spot Sign on CT angiography.
- The systolic blood pressure threshold for initiating treatment in patients with intracerebral hemorrhage is 150 mmHg.
- Ventriculostomy is preferred over medical therapy when elevated intracranial pressure and hydrocephalus result in decreased level of consciousness in intracerebral hemorrhage.
- Corticosteroids are ineffective in reducing cerebral edema in intracerebral hemorrhage and should not be routinely administered.
- Mannitol and hypertonic saline may temporarily reduce intracranial pressure in intracerebral hemorrhage when used as short-term bolus osmotherapy.
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