Stroke Awareness (Overview)

Stroke

Mannitol

Cardioembolic stroke

FAST

CT scan

Subarachnoid hemorrhage (SAH)

Nimodipine

Ischemic stroke

Thrombus

Call 911

High cholesterol

325mg

3 hours

60 minutes

If blood pressure is greater than 220/120 mmHg

Controlling cerebral perfusion

Alteplase (TPA)

Within 24 hours

Sudden numbness or weakness in arms, face, or leg. Sudden confusion. Sudden trouble seeing. Sudden dizziness. Sudden severe headache.

Lower blood pressure to ≤185/110 mmHg

False

False

True

True

True

True

The recommended treatment for ischemic stroke is Alteplase (tissue plasminogen activator or tPA) within 4.5 hours of symptom onset.

The recommended treatment for intracerebral hemorrhages (ICH) is controlling increased intracranial pressure (ICP) and using mannitol.

The medical term for bleeding resulting from a cerebral aneurysm is subarachnoid hemorrhage (SAH).

Hypertension (high blood pressure), a history of stroke or transient ischemic attack (TIA), smoking, African American ethnicity, dyslipidemia, age over 55 years old, sickle-cell disease, atherosclerosis, and patent foramen ovale (PFO)

325mg orally within 24-48 hours after stroke onset

Restoring blood flow to the brain, maintaining normal intracranial pressure (ICP), controlling cerebral perfusion, and managing blood pressure

Restoring blood flow to the brain = Returning blood supply to the affected area of the brain Maintaining normal intracranial pressure (ICP) = Controlling the pressure within the skull Controlling cerebral perfusion = Regulating blood flow in the brain Managing blood pressure = Keeping blood pressure within a healthy range

Hypertension = High blood pressure African American ethnicity = Being of African American descent Smoking = The act of inhaling and exhaling the smoke of burning tobacco Age over 55 years old = Being older than 55 years

Sudden numbness or weakness in arms, face, or leg = Immediate loss of sensation or strength in specific body parts Sudden confusion = Rapid onset of mental disorientation Sudden dizziness = Sudden loss of balance or feeling lightheaded Sudden severe headache = Intense and sudden onset of head pain

Ischemic Stroke = Caused by a thrombus in the brain Cardioembolic Stroke = Occurs when an embolus in the heart travels to the brain Intracerebral Hemorrhage (ICH) = Bleeding in the brain due to ruptured blood vessels Subarachnoid Hemorrhage (SAH) = Bleeding resulting from a cerebral aneurysm

Mannitol = Recommended treatment for increased intracranial pressure (ICP) associated with ICH Nimodipine = Recommended treatment for SAH Prophylactic Anti-Convulsants = May be considered in cases of SAH Aspirin = Recommended for stroke prevention, but not within 24 hours of fibrinolytic treatment

American Heart Association/American Stroke Association (AHA/ASA) = Provides guidelines for the treatment and secondary prevention of strokes CT Scan = Crucial within 45 minutes of arrival to the emergency room to differentiate between ischemic and hemorrhagic strokes FAST = Acronym used to recognize the signs and symptoms of a stroke 911 = Should be called immediately upon recognizing the signs and symptoms of a stroke

CT scan

Mannitol

Subarachnoid hemorrhage (SAH)

False

False

True

An ischemic stroke is caused by a thrombus in the brain, while a hemorrhagic stroke is due to bleeding events in the brain from ruptured blood vessels. An example of an ischemic stroke is a non-cardioembolic stroke caused by a thrombus in the brain. An example of a hemorrhagic stroke is an intracerebral hemorrhage or subarachnoid hemorrhage.

For intracerebral hemorrhages (ICH), the recommended treatment is controlling the increased intracranial pressure (ICP) using mannitol. Prophylactic anti-convulsants should not be used in the treatment of ICH. For subarachnoid hemorrhages (SAH) resulting from a cerebral aneurysm, the recommended treatment is nimodipine. Prophylactic anti-convulsants may be considered in cases of SAH.

The signs and symptoms of a stroke include droopy or numbness on one side of the face, difficulty raising both arms, and slurred speech. These signs and symptoms can be recognized using the acronym 'FAST', which stands for Face, Arms, Speech, and Time. Face: Ask the person to smile and check if one side of the face is droopy or numb. Arms: Ask the person to raise both arms and see if they have difficulty doing so. Speech: Check if the person's speech is slurred or if they have trouble speaking. Time: It is crucial to call 911 immediately upon recognizing these signs and symptoms to save brain tissue.

Ischemic stroke = Caused by a thrombus in the brain Cardioembolic stroke = Occurs when an embolus in the heart travels to the brain Hemorrhagic stroke = Events where there is bleeding in the brain due to ruptured blood vessels Non-cardioembolic stroke = Caused by a thrombus in the brain

Mannitol = Intracerebral hemorrhages (ICH) Nimodipine = Subarachnoid hemorrhages (SAH) Prophylactic anti-convulsants = SAH No prophylactic anti-convulsants = ICH

Face = Ask the person to smile. Is one side droopy or numb Arms = Raise both arms Severe headache = Sign of subarachnoid hemorrhages (SAH) Increased intracranial pressure (ICP) = Associated with intracerebral hemorrhages (ICH)

Diabetes

3 hours

60 minutes

True

True

True

The risk factors for stroke include hypertension (high blood pressure), a history of stroke or transient ischemic attack (TIA), smoking, African American ethnicity, dyslipidemia, age over 55 years old, sickle-cell disease, atherosclerosis, and patent foramen ovale (PFO).

The goals for stroke management include restoring blood flow to the brain, maintaining normal intracranial pressure (ICP), controlling cerebral perfusion, and managing blood pressure.

Alteplase (TPA) is the only fibrinolytic agent used to treat acute ischemic stroke.

The recommended door-to-needle time for administering Alteplase (TPA) to treat acute ischemic stroke is within 60 minutes.

Hypertension = High blood pressure Atherosclerosis = Buildup of plaque in the arteries Sickle-cell disease = Inherited red blood cell disorder Patent foramen ovale (PFO) = A hole in the heart that didn't close the way it should after birth

Restoring blood flow to the brain = Treatment to remove or dissolve the blood clot causing the stroke Maintaining normal intracranial pressure (ICP) = Prevention of brain swelling Controlling cerebral perfusion = Optimizing blood flow to the brain Managing blood pressure = Keeping blood pressure within a safe range to prevent further damage

Alteplase (TPA) = Used to treat acute ischemic stroke within three hours of symptoms Aspirin (ASA) = Given within 24 hours of fibrinolytic treatment for stroke prevention Nimodipine = Used in the treatment of cerebral aneurysm Prophylactic anti-convulsants = Used to control increased intracranial pressure (ICP) in subarachnoid hemorrhages (SAH)

325mg

Only if the blood pressure is greater than 220/120 mmHg

Less than 180/110 mmHg

True

True

False

325mg

if the blood pressure is greater than 220/120 mmHg

HTN goal

Aspirin (ASA) = Recommended to be given in a dose of 325mg orally within 24-48 hours after stroke onset to prevent early recurrent stroke Blood pressure medications = Should only be given if the blood pressure is greater than 220/120 mmHg when a patient is not receiving Alteplase Hypertension management = Involves giving blood pressure medications to lower blood pressure before using Alteplase Alteplase treatment = Should not be given within 24 hours of fibrinolytic treatment

Ischemic stroke = Occurs when blood flow to a specific area of the brain is restricted Hemorrhagic stroke = Caused by bleeding resulting from a cerebral aneurysm Subarachnoid hemorrhages (SAH) = Associated with increased intracranial pressure (ICP) and should be controlled with prophylactic anti-convulsants Embolus stroke = Occurs when an embolus in the heart travels to the brain

Aspirin (ASA) = Recommended treatment for ischemic stroke Alteplase (TPA) = The only fibrinolytic agent used to treat acute ischemic stroke Nimodipine = Not the recommended treatment for cerebral aneurysm Prophylactic anti-convulsants = Used in the treatment of intracerebral hemorrhages (ICH)

325mg orally

If the blood pressure is greater than 220/120 mmHg

To lower blood pressure

Increased risk of bleeding

Increased risk of serious bleeding or thrombotic thrombocytopenic purpura (TTP)

5 days before surgery

Alteplase

90 mg

Aspirin

True

True

False

False

True

False

GI Hemorrhage, Hematoma, Pruritus

Serious bleed, combination with omeprazole/esomeprazole, serious bleed, patients with a serious bleed

Fluid/Electrolyte Loss, Dehydration, Hyperosmolarity, Hyperkalemia, Acidosis, increased Osmolar GAP

Contraindications for using Alteplase include active bleeding, recent trauma within three months, uncontrolled high blood pressure, and NSAID or salicylate allergy.

The adverse drug reactions of Aspirin and Yosprala include dyspepsia, heartburn, nausea, and tinnitus.

Aggrenox inhibits Adenosine and increases cAMP.

Clopidogrel = Bleeding risk and should be stopped 5 days before surgery Mannitol = Drug accumulation in the brain causing Rebound ICP Nimodipine = Hypotension and should NOT be administered as an IV or via any parental route

Clopidogrel = Serious bleed Mannitol = Renal disease, anuria, dehydration, heart failure, and pulmonary edema/congestion Nimodipine = Patients at risk of hypotension

Clopidogrel = Secondary stroke prevention if a patient is allergic or contraindicated to aspirin Mannitol = Promoting Osmotic Diuresis to reduce ICP in ICH Nimodipine = DHP-CCB with adverse side effects that include hypotension, bradycardia, headache, nausea, and edema

Alteplase = Major bleeding (ICH), angioedema, and cholesterol embolization Aspirin = Bleeding, gastrointestinal bleeds/ulcers, and Reye's syndrome Yosprala = Bleeding, gastrointestinal bleeds/ulcers, and Reye's syndrome Aggrenox = Hypotension

Alteplase = 90 mg Aspirin = Not specified Yosprala = Not specified Aggrenox = Not specified

Alteplase = Fibrinolytic Aspirin = Irreversible COX-1/2 inhibitor, Anti-platelet, Anti-Pyretic, Analgesic, Anti-inflammatory Yosprala = Irreversible COX-1/2 inhibitor, Anti-platelet, Anti-Pyretic, Analgesic, Anti-inflammatory Aggrenox = Inhibits Adenosine and increases cAMP