Neuro - Malignant MCA Syndrome

Question 1

What is the time window for thrombolysis?

Answer 1

Within 4.5 hours of symptom onset

Question 2

What is the thrombolysis dose in acute stroke?

Answer 2

• Alteplase- 900 mcg/kg (up to 90mg) over 60mins- First 10% as an injection, rest as an infusion.-

Question 3

What is the management of malignant MCA syndrome?

Answer 3

Resuscitation in ABCDE approach correcting abnormalities as they are foundNeuroprotection and stabilisation:- head up 30-40- avoid pyrexia, hypoxia, hypotension- pCO2 4.5-5- pO2 >12- sedation and paralysis- target MAP 80-90 assuming raised ICP

ICP management:- deepen sedation - may need barbiturate coma- osmotherapy- neurosurgical intervention - decompressive craniotomy ( age <60, within 48hrs) - improves survival but neurological outcomes not great (DESTINY I/II, DECIMAL, HAMLET)