Management of STROKE

Question 1

A typical patient loses how much neuron every minute in which stroke is untreated

Answer 1

1.9 million neuron

Question 2

Stroke Diagnosis

Answer 2

Profound Weakness
➕
CT Brain: To assess Hemorrhage
(OR)
DWMRI: Hyperintensity ➡️ Infarct ➡️ Stroke

Question 3

T2W MRI shows STROKE minimum after

Answer 3

4-6 days

Question 4

Cerebral Blood Flow
✨ < 10 ml/mg/min
✨ 10-22 ml/mg/min
✨ > 22 ml/mg/min

Answer 4

✨ < 10 ml/mg/min
🎯 Infarcted Area ➡️ NOT SALVAGEABLE

✨ 10-22 ml/mg/min
🎯 ISCHEMIC PENUMBRA

✨ > 22 ml/mg/min
🎯 NORMAL

Question 5

Penumbra

Answer 5

Peripheral region of Infarct in the brain

Question 6

Penumbra can be detected by

Answer 6

Perfusion Weighted MRI

Question 7

ADC
⭐ Use

Answer 7

Apparent Diffusion Coefficient
⬇️
USE: Shows HYPOINTENSITY in ACUTE INFARCT

Question 8

Hyperintensity in DWMRI (White)
➕
Hypointensity in ADC (Black)
Means?

Answer 8

Acute INFARCTION

Question 9

Hypointensity in DWMRI (White)
➕
Hyperintensity in ADC (Black)
Means?

Answer 9

Chronic Infarct

Question 10

Golden Hour of Stroke

Answer 10

4.5 hrs (4-5 hrs)

✨ Thrombolysis can be done

Question 11

Thrombolysis in Stroke is INEFFECTIVE, if patient presents

Answer 11

After 5 hrs

Question 12

💊💉 MANAGEMENT of STROKE

Answer 12

Small Inaccessible Vessel:
1. Thrombolysis

Large Vessel or 1st Order Branches:
2. MR angiography ➕ Endovascular Clot Retrieval & Stenting

Question 13

Indications for THROMBOLYSIS

Answer 13

1. LESION in 2nd & 3rd Order VESSELS & patient present within 4.5hrs
2. Clinical diagnosis of Stroke ➕ NORMAL CT ➕ No Endovascular intervention ➕ patient present within 4.5hrs

Question 14

🚫 CONTRAINDICATION of THROMBOLYSIS

Answer 14

1. Age < 18 yrs
2. Platelet count < 1 lakh/mm³
3. Blood Sugar < 50 & > 400 mg/dl
4. H/O of Surgery in last 14 days or GI bleeds in last 21 days
5. BP < 185/110 with (OR) without drugs
6. Edema in > ⅓rd of MCA territory

Question 15

Drug used for THROMBOLYSIS in STROKE

Answer 15

Alteplase
0.9mg/kg IV
✨ 10% as IV Bolus
✨ 90% as IV infusion over 1 hr

Question 16

Anti platelet to be given in STROKE

Answer 16

Aspirin 300 mg stat Dose followed by 150 mg Maintainance

Question 17

Double Anti-Platelet therapy
Indications

Answer 17

1. Pt with TIA who can develo Stroke
2. Minor STROKE
3. Developed Stroke while on Single Anti-Platelet

Question 18

Anticoagulation INDICATIONS in STROKE

Answer 18

CARDIOEMBOLIC stroke
✨ Atrial Fibrillation with Mitral Stenosis
✨ Post Mitral Valve Replacement