Please enable JavaScript.

Coggle requires JavaScript to display documents.

Acute Stroke: Key Facts (Clinical Features: Bamford Classification (TACS:…

- - - - Medical
        
        Consider thrombolysis if 18-80yrs and <4.5hrs since onset of symptoms
        Alteplase (rh-tPA)
        → ↓ death and dependency (OR 0.64)
        CT 24h post-thrombolysis to look for haemorrhage
        
        Aspirin 300mg PO/PR once haemorrhagic stroke excluded ± PPI
        Clopidogrel if aspirin sensitive
      - Surgery
        
        Neurosurgical opinion if intracranial haemorrhage
        
        May coil bleeding aneurysms
        
        Decompressive hemicraniectomy for some forms of MCA infarction.
      - Stroke Unit
        Specialist nursing and physio
        Early mobilisation
        DVT prophylaxis
        ~
        Secondary Prevention
        Rehabilitation
    - - Glucose: 4-11mM: sliding scale if DM
        
        BP: Rx of HTN can → ↓ cerebral perfusion
        
        Neuro obs
    - - FBC: infection (sepsis may → stroke)
        
        U+E: electrolyte disturbances may mimic stroke
        
        Glucose: exclude hypoglycaemia
        
        Clotting: ↑ or ↓ INR may indicate cause
- - - - Warfarin instead of aspirin/clopidogrel if
        
        Cardioembolic stroke or chronic AF
        
        Start from 2wks post-stroke (INR 2-3)
        
        Don’t use aspirin and warfarin together.
        
        Carotid endarterectomy if good recovery + ipsilateral stenosis ≥70%
- - - - Thrombophilia Screen
        
        FBC, clotting, fibrinogen concentration
        
        APC resistance / F5 Leiden
        
        Lupus anticoagulant
        
        Anti-cardiolipin Abs
        
        Assays for protein C and S and AT3 activity
        
        PCR for prothrombin gene mutation