Managing stroke beyond windlow period

Stroke is common. This presentation discusses the broad outlines of acute stroke management, especially in the first 24 hours after onset of symptoms. It would be useful for physicians as well as neurologists.

1. MANAGING STROKE BEYOND WINDOW PERIOD DR SUDHIR KUMAR MD DM CONSULTANT NEUROLOGIST APOLLO HOSPITALS, HYDERABAD

2. How much is Window Period? For IV thrombolysis- 4.5 hours For mechanical thrombectomy: 6 hours Within the window period- earlier the better.

3. Wake up Strokes Those who woke up with stroke or if stroke onset time is unknown, thrombolysis can be done if: Diffusion-FLAIR mismatch Diffusion-perfusion mismatch

4. Diffusion-FLAIR Mismatch

5. Diffusion-Perfusion mismatch

6. Strokes between 6-24 hours Mechanical thrombectomy is an option, if there is diffusion-perfusion mismatch on MRI. Here too, the earlier, the better.

7. THEREFORE, REFER ALL STROKE PATIENTS WITHIN 24 HOURS TO A “STROKE-READY” HOSPITAL.

8. Apollo is Always STROKE READY

9. Do Not Give Aspirin to ALL stroke patients.

10. Start ANTIPLATLET for Ischemic Stroke Patients

11. HEPARIN DOES NOT DISSOLVE CLOT IN BRAIN Avoid heparin for treating acute ischemic stroke (it is not a substitute for thrombolysis) Heparin, however, can be given for cardio-embolic stroke to prevent cot formation in the heart. Heparin can also be given for DVT prophylaxis.

12. BP Management in Acute Stroke Q: 6 hours after onset, in a patient with ischemic stroke, BP: 180/105 mmHg , what would you do? Give labetalol IV Give sublingual nifedipine Give Tab telmisartan Do nothing

13. TARGET BP

14. Managing Diabetes in A cute Stroke Acute ischemic stroke, non-diabetic, on admission, has a blood sugar 190 mg%, is he a diabetic?

15. Hyperglycemia after stroke Common (42% at admission, another 20% develop within 48 hours) Some have stress hyperglycemia, only 28% are diabetics HbA1C >6.5% at admission is suggestive of diabetes.

16. TARGET BLOOD GLUCOSE 140-180 mg%

17. CHECK SWALLOWING FUNCTION Risk of aspiration pneumonia in stroke patients is high Medullary infarction Larger infarcts with low GCS Opercular syndrome

18. NEUROPROTECTION Piracetam - may help in post-stroke aphasia Citicholine - improves recovery and leads to better functional status at 3 months after stroke

19. STEROIDS Not helpful in lowering ICP May lead to poorer outcome due to side effects (infections, high BP/sugars)

20. COMMENTS/QUERIES? Whatsapp: [phone] Email: [email protected]