Managing stroke beyond windlow period
- 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: 1. Diffusion-FLAIR mismatch 2. 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? 1. Give labetalol IV 2. Give sublingual nifedipine 3. Give Tab telmisartan 4. Do nothing
- 13. TARGET BP
- 14. Managing Diabetes in Acute 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 1. Medullary infarction 2. Larger infarcts with low GCS 3. 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: 9866193953 • Email: drsudhirkumar@yahoo.com