Acute Stroke Care

Description:

You have just encountered a possible stroke patient. You ask yourself: what should I do first? How do I know it is a stroke? Is it too late to reverse the damage? This book provides integral assistance in answering these critical questions. All content is arranged in chronological order, covering all considerations in assessing and treating patients in the emergency room, stroke unit, and rehabilitation facilities. This new edition offers readers the latest information on stroke treatment, and features brand new chapters on stroke radiology, endovascular therapy, the uncommon causes of stroke, cerebral venous thrombosis, stroke prevention, and the transition to outpatient care. The comprehensive set of appendices contains useful reference information, including dosage algorithms, conversion factors, and stroke scales.

Table of Contents:

Chapter 1 Stroke in the Emergency Department

Is This a Stroke?

What Type of Stroke?

Chapter 2 What to Do First

Airway – Breathing – Circulation (ABCs)

What Was the Time of Onset?

How Bad Are the Symptoms Now?

Do a Non-Contrast Head CT

If the CT Shows No Blood, Try to Get the Artery Open

Recommended Diagnostic Evaluation

Chapter 3 Ischemic Stroke

Definition

Etiology

Diagnosis

The Four Components of Ischemic Stroke Care

Acute Therapy and Optimization of Neurological Status

Etiological Work-up for Secondary Prevention

Prevention of Neurological Deterioration or Medical Complications

Recovery and Rehabilitation

Ischemic Stroke Outcome

General Timeline

Chapter 4 Stroke Radiology

Computed Tomography

Head CT with Contrast

Magnetic Resonance Imaging

MRI Sequences

Usual Sequences Ordered for Acute Ischemic Stroke Patients

Abbreviated Protocol for Uncooperative Patients

Usual Sequences Ordered for Acute ICH Patients

Cerebral Angiogram

Diffusion Tensor Imaging

Chapter 5 Intravenous Thrombolysis

tPA Indications

tPA Contraindications

Procedure

Risks Versus Benefits of tPA

tPA-Related Intracranial Hemorrhage: Management Protocol

Oropharyngeal Angioedema: Management Protocol

Chapter 6 Endovascular Therapy

Time is Still Important

Planning an Endovascular Case

During the Procedure

After the Procedure

Risks and Benefits of EVT

Posterior Circulation

Chapter 7 Neurological Deterioration in Acute Ischemic Stroke

Probable Causes

Initial Evaluation of Patients with Neurological Deterioration

Stroke Enlargement

Drop in Perfusion Pressure

Recurrent Stroke

Cerebral Edema and Mass Effect

Hemorrhagic Transformation

Metabolic Disturbance

Seizure

Symptom Fluctuations Without a Good Cause

The Uncooperative Patient

Chapter 8 Ischemic Stroke Etiology and Secondary Prevention

Diagnostic Studies

Control Risk Factors

Antiplatelets and Anticoagulants

Atrial Fibrillation

Carotid Stenosis

Carotid Occlusion

Intracranial Stenosis

Lacunar Strokes

Cervical Arterial Dissection

Patent Foramen Ovale

Chapter 9 Transient Ischemic Attack

Definition

Etiology

Presentation

Differential Diagnosis

Clinical Approach to a Patient With Suspected TIA

Prognosis After TIA

Chapter 10 Less Common Causes of Stroke

Causes

Tests to Consider

Chapter 11 Cerebral Venous Sinus Thrombosis

Epidemiology

Pathogenesis

Risk Factors

Clinical Picture

Diagnosis

Acute Management

Chronic Management

Complications of CVST

Prognosis and Recurrence

Chapter 12 Intracerebral Hemorrhage

Definition

Etiology

Presentation

Diagnosis and Evaluation

Management

Prognosis and Outcome

Chapter 13 Subarachnoid Hemorrhage

Definition

Epidemiology

Presentation

Diagnosis

Management of Ruptured Aneurysms

Unruptured Aneurysms

Chapter 14 Organization of Stroke Care

Timely Care

Prehospital Stroke Care

Prehospital Stroke Scales

Drip-and-Ship versus Mothership Models

Stroke Centers

Telemedicine for Stroke (Telestroke)

Stroke Teams

Stroke Units

Chapter 15 Stroke Rehabilitation

Early Acute Stroke Rehabilitation Trials

Multidisciplinary Rehabilitation Team

Discharge Disposition

Chapter 16 Transition to Outpatient Stroke Care

Psychosocial Evaluation

Stroke Prevention Clinics

Common Post-Stroke Sequelae

Appendix 1 IV tPA Dosing Chart

Appendix 2 Transcranial Doppler Ultrasound

Appendix 3 Medical Complications

Appendix 4 Brainstem Syndromes

Appendix 5 Anatomy of Cerebral Vasculature

Appendix 6 Brain Death Criteria

Appendix 7 Stroke Assessment Scales

Further In-Depth Reading

Index