Management of TIAs and Ischemic Stroke

First Things First (assess & treat for the following)

• Stroke
  • Definition: sudden & acute onset of focal neuro symptoms
  • U.S.: ~750,000 strokes annually
  • 3rd leading cause of death for adults
  • Leading cause of disability in adults
  • 2% occur in people <age 65
• Urgent attention
  • Airway & breathing
  • Cardiac arrhythmias
  • HTN
  • Seizure
• Goals: emergency evaluation
  • Confirm ischemic stroke.
  • Rule out hemorrhage or other disorder.
  • Assess possible reversibility.
  • Yield info re: etiology.
  • Assess likelihood of complications.
  • Begin appropriate treatment.
• Etiologies addressed in ICU
• Ischemic strokes
  • Large-vessel thrombosis status post treatment w/ thrombolytics
  • Crescendo TIAs: recurrent & increasing frequency of TIAs
    • Most commonly due to carotid disease
    • Heparinize & stabilize while preparing for urgent surgery (CEA).
  • Malignant MCA: very large stroke associated w/ decline in mental status
    • May require surgical decompression
  • Cardioembolic etiology
  • Watershed infarct: involves border zones between arterial distributions
    • Due to generalized hypoperfusion
• Hemorrhagic strokes
  • Intracerebral hemorrhage
  • Subarachnoid hemorrhage