Management of TIAs and Ischemic Stroke

Management of TIAs and Ischemic Stroke is a topic covered in the Pocket ICU Management.

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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

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Last updated: May 6, 2010