Ischemic Stroke Case Study
Stroke
I. Pathophysiology
A. Ischemic Stroke
1. Results from blockage of a cerebral artery, leading to decreased blood flow.
2. Cerebral blood arteries dilate and constrict due a process called cerebral autoregulation.
3. This process is affected by stroke
4. One possible ischemic stroke occurs due to blockage of an intracranial vessel due to an embolus from a distant area (i.e. cardiogenic embolus),
5. Another possible ischemic stroke occurs due to in situ thrombosis of an intracranial vessel, usually one of the smaller penetrating arteries (usually due to carotid plaque on the arteries).
6. Another possible ischemic stroke is due to hypoperfusion caused by flow-limiting stenosis of a major extracranial artery.
7. If blood cannot get to the brain, oxygen …show more content…
Recent gastrointestinal or urinary tract hemorrhage (within previous 21 days)
f. Recent acute myocardial infarction (within previous 3 months)
5. Intravenous rtPA (0.9 mg/kg, maximum dose 90 mg) is recommended for selected patients who may be treated within 3 hours of onset of ischemic stroke
6. In patients eligible for intravenous rtPA, benefit of therapy is time dependent, and treatment should be initiated as quickly as possible. The door-to-needle time (time of bolus administration) should be within 60 minutes from hospital arrival
7. Intravenous rtPA (0.9 mg/kg, maximum dose 90 mg) is recommended for administration to eligible patients who can be treated in the time period of 3 to 4.5 hours after stroke onset (Level of Evidence B).
8. The eligibility criteria for treatment in this time period are similar to those for people treated at earlier time periods within 3 hours, with the following additional exclusion criteria:
a. Patients >80 years old,
b. Those taking oral anticoagulants regardless of INR
c. Those with a baseline NIHSS score >25
d. Those with imaging evidence of ischemic injury involving more than one third of the MCA territory
e. Those with a history of both stroke and diabetes
I. Pathophysiology
A. Ischemic Stroke
1. Results from blockage of a cerebral artery, leading to decreased blood flow.
2. Cerebral blood arteries dilate and constrict due a process called cerebral autoregulation.
3. This process is affected by stroke
4. One possible ischemic stroke occurs due to blockage of an intracranial vessel due to an embolus from a distant area (i.e. cardiogenic embolus),
5. Another possible ischemic stroke occurs due to in situ thrombosis of an intracranial vessel, usually one of the smaller penetrating arteries (usually due to carotid plaque on the arteries).
6. Another possible ischemic stroke is due to hypoperfusion caused by flow-limiting stenosis of a major extracranial artery.
7. If blood cannot get to the brain, oxygen …show more content…
Recent gastrointestinal or urinary tract hemorrhage (within previous 21 days)
f. Recent acute myocardial infarction (within previous 3 months)
5. Intravenous rtPA (0.9 mg/kg, maximum dose 90 mg) is recommended for selected patients who may be treated within 3 hours of onset of ischemic stroke
6. In patients eligible for intravenous rtPA, benefit of therapy is time dependent, and treatment should be initiated as quickly as possible. The door-to-needle time (time of bolus administration) should be within 60 minutes from hospital arrival
7. Intravenous rtPA (0.9 mg/kg, maximum dose 90 mg) is recommended for administration to eligible patients who can be treated in the time period of 3 to 4.5 hours after stroke onset (Level of Evidence B).
8. The eligibility criteria for treatment in this time period are similar to those for people treated at earlier time periods within 3 hours, with the following additional exclusion criteria:
a. Patients >80 years old,
b. Those taking oral anticoagulants regardless of INR
c. Those with a baseline NIHSS score >25
d. Those with imaging evidence of ischemic injury involving more than one third of the MCA territory
e. Those with a history of both stroke and diabetes