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Long Case Stroke
Long Case Stroke
Long Case Stroke
Service Delivery
2) Multidisciplinary care
PT/OT
Speech therapist assessment of swallowing function
4) Rehabilitation
Early intervention improves physical and functional outcomes. Start ASAP
Rehab preferably done at dedicated stroke rehab unit. If not, perform rehab at a mixed
rehab unit.
Acute Management of Stroke 2) Anticoagulants Warfarin
Indications: AF, valvular heart disease, recent MI
Target INR: 2-3
A) Principles of Management of Cerebral infarction SE: hemorrhagic transformation
3) Carotid For moderate to severe carotid artery stenosis (>60%) with
1) Aspirin Initiate ASAP (within 48 hrs) – safe even during acute phase of stroke endarterectomy ipsilateral carotid territory TIA or non-disabling ischaemic stroke
Reduces recurrence of stroke Only for surgically fit patients, and under experienced surgeons.
Reduces 4) HPT control For all stroke patients, regardless of type of stroke or pre-stroke BP
2) Thrombolysis IV r-tPA (within 3 hrs) or intra arterial prourokinase (within 6 hrs) status
Streptokinase is contraindicated in view of lack of beneficial effect Start only after acute phase of stroke
However, thrombolysis runs the risk of catastrophic ICH. Since it is 5) Lipid Statins to reduce lipid levels
difficult to predict who is at risk of ICH and who might benefit, 6) Stop cigarette smoking
thrombolysis Rx should not be routinely used. 7) Ctrl DM risk factors
3) BP control Do no lower BP unless severely hypertensive. A/w worse outcomes.
4) Other therapies Heparin, steroid, neuroprotectants and haemodilution (plasma
volume expanders) have not been found to be beneficial and should
be avoided. Service Delivery
B) Principles of Management of Haemorrhage (excluding SAH) 1) Manage within specialised stroke unit if possible
Correct coagulation defects, esp for PTs on anticoagulant / thrombolytics Rx, and those Reduced M&M
with bleeding diatheses. Reduced secondary complications of stroke
Stop all thrombolytics, Antiplatelet agents and anticoagulants. Reduced need for institutional care thru reduction in disability.
1) Anti-platelet therapy Long term Antiplatelet Rx reduces risk of serious vascular events
(recurrent stroke, MI, vascular death)
Aspirin 75-150 mg/day
Alternatives (when aspirin is CI or fails): Ticlopidine, clopidogrel,
dipyridamole