Stroke (main)

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ER Work-Up

0) Icon/Glu check

1) Head CT (non-con)

2) ECG (a. fib)

3) UA/Utox

4) CBC, Chem 7, LFTs, PT/PTT

4+) Trop (in elderly; poss silent MI)


DDX Ischemic

1) Thrombosis (atherosclerosis, vasculitis, dissection)

2) Embolic (cardiac -a.fib, valve, septic- CAS, hypercoagulable)

3) Vasospasm

4) Hypotension/watershed


Treatment

A) Ischemic

    1) <3 hrs -->  see Neuro: CVA (tPA Criteria)
    2) >3 hrs
         a) ASA (if ASA intolerant or failure, then Ticlopidine, Plavix, or Coumadin)
         b) HTN Control (no rx unless >220/120 -- labetolol, nitro, or esmolol gtt)
              -e.g. labetolol 5mg IV Q15min (max =300mg)
         c) Heparin only if cardiac embolic source/a-fib.

B) Hemorrhagic --> see Neuro: Intracranial Hemorrhage (ICH)


Neuro Work-Up

5) ESR, ANA, RPR, TSH

6) Guiac

7) Fasting lipids

8) Carotic US or MRA carotids

9) Echo w/double bubble


(YOUNG ONLY)

10) HIV

11) Factor V Leiden, homocystein, protein C&S

12) Lupus anticoagulant, anticardiolipin Ab

13) AT III, RF, sickle cell


Source

8/12/07 DONALDSON (adapted from Smith, Lampe, NEJM '07)