Acute stroke care : a manual from the University of Texas-Houston Stroke Team

255 Pages·2011·3.444 MB·English

by  Ken Uchino, Jennifer K Pary, James C Grotta

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Acute Stroke Care
Second Edition

Acute
Stroke Care
A Manual from the University
of Texas-Houston Stroke Team
SECOND EDITION
Ken Uchino, . .
M D
Jennifer Pary, . .
M D
James Grotta, . .
M D
CAMBRIDGE UNIVERSITY PRESS
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Informationonthistitle:www.cambridge.org/9780521184847
©K.Uchino,J.Pary,andJ.Grotta2011
Thispublicationisincopyright.Subjecttostatutoryexception
andtotheprovisionsofrelevantcollectivelicensingagreements,
noreproductionofanypartmaytakeplacewithoutthewritten
permissionofCambridgeUniversityPress.
Firsteditionpublished2007
Secondeditionpublished2011
PrintedintheUnitedKingdomattheUniversityPress,Cambridge
AcatalogrecordforthispublicationisavailablefromtheBritishLibrary
ISBN978-0-521-18484-7Paperback
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websitesis,orwillremain,accurateorappropriate.
Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-
dateinformationwhichisinaccordwithacceptedstandardsandpracticeatthe
timeofpublication.Althoughcasehistoriesaredrawnfromactualcases,every
efforthasbeenmadetodisguisetheidentitiesoftheindividualsinvolved.
Nevertheless,theauthors,editorsandpublisherscanmakenowarrantiesthatthe
informationcontainedhereinistotallyfreefromerror,notleastbecauseclinical
standardsareconstantlychangingthroughresearchandregulation.Theauthors,
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damagesresultingfromtheuseofmaterialcontainedinthisbook.Readersare
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manufacturerofanydrugsorequipmentthattheyplantouse.
Contents
Preface page xi
Listofabbreviations xv
1 Stroke in the emergency department
1
Isthisastroke? 1
Whattypeofstroke? 6
2 What to do first
7
Airway–breathing–circulation(ABCs) 7
Whatwasthetimeofonset? 8
Howbadarethesymptomsnow? 9
Doanon-contrastheadCT 9
IftheCTshowsnoblood,trytogetthearteryopen 10
Recommendeddiagnosticevaluation 10
3 Ischemic stroke
12
Definition 12
Etiology 12
Diagnosis 12
Thefourcomponentsofischemicstrokecare 13
v
vi Contents
Acutetherapyandoptimization
ofneurologicalstatus 13
Etiologicalwork-upforsecondaryprevention 21
Preventionofneurologicaldeterioration
ormedicalcomplications 25
Recoveryandrehabilitation 28
Ischemicstrokeoutcome 29
Generaltimeline 31
4 TPA protocol
32
TPAindications 32
Contraindications 33
Procedure 38
Dose 39
Samplepost-TPAorders 39
Risksvs.benefitsofTPA 41
Unproventherapies 44
5 Neurological deterioration in acute
ischemic stroke
50
Probablecauses 50
Initialevaluationofpatientswithneurological
deterioration 51
Strokeenlargement 51
Dropinperfusionpressure 52
Recurrentstroke 52
Cerebraledemaandmasseffect 54
Hemorrhagictransformation 58
Metabolicdisturbance 60
Seizure 61
Contents vii
Symptomfluctuationswithoutagoodcause 62
Theuncooperativepatient 62
6 Ischemic stroke prevention: why
we do the things we do
63
Investigations 63
Ischemicstrokeprevention:generalmeasures 67
Atrialfibrillation 73
Carotidstenosis 77
Acutecarotidocclusion 81
Intracranialstenosis 83
Lacunarstrokes 84
Cervicalarterialdissection 86
Patentforamenovale 88
7 Transient ischemic attack (TIA)
90
Definition 90
Etiology 90
Presentation 91
Differentialdiagnosis 91
Clinicalapproachtoapatientwith
suspectedTIA 91
PrognosisafterTIA 94
8 Intracerebral hemorrhage (ICH)
96
Definition 96
Etiology 97
Presentation 98
Diagnosisandevaluation 99
viii Contents
Management 100
Prognosisandoutcome 106
9 Subarachnoid hemorrhage (SAH)
109
Definition 109
Epidemiology 109
Presentation 110
Diagnosis 110
Rupturedaneurysms:management 112
Prognosis 117
Admissionsequence 118
Unrupturedaneurysms 119
10 Organization of stroke care
122
Timelycare 122
Strokeunits 123
Strokecenters 123
Stroketeams 124
11 Rehabilitation
126
Take-homemessages 126
Secondarystrokeprevention 127
Preventionofmedicalcomplications 127
Multidisciplinaryrehabilitationteam 127
Dischargeplanning 134
Appendix1.Numbersandcalculations 137
Appendix2.IVTPAdosingchart 139