विवरण
Rapid transfer of stroke patients to the ICU allows for immediate assessment and intervention.Continuous monitoring of vital signs, neurological status, and oxygen saturation is essential to detect changes promptly. Administration of clot-dissolving agents like tissue plasminogen activator (tPA) within the therapeutic window can restore blood flow in ischemic stroke patients. For large vessel occlusion, mechanical removal of the clot using catheter-based techniques can be performed in eligible patients. Maintain stable blood pressure and perfusion to the brain while avoiding extremes that might exacerbate cerebral edema or hemorrhage. Ensure proper airway management and oxygenation to prevent secondary brain injury. Frequent imaging (CT or MRI) monitors for changes in brain structure, blood flow, and response to treatment. Continuous ICP monitoring helps manage elevated pressure and prevent cerebral herniation.
सारांश
- Stroke, or cerebrovascular accident, can be ischemic (due to a blockage) or hemorrhagic (due to bleeding). Stroke is essentially a brain attack, with the first 180 minutes being critical for intervention. Early diagnosis and treatment are crucial, as every second counts due to neuron loss.
- Stroke is defined as rapidly developing clinical signs of focal brain disturbance with symptoms lasting 24 hours or longer, potentially leading to death. This can occur when blood flow to a brain region is disrupted due to vessel obstruction or bleeding. Stroke affects a significant number of people annually and has a large economic impact.
- Risk factors for stroke are categorized as irreversible (age, gender, heredity) and preventable or modifiable (hypertension, heart disease, diabetes, smoking, alcohol). Understanding and managing these factors is crucial for stroke prevention.
- Clinical manifestations of stroke can range from mild (TIA resolving within 24 hours) to moderate and severe, impacting motor skills, sensory functions, language, and consciousness. Management includes detailed history, physical examination including ABCs, assessing consciousness level (NIHSS, GCS), and identifying the affected arterial territory.
- Types of ischemic stroke include embolic (blood clot traveling to the brain) and thrombotic (clot forming in brain's blood supply). Common causes include thrombosis, large vessel thrombosis, atrial fibrillation, mural thrombus, mitral stenosis, and infective endocarditis. Uncommon causes consist of hypercoagulable states, malignancy, vasculitis, and certain drugs.
- Brain imaging, especially non-contrast CT, is crucial for early diagnosis, helping to identify hematomas and non-vascular causes. CT can also show early signs of infarct, such as sulcal effacement and hypodensity, that if present indicate poor prognosis. Rapid diagnosis is crucial.
- Immediate care involves a dedicated unit with a multidisciplinary team, following the FAST code (Face, Arms, Speech, Time). Indications for ICU admission include impaired consciousness, comorbidities, stroke after CABG, symptomatic hemorrhagic conversion, or post-thrombolysis.
- Management of hypertension is critical, because elevated blood pressure exacerbates neurological deficits. Blood pressure must be monitored closely, and antihypertensive medications can be utilized to achieve target blood pressure levels. Patients presenting with hypotension also require management.
- Intravenous thrombolysis is a treatment option if a patient meets inclusion and exclusion criteria. Criteria for exclusion consist of rapidly improving or minor symptoms, possible ICH or large infarct on CT, history of severe head trauma, and uncontrolled blood pressure. Ineligible patients may be candidates for intra-arterial thrombolysis.
- Mechanical thrombectomy, using devices such as the Merci Retriever, can be considered for patients who have failed IV thrombolysis or are ineligible. Adjunctive treatments include oral antiplatelet agents, but not anticoagulants. Other neuroprotective therapies, such as hypothermia, are being researched, but not yet concretely applied.
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