STROKE (BRAIN ATTACK) - William A. Tosches, MD; Michael Previti, MD11

STROKE (BRAIN ATTACK) - William A. Tosches, MD; Michael Previti, MD

TREATMENT

· Acute phase: Inpatient care

· Surgical therapy

  - In medically fit patients with nondisabling stroke, carotid endarterectomy is indicated for stenosis of >70% on side ipsilateral to stroke.

  - Medical therapy for <50% stenosis, 50-69% depends on risk factors

GENERAL MEASURES

· Maintain oxygenation.

· Monitor cardiac rhythm for 48 hours.

· Control hyperglycemia (keep glucose <220 mg/dL [12.1 mmol/L]).

· Treat blood pressure >185/110 if patient will be or has been treated with IV tissue plasminogen activator.

· Do not treat elevated BP unless acute end-organ dysfunction (encephalopathy, myocardial ischemia, aortic dissection, acute renal failure) is suspected.

· Prevent hyperthermia.

· Introduce physiotherapy and ambulation early.

· Subcutaneous heparin 5,000 units SC q12h

Diet

· Alert with no dysphagia: Diet as tolerated (no added salt if hypertensive)

· Alert with dysphagia: Pureed dysphagia diet or nasogastric feeding tube if indicated

Activity

Ambulate as soon as possible.