The Code Stroke Handbook: Approach to the Acute Stroke Patient

Description

A 65-year-old patient arrives at the Emergency Department with stroke symptoms that began 45 minutes ago. You are called STAT! Acute stroke management has changed dramatically in recent years. Tremendous advances have been made in acute treatments, diagnostic neuroimaging, and organized systems of care, and are enabling better outcomes for patients. Stroke has evolved from a largely untreatable condition in the acute phase to a true medical emergency that is potentially treatable—and sometimes curable. The Code Stroke emergency response refers to a coordinated team-based approach to stroke patient care that requires rapid and accurate assessment, diagnosis, and treatment in an effort to save the brain and minimize permanent damage. The Code Stroke Handbook contains the "essentials" of acute stroke to help clinicians provide best practice patient care. Designed to assist frontline physicians, nurses, paramedics, and medical learners at different levels of training, this book highlights clinical pearls and pitfalls, guideline recommendations, and other high-yield information not readily available in standard textbooks. It is filled with practical tips to prepare you for the next stroke emergency and reduce the anxiety you may feel when the Code Stroke pager rings. Key Features An easy-to-read, practical, clinical resource spread over 12 chapters covering the basics of code stroke consultations: history-taking, stroke mimics, neurological examination, acute stroke imaging (non-contrast CT/CT angiography/CT perfusion), and treatment (thrombolysis and endovascular therapy) Includes clinical pearls and pitfalls, neuroanatomy diagrams, and stroke syndromes, presented in an easily digestible format and book size that is convenient to carry around for quick reference when on-call at the hospital Provides foundational knowledge for medical students and residents before starting your neurology, emergency medicine, or internal medicine rotations Readership Medical students, residents, interns, neurologists, emergency physicians, internists, nurses, and paramedics Front Matter......Page 3 Copyright......Page 4 Preface......Page 5 Acknowledgments......Page 7 History taking......Page 8 Important initial questions to ask......Page 11 A word about…. Time is brain......Page 17 Further reading......Page 20 Stroke mimics......Page 21 What are clinical clues to differentiate seizure or migraine aura from stroke/TIA?......Page 23 Limb shaking TIA......Page 25 Migraine......Page 26 Clinical cues to help differentiate a peripheral from a central cause of vertigo......Page 28 Stroke and decreased level of consciousness......Page 31 Are the visual symptoms monocular or binocular?......Page 33 Diplopia......Page 36 What clues on history suggest a psychogenic disorder?......Page 37 Further reading......Page 39 NIH stroke scale and neurological examination......Page 40 National Institutes of Health Stroke Scale......Page 43 How do I assess visual fields if the patient is not able to reliably communicate?......Page 54 How do I assess for neglect?......Page 55 How do I distinguish visual extinction from a visual field deficit?......Page 56 What clues on physical examination suggest a functional (psychogenic) disorder?......Page 57 Further Reading......Page 61 Stroke syndromes......Page 62 Anterior circulation......Page 66 Middle cerebral artery......Page 70 Occlusion of the upper trunk of the MCA......Page 71 Occlusion of the inferior trunk of the MCA......Page 73 Occlusion of distal MCA branch......Page 74 Other MCA syndromes......Page 75 Anterior cerebral artery......Page 76 Occlusion of the recurrent artery of Heubner......Page 78 Posterior circulation......Page 79 Occlusion of the basilar artery......Page 81 Proximal basilar artery occlusion......Page 82 Top of the basilar syndrome......Page 84 Posterior cerebral artery......Page 85 Lacunar syndromes......Page 87 Brainstem syndromes......Page 91 Inferior medial pontine syndrome (Foville syndrome)......Page 95 Medial mid-pontine syndrome......Page 98 Paramedian midbrain (Benedikt syndrome)......Page 101 Anterior spinal artery syndrome......Page 106 Thalamic syndromes......Page 108 Further reading......Page 110 Stroke imaging: Noncontrast head CT......Page 111 Approach to interpreting the acute noncontrast head CT......Page 117 Hyperdense vessel signs......Page 124 Acute ischemic changes on CT head (ASPECTS score)......Page 127 Identifying other structural lesions......Page 133 References and Further Reading......Page 136 Stroke imaging: CT angiography......Page 137 Identifying extracranial carotid stenosis or dissection......Page 146 CT angiography for intracerebral hemorrhage......Page 151 Further reading......Page 154 Stroke imaging: CT perfusion......Page 155 CTP considerations and pitfalls......Page 166 Further reading......Page 167 Acute ischemic stroke treatment: Alteplase......Page 168 Intravenous thrombolysis: efficacy and patient selection......Page 169 Time to treatment......Page 171 How to administer tPA at the bedside......Page 172 tPA complications......Page 175 tPA contraindications......Page 177 Special considerations......Page 181 References and Further Reading......Page 184 Acute ischemic stroke treatment: Endovascular therapy......Page 185 Efficacy of endovascular therapy......Page 186 References and Further Reading......Page 193 Basilar artery occlusion......Page 194 Management of basilar artery occlusion......Page 196 References and Further Reading......Page 200 Acute stroke treatment: Acute blood pressure management and anticoagulation reversal......Page 201 Intracerebral hemorrhage acute blood pressure management......Page 203 Management of anticoagulation-associated intracranial hemorrhage in the acute stroke setting......Page 204 References and Further Reading......Page 206 Single antiplatelet therapy......Page 207 Dual antiplatelet therapy......Page 208 References and Further Reading......Page 212 A......Page 213 B......Page 214 C......Page 215 D......Page 216 H......Page 217 I......Page 218 M......Page 219 N......Page 220 R......Page 222 S......Page 223 V......Page 225 W......Page 226