Stroke in afya

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Immediate image - as for TIA, else image within 24 hrs
Thrombolysis - acute ischaemia, within 3 hrs of Sx onset, in specialist stroke unit (aim BP 185/110)
Admit to specialist unit - mobilise, aspirin, nutrition, swallow,

Acute stroke Mx
consider - blood glc, hydration, O2 sats and temp
BP - don't lower acutely unless hypertensive encephalopathy
Aspirin 300mg asap once haemorrhagic stroke excluded
If AF - start anticoagulents 14 days after onset of ischaemic stroke
If Cholesterol >3.5 start statin (delay 48hrs due to risk of haemorrhagic transformation)

Thrombolysis
If within 4.5 hrs of onset of Sx and haemorrhage has been excluded
Currently Alteplase recommended by NICE

''Absolute CI to Thrombolysis''
Previous intracranial haemorrhage
- Seizure at onset of stroke
- Intracranial neoplasm
- Suspected subarachnoid haemorrhage
- Stroke or traumatic brain injury in preceding 3 months
- Lumbar puncture in preceding 7 days
- Gastrointestinal haemorrhage in preceding 3 weeks
- Active bleeding
- Pregnancy
- Oesophageal varices
- Uncontrolled hypertension >200/120mmHg

''Relative CI to thrombolysis''
Concurrent anticoagulation (INR >1.7)
- Haemorrhagic diathesis
- Active diabetic haemorrhagic retinopathy
- Suspected intracardiac thrombus
- Major surgery / trauma in preceding 2 weeks

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