0071643192.pdf

■ Glucose control

■ Treat hyperglycemia to keep blood glucose 100–200.

■ Avoid IV solutions with glucose.

■ Avoid steroids, if possible.

■ Systemic tPA (thrombolysis)

■ Criteria

■ Symptoms <3 hours duration

■ Age >18 years

■ Blood pressure <185/110

■ Meaningful neurologic deficit that is not resolving

■ Nofinding on noncontrast CT head scan or clear ischemic penumbra

on contrast perfusion images

NEUROLOGY

TABLE 15.1. Ischemic Stroke—Clinical Findings

AREA OFBLOCKAGE MAJORFINDING OTHERFINDINGS

Anterior cerebral artery Contralateral weakness of leg > arm Altered mentation and judgment

and face with minimal sensory Perseveration

findings Primitive reflexes (grasp and suck)

If both arteries originate from occluded

common trunk (bilateral infarct) →paraplegia

and severe dysarthria

Middle cerebral artery Contralateral weakness and Homonymous hemianopsia

numbness of arm and face > leg Gaze preference toward side of infarct

If dominant hemisphere: Receptive/expressive

aphasia

Nondominant hemisphere: Inattention and

neglect

Lacunar artery Pure motor orpure sensory findings Clumsy hand—dysarthria syndrome

Posterior cerebral artery Contralateral visual field and light touch/ Memory loss

pinprick deficit with minimalweakness

Vertebrobasilar artery Crossed deficits: Ipsilateral cranial nerve Bilateral spasticity

deficits with contralateral weakness Syncope and drop attacks

Distal vertebral or posterior Crossed pain and temperature deficits: Ipsilateral Horner syndrome and cranial nerve

inferior cerebellar artery Ipsilateral loss on face, contralateral deficits may be present.

Lateral medullary (Wallenberg) on body Gait and limb ataxia

syndrome

Basilar artery “Locked in” syndrome (complete paralysis

of voluntary muscles except eye

movement; normal level of consciousness)

Cerebellar artery Sudden inability to walk or stand with Lateralizing dysmetria (eg, finger-nose-finger)

headache, nausea/vomiting and cerebellar Dysdiadokokinesis (rapid alternating

findings movements)