■ See Table 15.2 for summary of indications and contraindications to
thrombolytics.
■ Dose: 0.9 mg/kg with 10% given as bolus, remaining infused over
60 minutes
■ Intra-arterial tPA
■ Used for brainstem strokes, some data supported for use in delayed
time periods (>3 hours).
■ Aspirin: 160–325mg within 48 hours (unless thrombolysis candidate) for
secondary stroke prevention
■ Clopidogrel or ticlopidine if aspirin allergic
■ Aggrenox:A combination of low-dose aspirin and dipyridamole (antiplatelet
agent); greater risk reduction than aspirin alone
■ Early neurosurgical consultation for all cerebellar strokes (increased risk
of herniation)
■ Avoid:
■ Routine seizure prophylaxis
■ Heparin: No proven benefit in acute stroke (even embolic)
■ Sublingual calcium channel blockers (unpredictable drops in BP)
TRANSIENTISCHEMICATTACK
Transient ischemic attack is a neurologic deficit that has complete clinical
resolution within 24 hours. Up to 20% of patients with TIA will go on to have
a stroke within 90 days, half of these within 2 days.
SYMPTOMS/EXAM
■ Related to vascular distribution involved (see Table 15.1)
NEUROLOGYFIGURE 15.2. Noncontrast head CT demonstrating right middle cerebral artery
distribution stroke. (A) Note the well-defined area of hypodensity (arrows) in the right
middle cerebral artery (MCA) territory. (B) Acute thrombus in the right MCA (arrow).
(Reproduced, with permission, from Chen MYM, Pope TL, Ott DJ. Basic Radiology. New York:
McGraw-Hill, 2004:336–337.)
Heparin has no proven benefit
in acute stroke.