General

CT identifies patients in stroke treatment window

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25 Nov 2016 - General
 

The link to the article: http://www.nature.com/nrneurol/journal/vaop/ncurrent/full/nrneurol.2016.184.html

*For some reason I cannot share it through the share link button*

Timing is very crucial to the administration of intravenous thrombolysis. One caveat to following the standard guideline of giving intravenous thrombolysis within the 4.5 hr period is the lack of an objective measure that detects onset. At present CT scans and MRIs are limited to identifying if there is vascular compromise, the location of such, and if there is a compressive effect to the surrounding neural tissue. I think that if this form of treatment will be available, the it will help determine patients who are indeed eligible for intravenous thrombolysis. Moreso, another multicenter study can be done utilizing this technology to improve current guidelines, since these guidelines are also based on nonobjective parameters when it comes to determining stroke ictus. Do you follow a similar guideline in your local practice? 

Thanks for sharing the experience. The door to needle time is very importance in thrombolysis of ischaemic stroke. I would say the standard guideline of thrombolysis within 4.5 hours will be the standards guideline. Stroke is a clinical diagnosis, C...
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Marinelle Castro The same protocol is also done in our institution. If the history and physical examination suggest a possible upper motor neuron lesion, the internal medicine service (neur...
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Mark Edmon Tan In our institution, we also rely on history and physical exam to get the location of the stroke. However, we always perform a plain cranial CT on all patients who are potent...
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Marinelle Castro It becomes really problematic with thrombotic infarcts, most of which occur during sleep. It would be extremely unreliable to base giving of rTPA on clinical history. Right...
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Habiba Twakkol Thank you for giving your valuable insights on the topic. I have seen the devastating complication of intravenous thrombolysis. Some of the patients who developed hemorrhagi...
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In my experience, there is a problem with determining reliability of stroke ictus, which one of the determinants if the patient is a good candidate for intravenous thrombolysis. Most of the time, relatives are an unreliable source because they are no...
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Marinelle Castro i'm a pharmacist and this is not my work field but I think that there are certain symptoms you see which lead you to take this step even if the examination is not compl...
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Marinelle Castro I agree that timing is very crucial and we are lucky that the window was adjusted to within 4.5 hours from the previous 3 hours post-ictus. Immediate thrombolytic agents ma...
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