Documentos de Académico
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Neurology Cardiology
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V ectives
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hich of the following are
warning signs of stroke?
A. Sudden weakness or num ness of the face, arm or leg,
especially on one side of the ody
B. Sudden confusion, trou le speaking
or understanding
C. Sudden chest pain
D. Sudden trou le seeing in one or oth eyes
E. Sudden trou le walking, dizziness, loss of alance or
coordination
F. Sudden, severe headache with no known cause
A. Sudden weakness or num ness of the face, arm or leg,
especially on one side of the ody
B. Sudden confusion, trou le speaking
or understanding
C. Sudden chest pain
D. Sudden trou le seeing in one or oth eyes
E. Sudden trou le walking, dizziness, loss of alance or
coordination
F. Sudden, severe headache with no known cause
Is heart attack easier to diagnose
than stroke?
± Diagnosis is ± Diagnosis is
relatively easy. difficult. Many
EKG and cardiac things can mimic
enzymes readily stroke. There is
no lood test for
availa le. stroke. M~I not
readily availa le.
M~I with diffusion weighted
imaging
± Healthy 61 year-
year-old man developed
confused speech 1 day after falling out of
a tree.
± August 11th, topping a tree, fell and
sustained a left collar one fracture and
small puncture of the lung.
± Next night suddenly developed confused
speech.
± Trauma (fall out of a tree)
± Vascular pro lem (leg vein inury)
± Blood disorder (hypercoagula ility)
± Congenital heart anomaly (patent foramen
ovale)
How are heart attack and stroke
SIMILA~?
± Time is critical
± The first priority is to save tissue at
risk
Kidwell 2004
ñou need to call 911 ASAP for oth
heart attack and stroke!
± There is a 3 hour time limit for the medication
t-PA, and the sooner itƎs given the etter!
± Future strokes may e prevented if we identify
the cause of stroke ASAP
± People rought y am ulance are treated faster
± Neurological deterioration and other
complications may e prevented if a patient is
hospitalized earlier
± wune 2006 7AM: A 75 year-
year-old
woman collapsed at home, rought
to her local emergency room. She
cannot move her right side or speak.
The doctors there are not
comforta le using t-
t-PA so transfer to
DHMC is requested.
± 1:02 PM: Arrival DHMC ED.
4:49 PM artery is opened
± The system needs to e very
coordinated
P~EPA~ED ~APID EVALUATIVN INDIVIDUALIZED
CA~E
Improving Stroke Care
at DHMC
=
$ %
# !(!'%! !!('+*1% ! "
" "' #!!! !" "%!
=
18/111 (16%) received t-PA
Average cost for transportation $4,623
2004: 144 pts ~x t-PA
50% had t-PA started at 1
of 47 referring hospitals
>50% of these have <60
eds
MGH TeleStroke
Effectiveness of Stroke Prevention
A solute risk reduction in a year:
Strategy A~~ (%)
ß ß
* 2 1 3
+#!4
/
/ /
/ /
/ /
/ /
/
2 5! 6! 6! 6! 6!
*" ! 6! 6! 6!
35 6! 6!
*72 6!
þ
hich action would you take if you
thought someone was having a
heart or stroke?
A. take the person a hospital
B. advise the person to call a doctor
C. call 911
D. call a spouse or family mem er
E. do something else
hich action would you take if you
thought someone was having a
heart or stroke?
A. Take the person a hospital
B. Advise the person to call a doctor
C. Call 911
D. Call a spouse or family mem er
E. Do something else
± Bleeding into the ± Brain
heart doesnƎt hemorrhage is
occur common
CT scan: ischemic stroke
Intracere ral hemorrhage
at 1 hour and 6 hours
Intra--arterial throm olysis
Intra
Time window=6 hours
High resolution M~I to identify the
u plaque
± ñou need to open the artery
Like with heart disease, the
treatment and prevention of stroke
needs to e individualized!
± A 65 yo man attends a vascular disease
prevention fair and an ultrasound shows a
lockage of his left carotid artery. He is
told to speak to his doctor ASAP and he
ecomes worried that there is a Ɛtime
om ticking in his neck.