Week 5: Acute Stroke Guidelines, part 4

Wrapping up our whirlwind tour of the guidelines!

Section 4: Other treatment ideas and supportive stroke care

  • Hemodilution and vasodilators don’t seem to work. A very selected subset of patients may benefit from pressors. Hypothermia had mixed results.
  • Albumin may have a positive impact, definitive results pending.
  • Nimodipine works in SAH but not in ischemic stroke; the neuroprotective effect likely outweighed by BP lowering.
  • The combination of caffeine and alcohol seemed relatively safe in a pilot study!
  • For patients already on statins, interrupting therapy even briefly was associated with worse outcomes.
  • Specialized stroke outcomes are key: the benefits persist for years, with an effect comparable to administration of tPA. The number needed to treat for a CSC to prevent 1 death or institutional care at 1 year was only 29.
  • Healthcare providers can safely do a bedside swallow eval; a “wet voice” after swallowing is a good predictor of aspiration.
  • PREVAIL study showed lovenox is better than BID heparin for DVT prevention in ischemic stroke.
  • 25% of strokes will deteriorate within 1-2 days: 1/3 because of stroke progression, 1/3 because of swelling, and the remaining third equally split between hemorrhage and recurrent stroke.
  • The benefit for decompressive surgery is only shown for patients younger than 60.

And that’s all, folks. Normal length articles return next week.

Advertisements

1 Comment

Filed under Articles

One response to “Week 5: Acute Stroke Guidelines, part 4

  1. Pingback: Week 6: Management of Acute Stroke, part 1 | Evidenced

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s