Transient ischemic attack (TIA)

Express trial
ISCHEMIC STROKE Transient ischemic attack (TIA) Created 23/03/2021, last revision 16/09/2022 [toc] 2021 ESO guidelines on the management of transient ischemic attack (TIA) a transient ischemic attack (TIA) is a medical emergency despite its seemingly mild course, TIA is a serious predictor of subsequent ischemic stroke and death following TIA, the risk of recurrent stroke ... Read more

SSS-TOAST classification

ISCHEMIC STROKE / CLASSIFICATION SSS-TOAST CLASSIFICATION OF ISCHEMIC STROKE Created 26/09/2022, last revision 26/09/2022 The SSS-TOAST classification is an evidence-based classification algorithm, which reflects advances in stroke imaging and epidemiology [Ay, 2005] based on certain clinical and imaging criteria, each TOAST subtype is divided into 3 subcategories "certain", "probable", or "possible" the new algorithm refines ... Read more

Extracranial-intracranial bypass

ISCHEMIC STROKE / PREVENTION Extracranial-intracranial bypass Created 23/09/2022, last revision 23/09/2022 ICA occlusion is responsible for ~15-25% of strokes ICA occlusion is associated with a 2-year stroke risk of about 10-15% the risk is even higher in the presence of impaired VMR  [Vernieri, 1999] extracranial-intracranial (EC-IC) arterial bypass surgery was developed to prevent stroke by ... Read more

Focal cerebral arteriopathy (FCA)

Focal cerebral arteriopathy on DSA
ISCHEMIC STROKE / ETIOLOGY Focal cerebral arteriopathy (FCA) Created 22/09/2022, last revision 26/09/2022 [toc] Introduction focal cerebral arteriopathy (FCA) was originally referred to as transient cerebral arteriopathy (TCA) TCA was defined as a monophasic disease leading to unilateral intracranial stenosis (usually the siphon, M1, or A1 segments) follow-up vessel imaging may reveal progression or bilateral ... Read more

Recanalization therapy in pediatric stroke

ISCHEMIC STROKE / ACUTE THERAPY Recanalization therapy in pediatric stroke Created 21/09/2022, last revision 21/09/2022 [toc] AHA/ASA (2019) - Management of Stroke in Neonates and Children stroke is relatively rare in children but can lead to significant morbidity/mortality acute management strategies are extrapolated from adult studies, but with some specific considerations Specifics of stroke in ... Read more

Intra-arterial thrombolysis

Intra-arterial thrombolysis of an occluded basilar artery
ISCHEMIC STROKE / ACUTE THERAPY Intra-arterial thrombolysis Created 16/09/2022, last revision 22/09/2022 [toc] intra-arterial thrombolysis (IAT) = administration of thrombolytic agent via catheter directly into the occluded artery several trials using prourokinase (MELT, PROACT) and alteplase ( IMS-3, SYNTHESIS) showed the benefit of this therapy MELT  The Middle Cerebral Artery Embolism Local Fibrinolytic Intervention Trial)  ... Read more

Recanalization therapy in acute stroke

Recanalization therapy in acute stroke
ISCHEMIC STROKE / ACUTE THERAPY Recanalization therapy in acute stroke Created 16/09/2022, last revision 19/09/2022 [toc] Introduction Recanalization restoration of flow at the primary occlusion site AOL  Reperfusion restoration of anterograde flow in the vessels beyond the primary occlusion site (anterograde perfusion) TICI  Collateral circulation retrograde perfusion  Distal embolization new occlusion detected distal to the ... Read more

Contraindications to intravenous thrombolysis

ISCHEMIC STROKE / ACUTE THERAPY Contraindications to intravenous thrombolysis Created 12/09/2022, last revision 14/09/2022 ESO 2021AHA-ASA 2019Comments to some contraindicationsMenstruationGravidityIVT in children ESO 2021 new recommendations have been incorporated into the chapter Intravenous thrombolysis (IVT) and further into the tab "Comments to some contraindications" see the full ESO guidelines 2021 here AHA-ASA 2019 → Acute ... Read more

Sonothrombolysis

Schematic representation of the effect of microbubbles
ISCHEMIC STROKE / ACUTE THERAPY Sonothrombolysis Created 09/09/2022, last revision 09/09/2022 [toc] Introduction diagnostic ultrasound at high frequency (~2 MHz) and low intensity leads to acceleration of enzymatic processes induced by thrombolytics (sonothrombolysis) and can be applied externally using commercial transcranial and duplex Doppler devices it provides: improved penetration of fibrinolytic drugs into the thrombus ... Read more

Protocols for thrombolytic therapy

Orolingual angioedema
ISCHEMIC STROKE / ACUTE THERAPY Protocols for thrombolytic therapy Created 05/09/2022, last revision 09/09/2022 [toc] Blood pressure management during and after thrombolysis Maintain BP ≤ 180/105 mmHg before starting infusion and during the next 24 hours adequate blood pressure is a critical preventive measure to reduce the risk of intracranial hemorrhagic complications antihypertensive drugs are ... Read more
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