Anil Kumar980
Forum Senior
Topics: 15
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Oral Aspirin?
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| bugsbunny
Forum Junior
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Posts: 54
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I/V thrombolytics,,they r useful in first 6-8 hrs not in first 3 hours
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| mdwannabe
Forum Guru
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ASA first..then TPA
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| sk
Forum Senior
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oral aspirin followed by Iv anticoagulants
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| raddoc
Forum Newbie
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If the patient is hemiplegic since 4 hours only a CT scan can be normal because the changes of infarction take time to show up. Ideally in this setting a CTperfusion/MRDiff.Perf should be done and followed by neuroangiography and intra-arterial thrombolysis. This is a classical indication for intrarterial catheter delivered thrombolysis i.e. fixed neurological deficit with normal CT brain to rescue as much ischemic but not dead/infarcted parenchyma also called the "penumbra".
Of the given options I think IV thrombolysis followed by anticoagulation should be followed.
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| chd_guy
Forum Newbie
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Duration more than 3 hours is contraindication for THROMOLYTICS.
Unlike MI where thrombolytics can be given withinn 12 hours(though best within 6 hours)
Asprin heparin and other platelet agents are also not given in the acute course.
Answer is E
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| tuesday
Forum Senior
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Posts: 207
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Question does not have enough info.
Anyway if the CT scan is normal, do nothing as here are no any other s/sxs/
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| Dot
Forum Senior
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Posts: 168
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I think do MRI as infract can be easily seen and then start with anticoagulants.Mri is very confirmatory but i not available start anticoagulant.
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| mdwannabe
Forum Guru
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if the clinical evidence is there...but no sign on CT (assuming no other signs are present, like bleed)... thrombolyse... it takes 12-18 hrs for infarct to show up on CT. MRI...too long to wait. However, this guy is beyond the window of 3 hours unless LOCAL delivery is available, then it can be streched up to 5 hours...so ASA and anticoagulation to prevent rethrombosis is appropriate.
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| miky
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55 year old man presents to the A&E department with acute hemiplegia of 4 hrs duration. CT scan is normal. The MOST APPROPRIATE management at this time would be
a) Oral aspirin
b) IV thrombolytic therapy
c) IV anticoagulant therapy
d) Antibiotics
e) No active agents
It seems that this patient had an ischemic - type stroke since the CT scan is normal 4 hrs after onset. Ischemic changes tend to be visualized much later on a Ct scan.
Thrombolythic therapy is mostly effective if considered within 3 hrs of the onset. However, some medical textbooks say that the thrombolythics can be given even at 6 hrs from onset, being of some effectiveness.
So, if the patient has no counterindications to thrombolythics, I would try them first. However, oral Aspirin is a safer and better choice. If counterindications exist, I would treat this patient supportively (E).
My opinion :roll: .
However, a clear answer cannot be given since the author of this question did not mention anything about other diseases he patient has or the drugs he takes :cry: .
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| mdwannabe
Forum Guru
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most sources do report 6hrs...but that is LOCAL administration..meaning through angiography cath. of cerebral vessels.
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