BMJ Best Practice Podcast Ischaemic stroke
Apr 12, 2022
David Wang, a Professor of Neurology at the Barrow Neurological Institute, delves into the complexities of ischaemic stroke. He discusses the differences between thrombotic and embolic strokes and highlights the critical role of imaging, advocating for CT scans in acute phases. Wang covers diagnostic pitfalls and the importance of timely thrombolysis, as well as emerging treatments like tenecteplase. Additionally, he shares insights on antiplatelet therapies for secondary prevention and emphasizes the need for high-intensity statin therapy shortly after a stroke.
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CT First In Hyperacute Stroke
- Use non-contrast CT first in hyperacute stroke to exclude intracranial hemorrhage before considering reperfusion.
- Choose CT because it’s rapid and guides immediate decisions about thrombolysis or thrombectomy.
Imaging To Define Core And Penumbra
- Multimodality imaging (CT/CTA/CT perfusion or MRI perfusion) identifies core infarct and salvageable penumbra.
- This mismatch helps decide whether reperfusion therapies may still benefit the patient.
Essential Acute Investigations
- In acute assessment also perform 12-lead ECG, capillary glucose, chest x-ray as needed, and coagulation studies.
- Check anticoagulant use because active anticoagulation may contraindicate IV thrombolysis.