راهنمای سکته مغزی: رویکرد به بیمار سکته حاد

A 65-year-old patient arrives at the Emergency Department with stroke symptoms that began 45 minutes ago. You are called STAT! Acute stroke management has changed dramatically in recent years. Tremendous advances have been made in acute treatments, diagnostic neuroimaging, and organized systems of care, and are enabling better outcomes for patients. Stroke has evolved from a largely untreatable condition in the acute phase to a true medical emergency that is potentially treatable—and sometimes curable. The Code Stroke emergency response refers to a coordinated team-based approach to stroke patient care that requires rapid and accurate assessment, diagnosis, and treatment in an effort to save the brain and minimize permanent damage. The Code Stroke Handbook contains the "essentials" of acute stroke to help clinicians provide best practice patient care. Designed to assist frontline physicians, nurses, paramedics, and medical learners at different levels of training, this book highlights clinical pearls and pitfalls, guideline recommendations, and other high-yield information not readily available in standard textbooks. It is filled with practical tips to prepare you for the next stroke emergency and reduce the anxiety you may feel when the Code Stroke pager rings. Key Features An easy-to-read, practical, clinical resource spread over 12 chapters covering the basics of code stroke consultations: history-taking, stroke mimics, neurological examination, acute stroke imaging (non-contrast CT/CT angiography/CT perfusion), and treatment (thrombolysis and endovascular therapy) Includes clinical pearls and pitfalls, neuroanatomy diagrams, and stroke syndromes, presented in an easily digestible format and book size that is convenient to carry around for quick reference when on-call at the hospital Provides foundational knowledge for medical students and residents before starting your neurology, emergency medicine, or internal medicine rotations Readership Medical students, residents, interns, neurologists, emergency physicians, internists, nurses, and paramedics Front Matter Copyright Preface Acknowledgments History taking Important initial questions to ask A word about.... Time is brain Further reading Stroke mimics What are clinical clues to differentiate seizure or migraine aura from stroke/TIA? Limb shaking TIA Migraine Clinical cues to help differentiate a peripheral from a central cause of vertigo Stroke and decreased level of consciousness Stroke and visual symptoms Are the visual symptoms monocular or binocular? Diplopia What clues on history suggest a psychogenic disorder? Further reading NIH stroke scale and neurological examination National Institutes of Health Stroke Scale How to score dysarthria in a patient that is aphasic? How do I assess visual fields if the patient is not able to reliably communicate? How do I score ataxia if the patient is weak? How do I assess the sensory examination if the patient cannot communicate? How do I assess for neglect? How do I distinguish visual extinction from a visual field deficit? What clues on physical examination suggest a functional (psychogenic) disorder? Further Reading Stroke syndromes Anterior circulation Middle cerebral artery Occlusion of the upper trunk of the MCA Occlusion of the inferior trunk of the MCA Infarct of the deep basal ganglia (junctional plaque) Occlusion of distal MCA branch Occlusion of the proximal MCA segment (M1 segment) Other MCA syndromes Anterior cerebral artery Occlusion of the recurrent artery of Heubner Anterior choroidal artery Posterior circulation Occlusion of the basilar artery Proximal basilar artery occlusion Top of the basilar syndrome Posterior cerebral artery Lacunar syndromes Brainstem syndromes Medial medullary syndrome Inferior medial pontine syndrome (Foville syndrome) Inferior lateral pontine syndrome (Marie-Foix syndrome) Medial mid-pontine syndrome Lateral mid-pontine syndrome Midbrain peduncle (Weber syndrome) Dorsomedial midbrain (Claude syndrome) Paramedian midbrain (Benedikt syndrome) Spinal cord syndromes Anterior spinal artery syndrome Posterior spinal artery syndrome Thalamic syndromes Further reading Stroke imaging: Noncontrast head CT Approach to interpreting the acute noncontrast head CT Hyperdense vessel signs Acute ischemic changes on CT head (ASPECTS score) Identifying other structural lesions References and Further Reading Stroke imaging: CT angiography Identifying extracranial carotid stenosis or dissection CT angiography for intracerebral hemorrhage Reference Further reading Stroke imaging: CT perfusion CTP considerations and pitfalls Further reading Acute ischemic stroke treatment: Alteplase Intravenous thrombolysis: efficacy and patient selection Time to treatment Stroke severity How to administer tPA at the bedside tPA complications tPA contraindications Special considerations References and Further Reading Acute ischemic stroke treatment: Endovascular therapy Efficacy of endovascular therapy References and Further Reading Basilar artery occlusion Management of basilar artery occlusion References and Further Reading Acute stroke treatment: Acute blood pressure management and anticoagulation reversal Intracerebral hemorrhage acute blood pressure management Management of anticoagulation-associated intracranial hemorrhage in the acute stroke setting References and Further Reading Acute ischemic stroke treatment: Acute antiplatelet therapy Single antiplatelet therapy Dual antiplatelet therapy References and Further Reading Index A B C D E F G H I J L M N O P Q R S T U V W A 65-year-old patient arrives at the Emergency Department with stroke symptoms that began 45 minutes ago. You are called STAT!
Acute stroke management has changed dramatically in recent years. Tremendous advances have been made in acute treatments, diagnostic neuroimaging, and organized systems of care, and are enabling better outcomes for patients. Stroke has evolved from a largely untreatable condition in the acute phase to a true medical emergency that is potentially treatable—and sometimes curable. The Code Stroke emergency response refers to a coordinated team-based approach to stroke patient care that requires rapid and accurate assessment, diagnosis, and treatment in an effort to save the brain and minimize permanent damage.
The Code Stroke Handbook contains the "essentials" of acute stroke to help clinicians provide best practice patient care.
Designed to assist frontline physicians, nurses, paramedics, and medical learners at different levels of training, this book highlights clinical pearls and pitfalls, guideline recommendations, and other high-yield information not readily available in standard textbooks. It is filled with practical tips to prepare you for the next stroke emergency and reduce the anxiety you may feel when the Code Stroke pager rings.

• An easy-to-read, practical, clinical resource spread over 12 chapters covering the basics of code stroke consultations: history-taking, stroke mimics, neurological examination, acute stroke imaging (non-contrast CT/CT angiography/CT perfusion), and treatment (thrombolysis and endovascular therapy)
• Includes clinical pearls and pitfalls, neuroanatomy diagrams, and stroke syndromes, presented in an easily digestible format and book size that is convenient to carry around for quick reference when on-call at the hospital
• Provides foundational knowledge for medical students and residents before starting your neurology, emergency medicine, or internal medicine rotations