Treatment of Hemiplegia

4main features in treatment
• Quick transport to hospital, assessment, and CT scan in one hour
• Dissolving the blood clot with thrombolytic t-PA in 3hrs.-(if t-PA criteria are
met.)
• Also treat the risk factors- hypertension, diabetes and others P a g e | 20

• Post stroke rehabilitation started at the earliest.






Pearls for practice:
In patients presenting soon enough, for t-pa therapy, time allotted for different steps are :
for physician’s examination-10 min:
(Most important thing in evaluation is time of onset of symptoms)
For CT testing-within 25 min of arrival
CT interpretation within 20 min of test completion
IV t-PA(Tissue plasminogen Activator) administration –within 3hrs of stroke onset
patient if not candidate for iv t-PA ,after excluding hemorrhage on CT,should be put on aspirin at
earliest indicated.
BP if persistently high above 220syst and 120diastole only must be treated and
hyperglycemia in the range of 140-180mg /dl .
CHART.2..Treatment of stroke P a g e | 21


 Treatment of Ischemic Stroke:
1. Urgent restoration of blood flow; ( if diagnosed within 3 hours)-
-With thrombolytic t-PA (tissue plasminogen activator).
But before that hemorrhagic stroke is to be ruled out definitely.
t-PA is to be administered within 3hrs of stroke
onset and
in less than 60 min.- of arrival to causality.

2. Aspirin or aspirin with Clopidogrel;
But aspirin is contraindicated within 24 hrs of treatment with t-PA.
Still must be given within 48 hrs of symptoms.
After ruling out hemorrhage, and if ischemic patient is found unfit
 -for t-PA, is to be promptly put on aspirin
 3. Control of blood sugar, fever, seizures
 4. Hypertension is not treated immediately unless level is 220/120
Treatment of raised intracranial tension:
 ( a.) elevate the head end,( b). Restrict fluids,( c).administer osmotic
 diuretics, (d).hyperventilate
 Treatment of Hemorrhagic stroke
1. No specific medicine available for hemorrhage as
such.
2. Drugs for control of blood pressure, ,cerebral edema,
fever, seizures
3. Monitor for signs of raised intracranial tension; if
raised treat with intravenous mannitol with or without frusemide
4. Avoid straining while coughing, passing stools,
vomiting, changing posture
Surgery for hemorrhagic stroke:
a. In ‘huge’ cerebral hematoma, blood removed- to
reduce ICT
b. In cases of berry aneurysm, repair by clamping off
with metal clip/or by endovascular coil embolisation which blocks it.
c. Indication for surgery depends on site of aneurysm P a g e | 22



Lacunar infarcts: Aggressive treatment of hypertension.
TIA :
• Often there is no way to differentiate TIA from acute stroke.
• Do not wait to see if symptoms go away.
• Using ABCD score, assess risk of TIA developing stroke in future.


Athero thrombotic large/small vessels
o Aspirin
o Clopidogrel
o ASA/dipyridamole
• Anticoagulation;
Heparin: For thrombotic stroke in evolution or in posterior circulation
involvement.
Warfarin in Atrial fibrillation
• Antiplatelet agent: Aspirin-especially in TIA and as an alternative to
anticoagulation
Recurrent TIA after aspirin- aspirin plus dipyridamole
• Also treat the underlying cause e.g. -anticoagulants in atrial fibrillation
• Surgical treatment: For carotid thrombosis: carotid end- arterectomy.

Education:
Patient and family is to be educated regarding-
Early stroke symptoms, risk factors, diagnostic procedures treatment options