Question

A 60-year-old hypertensive male is brought to a Stroke unit with acute onset right hemiparesis and aphasia (NIHSS score 16) of 8 hours duration.
Draw a flowchart to elucidate the clinical, diagnostic and management protocol in such a patient.

Hint:

The time window for thrombolysis and thrombectomy is critical in stroke management. Early intervention improves outcomes.

Answer 1

The management protocol for an acute ischemic stroke patient with right hemiparesis and aphasia involves a well-structured flowchart that includes the following steps:
Step 1: Initial Assessment:
- Assess the patient's vital signs, blood pressure, and oxygen saturation.
- Establish the time of symptom onset (this is crucial for determining treatment options).
- Perform a NIHSS (National Institutes of Health Stroke Scale) assessment to determine the severity of the stroke.
Step 2: Imaging:
- Perform a non-contrast CT scan to rule out hemorrhagic stroke and confirm the ischemic stroke.
- Consider MRI if further imaging is needed to assess the extent of ischemia.
Step 3: Thrombolysis (If Within 4.5 hours of symptom onset):
- If eligible, administer intravenous rtPA (tissue plasminogen activator) to dissolve the clot.
Step 4: Endovascular Therapy (For Severe Cases or Beyond 4.5 hours):
- Consider thrombectomy (aspiration thrombectomy or mechanical thrombectomy) for patients with a large vessel occlusion, typically within 6-24 hours from symptom onset.
Step 5: Post-Thrombectomy Care:
- Monitor for signs of hemorrhagic transformation or other complications.
- Initiate secondary stroke prevention (antiplatelets, anticoagulation as appropriate).