What does the mnemonic BEFAST stand for in identifying stroke symptoms?
- B: Balance
- E: Eyes
- F: Face
- A: Arms
- S: Speech
- T: Time
Each component helps in recognizing potential stroke symptoms quickly.
In stroke cases, why is time critical?
Time is critical due to brain tissue viability
As time progresses, more neurons die and the penumbra converts into core infarct area.
What are the two distinct areas in an occluded blood vessel during a stroke?
- Normal perfused viable brain tissue
- Infarct core (dead area)
The penumbra is the surrounding ischemic area containing alive but nonfunctioning neurons.
What imaging technique is considered the ‘workhorse’ in stroke diagnosis?
CT scan
Non-contrast CT (NCCT) is the first imaging technique used to rule out hemorrhagic stroke.
How long do NCCT changes in ischemic stroke take to manifest?
3-5 hours
Normal NCCT with acute focal neurological deficit suggests acute ischemic stroke.
What is the most sensitive test for stroke diagnosis?
Diffusion-weighted MRI
It shows changes (diffusion restriction) within 10 minutes of stroke onset.
What does the initial ER checklist for stroke management include?
- Airway
- Breathing
- Circulation
Establishing two IV lines is also part of the initial management.
What should be administered if capillary blood glucose is less than 50 mg/dL?
Dextrose 50
Low blood glucose is a contraindication for thrombolysis.
What is the blood pressure threshold for administering IV labetalol if thrombolysis is planned?
185/110 mmHg
Nicardipine is an alternative to IV labetalol.
What does the NIHSS stand for?
National Institutes of Health Stroke Scale
It is a protocol to assess stroke severity.
What is the scoring range for NIHSS indicating a severe stroke?
21-42
Other scoring ranges include 0-4 for minor stroke and 16-20 for moderate-severe stroke.
What does the AMPLE history acronym stand for?
- A: Allergies
- M: Medications
- P: Past medical history
- L: Last meal
- E: Event history
This is used due to time constraints in stroke management.
What is the ABCD2 scoring system used for?
Risk stratification for Transient Ischemic Attack (TIA)
It assesses age, blood pressure, clinical features, diabetes, and duration of symptoms.
What is a contraindication for thrombolysis regarding platelet count?
Platelet count <100,000
This is critical for determining eligibility for thrombolytic therapy.
What is the maximum dose of Alteplase for thrombolysis?
0.9 mg/kg (maximum 90 mg)
10% is given as IV bolus and 90% as a 1-hour IV infusion.
What are the criteria for thrombolysis within 3 hours?
- Age >18 years
- BP <185/110 mmHg
- Blood glucose >50 mg/dL
- No frank hyperdensities on imaging
These criteria ensure patient safety and treatment efficacy.
What is the target blood pressure post-thrombolysis?
<180/105 mmHg
This helps prevent complications after thrombolytic treatment.
What is the common risk factor for pneumonia in stroke patients?
- Increased age
- Higher NIHSS score
- Bulbar manifestations
- Dementia
- PPI/H2 receptor use
Most pneumonia cases are aspiration-related.
What is the recommended management for dysphagia in stroke patients?
NGT (nasogastric tube) or PEG if water swallow test is positive
Over 90% of dysphagia resolves within 2 weeks.
What is the STATE criteria for decompressive craniectomy eligibility?
- S: GCS score >8
- T: Time >48 hours
- A: Age >60 years
- T: Territory involvement >50% MCA
- E: Expectancy of life
This criteria helps determine the need for surgical intervention.
