Evans Syndrome
Autoimmune hemolytic anemia (AIHA) Immune thrombocytopenia and or autoimmune neurtopenia substantial portion has Autoimmune lymphoproliferative syndrome (ALPS) Treatment IVIG is used commonly to treat AIHA Steroid: initially effective, most relapse after stopping therapy, alternative therapy is required...
PCSK9
Alirocumab and evolocumab are fully humanized monoclonal antibodies that bind free plasma PCSK9 Mechanism = Decrease level of PCSK9= less free PCSK9 is available in plasma to bind to LDL-R= Increased LDL-R allow the liver to remove more LDL-C Alirocumab Dose Hyperlipidemia, primary:Initial: 75 mg sq every 2 weeks...
Statin Therapy
For hyperlipidemia, statin decreases the risk of stroke Lipid lowering by other means (eg, fibrates, resins, diet) has no significant impact on stroke incidence May have anti-atherothrombotic properties May have a role in plaque stabilization, reduce inflammation, slow carotid arterial disease progression, improve endothelial function, and reduce embolic stroke...
Acute Stroke – LKN 3-4 half hr
If Last known normal between 3-4.5 hours Evaluate risks and benefit of TPA If any of the following, no tpa over 80 years old taking oral anticoagulant NIHSS > 25 Previous Stroke plus Diabetes Imaging study showing evidence of injury over 1/3 of MCA territory...
Unruptured intracranial aneurysm
AAN 2015 guideline Link to original article = please read the original article Unruptured intracranial aneurysm = UIA Subarachnoid hemorrhage = SAH Risk factors and recommendations Smoking increase risks of UIA: smoking cessation Hypertension may play a role in growth and rupture: treat Hypertension Intermittent imaging studies needed to...
NIH Stroke scale
Abbreviated summary of NIHSS No Neuro deficit score is 0 Larger number INDICATES more deficit Level of consciousness: 0-3 Speech 2 questions: 0-2 2 commands: 0-2 Dysarthria: 0-2 Aphasia: 0-3 Gaze: 0-2 Motor each limb: 0-4 Ataxia: 0-2 Sensory: 0-2 Extinction/Neglect: 0-2 Additional resources NIH Stroke Scale online form...
Stroke etiology, documentation required
Large artery atherosclerosis Cardiac embolism Small Vessel disease Other determined etiology Dissection Hypercoagulability Other Cryptogenic Stroke Multiple potential etiologies Undetermined etiology Unspecified...
AISIntervention
Mechanical thrombectomy mRS = Modified Rakin Scale. ASPECTS = Alberta Stroke Program Early Computed Tomography Score Do not delay TPA if indicated. Occlusion of internal carotid artery or M1 segment Age 18 or over Acute stroke onset < 6 hours Prestroke mRS score <2 (meaning no significant disability despite symptoms,...
AISpostTpa
First 24 hr post TPA Get CTA of head and neck if not contraindicated, creatine normal. No antiplatelet (including aspirin), no anticoagulant for 24 hours Bed rest Keep BP <185/105 Acetaminophen if temperature over 38 degree C Treat hyperglycemia to achieve a range of 140-180 Avoid arterial puncture, Foley,...
AISTpaPos
Risks For treatment within 3 hours, good outcome with tpa 33% vs 23% for control group. (10% better chance of good outcome) Risk of symptomatic intracerebral hemorrhage: 6.8% in tpa group, 1.3% of control group. (1 in 14 will have a bleed. ) Risk of Fatal intracerebral hemorrhage within...