Page 46 - Radiology Book

stroke mimics and clinical features
Hypoglycemia
· History of diabetes
· Low serum glucose
· Decreased consciousness
Seizures
· History of seizures
· Witnessed seizure activity · Postictal period
Conversion Disorder
· Lack of cranial nerve ndings
· Nonvascularly distributed neurological
ndings
· Inconsistent exam
Hypertensive Encephalopathy
· Headache
· Delirium
· Signi cant hypertension · Cerebral edema
Complicated Migraine
· History of similar event · Preceding aura
· Headache
If the Patient is a TPA Candidate
· TPA Order Set (if available): Alteplase Administration · Call pharmacy and consult neurology
· Patient must have 2 large-bore IVs (may use smaller IV) · Patient must be placed on monitor and oxygen
· Massey Swallow Screen/transfer to ICU
If the Patient is not a TPA Candidate
· Non-TPA Order Set (if available): stroke without alteplase · Transfer to telemetry unit that supports stroke patients
stroke fibrinolytic cHecklist
· All boxes must be checked before TPA can be given. Note: The following checklist includes FDA-approved indications and contraindications for TPA administration for acute ischemic stroke. A physician with expertise in acute stroke care may modify this list. Inclusion Criteria All Yes boxes must be checked
yes
tPa inclusion criteria
Age 18 or older
Diagnosis of ischemic stroke causing measurable neurological de cit
Computed tomography does not show hemorrhage or nonstroke cause of de cit
Onset of symptoms less than 3 hours before treatment
Onset of symptoms within 3-4.5 hours before treatment · Age less than 80 years
· NIHSS <25
· Not on oral anticoagulation
· No history of diabetes and prior ischemic stroke
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Stroke