Transcript ALTERATIONS IN THE NERVOUS SYSTEM

ALTERATIONS IN THE
NERVOUS SYSTEM
TREATMENT OF CVA
Cerebrovascular Accident
Goals for Management
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CT Scan – No hemorrhage:
◦ Consider Fibrinolytic therapy
 Check for exclusions
 tPA
 No anticoagulants or antiplatelet therapy for 24 hours
◦ If not a candidate: Antiplatelet Therapy

CT Scan – Hemorrhage:
◦ Neurosurgery?
◦ If no surgery: Stroke Unit
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Monitor BP and treat Hypertension
Monitor Neuro status
Monitor blood glucose and treat as needed
Supportive therapy
Thrombolytic Therapy
IV (systemic) thrombolytic therapy
 Retavase (rtPA)
 Eligibility criteria
-no bleeding disorder
-no recent surgeries
-not on anticoagulants
 Intra-arterial thrombolysis
pro-urokinase*
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*http://emedicine.medscape.com/article/1160840-overview
Treatment for Ischemic Stroke
•
Thrombolytic Drugs: rtPA (recombinant tissue
plasminogen activator) Retavase
• binds to thrombi fibrin causing fibrinolysis
• Enzymatic action digests fibrin & fibrinogen
• Results is clot lysis
•
Administered within 3 hours of symptoms of
ischemic CVA
• Confirmed DX with CT
• Patient anticoagulated
•
ASA, Calcium Channel Blockers
Drug Therapy
Thrombolytic therapy
 Anticoagulants
 Lorazepam and other antiepileptic drugs
 Calcium channel blockers
 Stool softeners
 Analgesics for pain
 Antianxiety drugs
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Medications
Anticoagulants: to prevent further clot
formation (heparin)
 Lorazepam and other antiepileptics: to
prevent seizure activity
 Calcium channel blockers: to treat or
prevent cerebral vasospasm(verapamil)
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Medications Continued
Stool softeners: to prevent constipation
 Analgesics for pain
 Antianxiety drugs
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CVA – Surgical Treatment
• Carotid endarterectomy – preventive – >
100,000/year
• removal of atheromatous lesions
• Extracranial-intracranial bypass
• Clipping, wrapping, coiling aneurysm
• Treatment of AV Malformations
Hemorrhagic-Subarachnoid
Cerebral Aneurysm – Surgical Tx
Hemorrhagic-Subarachnoid
Cerebral Aneurysm – Coiling
Video of wire coils to treat
aneuryms
http://www.veoh.com/browse/videos/catego
ry/entertainment/watch/v18668828WJmj4g
Ra
Other Potential Measures
Cooling
 Ancrod
 Neuroprotective drugs
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