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ALTERATIONS IN THE NERVOUS SYSTEM TREATMENT OF CVA Cerebrovascular Accident Goals for Management 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 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* *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 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) Medications Continued Stool softeners: to prevent constipation Analgesics for pain Antianxiety drugs 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