1. In The Name Of God

2. Presented by: Dr Kadivar neurologist at Hazrat e Aliasghar Hospital
Ischemic CVA
Presented by: Dr Kadivar
neurologist at Hazrat e Aliasghar Hospital

3. What Do you should know? Definition of ISCHEMIC CVA Localization
Approaches at ER
Maintenance therapy
Hospital care

4. Sudden onset vascular insult, due to embolic process and or thrombotic etiology and or total occlusion.
At cortical infarction: contralateral weakness, gaze to cortical infarction site,
contralateral homonymous hemianopia,……..
At brainstem infarction: contralateral weakness and gaze to this site……

5. Case 1
A case of 70 y/o female with suddenly confusional state and lt sided weakness, dysarthria, lt central facial palsy, Dysphasia…..
BP:200/ T: ECG: Nl rhythm 73/min BS: 280 mg/dl LDL:110
GCS:9 Hb:10.5
PMHx: DM2 , HTN , Smoker

6. A B C D approaches
Position:30◦
Bed side chart score q1hour (Mental status, plantar reflex,puipilary reflex)
Save BP <220/120 for 48 – 72 hours
NPO for 24 hours and reevaluation again.
Heart monitoring & pulse oximetry
Iv fluid therapy normal saline
Save BS <200mg/dl , check with glucometer q6hour
Blood transfusion if Hb <10
TG,cholestrol,LDL,HDL (WHAT’S LDL Goals?)
Physiotherapy at chest, extremities…..
Hold Asprin,Plavix,Heparin, Atorvastatin for at least 72 hours
Please intubate the patient if GCS dropped or signs of herniation detected.

7. Case 2
A case of 68y/o male with suddenly slurred speech, Rt sided weakness, drowsiness, headache from this morning….
BP:195/ BS: CR: Bun: HB:9 ECG: fibrillation rhythm
PMHx: AF, HTN, CRF, DM2

8. A B C D approaches
Position: flat for 24 hours and then at 30◦
Bed side chart score q1hour (Mental status, plantar reflex,puipilary reflex)
NPO for hours and reevaluation again.
Heart monitoring & pulse oximetry
Iv fluid therapy normal saline
Save BP <180/100 due to renal failure, with Labetalol 2-4 cc in 5cc NS at 3min and re-evaluate BP 10 minute late (total dose is 300 mg)
Transfuse 1 bag P-RBC
TG,cholestrol,LDL,HDL
Physiotherapy at chest, extremities…..
Plavix 300 mg stat dose and then 75mg/ Qd
Atorvastatin 40 mg/Qhs

9. Case 3
A case of 72 y/o male with headache, lt homonymous hemianopia, from 2 days ago
BP:160/ BS: ECG: Fibrillation Rhythms HB: Hct:57
PMHx: Heavy Smoker, AF, HLP( LDL 135, HDL 35)

10. A B C D approaches
Please phlebotomy 1 bag and replacement with normal saline
IV fluid Normal saline for rehydration
Check Hct /Qd for optimal <55
You should decided for starting anticoagulant (warfarin)
ASA 325 mg /stat dose and 80 mg /Qd , unless at Aspirin failure you should ordered Plavix 300mg stat dose and 75 mg /Qd
Atorvastatin 40mg/Qhs for LDL Goal: <70

11. Case 4 A case of 55 y/o male with suddenly confusional statelt
t sided weakness , abnormal gaze to right side, dysarthria from 2 days ago…
BP: 210/ BS: T: TTE(EF):25% Na:125
PMHx: HF, HTN, HLP, controlled DM2

12. A B C D approaches
Position: flat for 24 hours and then at 30◦ (attention to pulmonary edema)
Bed side chart score q1hour (Mental status, plantar reflex,puipilary reflex)
NPO for 24 hours and reevaluation again.
Heart monitoring & pulse oximetry
Iv fluid therapy normal saline ?
Save BP < ?, with
Cardiologist consultation
TG,cholestrol,LDL,HDL
Physiotherapy at chest, extremities…..
Plavix 300 mg stat dose and then 75mg/ Qd
ASA 80 mg/Qd
Atorvastatin 40 mg / Qhs