1. ALTERATIONS IN THE NERVOUS SYSTEM
TREATMENT OF CVA

2. 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

3. Thrombolytic Therapy IV (systemic) thrombolytic therapy
Retavase (rtPA)
Eligibility criteria
-no bleeding disorder
-no recent surgeries
-not on anticoagulants
Intra-arterial thrombolysis
pro-urokinase* *

4. 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

5. Drug Therapy Thrombolytic therapy Anticoagulants
Lorazepam and other antiepileptic drugs
Calcium channel blockers
Stool softeners
Analgesics for pain
Antianxiety drugs

6. 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)

7. Medications Continued
Stool softeners: to prevent constipation
Analgesics for pain
Antianxiety drugs

8. CVA – Surgical Treatment
Carotid endarterectomy – preventive – > 100,000/year
removal of atheromatous lesions
Extracranial-intracranial bypass
Clipping, wrapping, coiling aneurysm
Treatment of AV Malformations

10. Hemorrhagic-Subarachnoid Cerebral Aneurysm – Surgical Tx

11. Hemorrhagic-Subarachnoid Cerebral Aneurysm – Coiling

12. Video of wire coils to treat aneuryms

13. Other Potential Measures
Cooling
Ancrod
Neuroprotective drugs