SAQ 395 – Neurology – acute ischaemic stroke thrombolysis

Neurology – acute ischaemic stroke thrombolysis.

a. Stroke mimics

• Seizure with Todd paresis.
• Toxic or metabolic causes such as hypoglycaemia, hyponatraemia, hepatic encephalopathy, or drug toxicity.
• Space-occupying lesion such as tumour or CNS abscess.
• Syncope or presyncope.
• Sepsis.
• Migraine.
• Subdural haemorrhage.
• Hypertensive encephalopathy.
• Infectious or autoimmune neurological disorders such as MS, GBS, botulism, or transverse myelitis.

b. Thrombolysis indications

• Acute ischaemic stroke within 3 hours of onset.
• No evidence of intracranial haemorrhage.
• Age over 18 years and under 80 years.
• Consent obtained.
• NIHSS greater than 2 and less than 25.
• INR less than 1.7 and no anticoagulation contraindication.

c. Thrombolysis statistics

• Number needed to treat for good functional outcome about 10.
• Number needed to harm for intracranial haemorrhage about 42.
• Number needed to harm for death about 122.
• Life-threatening bleeding occurs in about 1-3%.
• Major haemorrhage occurs in about 6%.
• Minor haemorrhage occurs in about 3%.