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MANAGEMENT OF
     PATIENTS

WITH HEMIPLEGIA
AIMS
Minimising    the volume of brain
 that is irreversibly damaged.
Preventing complications.
Reducing patient`s disability
 and handicap through
 rehabilitation.
Reducing the risk of r/c episodes.
MANAGEMENT
Supportive care
Thrombolysis
Aspirin & Heparin
Management of risk factors
Carotid endarterectomy &
 Angioplasty
SUPPORTIVE CARE
Early  admission
Dysphagia-early bedside test of
 swallowing
Nasogastric tube or IV
Distinguish patients with neuro
 deficits & those suffering from
 hypoxia,sepsis,epilepsy
Cerebellarhaematomas or infarcts
Anti oedema agents
Surgical compression to reduce
 ICT
THROMBOLYSIS

rt-PA
Given within 3 hrs of onset of
 symptoms
Increases the risk of h`gic
 transformation of cerebral infarcts
ASPIRIN & HEPARIN
Aspirinafter ischaemic stroke
Reduces r/c


Heparin-dec r/c & venous
 thromboembolism
Risk of intracranial & extracranial
 h`age
IC h`age excluded on brain imaging
MANAGEMENT OF RISK
 FACTORS

Chances  of r/c
Pts of ischaemic stroke-antiplatelet
 drugs & statins
Pts in AF-oral anticoagulants
Ischaemic & h`gic strokes-BP
 reduction
CAROTID ENDARTERECTOMY &
 ANGIOPLASTY

Pts  with TIA-50% stenosis of
 carotid artery of same side of
 lesion
Reduces risk of r/c
More effective in first couple of
 weeks
Angioplasty & stenting are more
 feasible but not superior to
 endarterectomy
MANAGEMENT OF ACUTE
STROKE

Airway
Breathing
Circulation
Hydration
Nutrition
Medication
BP &blood glucose
Temperature
Pressure areas
Incontinence
THANK YOU

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Management of hemiplegia