A 53 years old man is admitted with a history of CVA 2 days ago. Patient is drowsy with minimal response. CT picture is shown as in the figure. What will be your next line of management?
A. Aspirin and clopidogrel
C. Decompressive surgery
D. Mechanical thrombectomy
Ans. c. Decompressive surgery
- The patient is having a low GCS with CT showing significant edema in the MCA territory (at least >50%). In such cases brain herniation is impending and need to be referred for decompressive neurosurgery.
- “Stroke is a common cause of neurologic critical illness. Hypertension must be managed carefully, since abrupt reductions in blood pressure may be associated with further brain ischemia and injury. Acute ischemic stroke treated with tissue plasminogen activator (tPA) has an improved neurologic outcome when treatment is given within 3 h of onset of symptoms. The mortality rate is not reduced when tPA is compared with placebo, despite the improved neurologic outcome. The risk of cerebral hemorrhage is significantly higher in patients given tPA. No benefit is seen when tPA therapy is given beyond 3 h after symptom onset. Heparin has not been convincingly shown to improve outcomes in patients with acute ischemic stroke. Decompressive craniectomy is a surgical procedure that relieves increased intracranial pressure in the setting of space-occupying brain lesions or brain swelling from stroke; available evidence suggests that this procedure may improve survival among select patients (<55 years or age), albeit at a cost of increased disability for some