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Access the activity, “Large Hemispheric Infarction: Exploring the Latest Clinical
Advances in the Diagnosis and Treatment,...
Treatment Strategies for Patients Who
Have a Large Hemispheric Infarction
PRACTICE AID
Access the activity, “Large Hemisph...
Treatment Strategies for Patients Who
Have a Large Hemispheric Infarction
AIS: acute ischemic stroke; AS: ankylosing spond...
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Large Hemispheric Infarction: Exploring the Latest Clinical Advances in the Diagnosis and Treatment

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Gregory W. Albers, MD, prepared useful Practice Aids pertaining to large hemispheric infarction for this CME activity titled “Large Hemispheric Infarction: Exploring the Latest Clinical Advances in the Diagnosis and Treatment.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at https://bit.ly/2YmCBwW. CME credit will be available until September 9, 2021.

Veröffentlicht in: Gesundheit & Medizin
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Large Hemispheric Infarction: Exploring the Latest Clinical Advances in the Diagnosis and Treatment

  1. 1. Access the activity, “Large Hemispheric Infarction: Exploring the Latest Clinical Advances in the Diagnosis and Treatment,” at PeerView.com/NDJ40 Management of Acute Ischemic Stroke: AHA/ASA Guidelines1 PRACTICE AID a For intravenous eligibility criteria, see current AHA/ASA guidelines. b Intracranial internal carotid artery or M1 occlusion. c For DAWN and DEFUSE 3 criteria, see supplemental table 1 in reference. AHA: American Heart Association; AIS: acute ischemic stroke; ASA: American Stroke Association; ASPECTS: Alberta Stroke Program Early CT Score; CTA: CT angiography; CTP: CT perfusion; DWI: diffusion-weighted imaging; EVT: endovascular therapy; ICH: intracerebral hemorrhage; LHI: large hemispheric infarction; LKW: last known well; LVO: large vessel occlusion; mCTA: multiphase CT angiography; MRA: magnetic resonance angiography; NCCT: noncontrast CT; NIHSS: National Institutes of Health Stroke Scale. 1. Ospel JM et al. J Am Coll Cardiol. 2020;75:1832-1843. Suspected AIS NIHSS ≥6 No ICH or stroke mimic IV alteplase if indicateda ICH NCCT or MRI: ICH and ASPECTS mCTA or MRA Imaging recommendation LVOb (includes LHI) No LVO No EVT 0-6 h from LKW and ASPECTS ≥6 6-24 h from LKW EVT CTP or DWI: infarct core quantification EVT if DAWN/DEFUSE 3 criteria are fulfilledc
  2. 2. Treatment Strategies for Patients Who Have a Large Hemispheric Infarction PRACTICE AID Access the activity, “Large Hemispheric Infarction: Exploring the Latest Clinical Advances in the Diagnosis and Treatment,” at PeerView.com/NDJ40 A Timeline of Evidence-Based Therapies for Treating Patients With an LHI Tissue plasminogen activator (tPA)1,2 • Initiate within <4.5 hours • Increases survival in patients experiencing a severe stroke Endovascular thrombectomy3-9 • Initiate within 6 hours (earlier is better) • Improves patient outcome over tPA alone Antithrombotic therapy10 • Initiate within 48 hours Decompressive craniectomy10 • Dramatically reduced mortality in patients with a malignant MCA infarction • High likelihood of permanent and severe disability Antiosmotic therapy10 • Initiate 1-4 days for cerebral edema • Mannitol and hypertonic saline are reasonable choices; avoid steroids and barbiturates
  3. 3. Treatment Strategies for Patients Who Have a Large Hemispheric Infarction AIS: acute ischemic stroke; AS: ankylosing spondylitis; COX-2: cyclooxygenase-2; JRA: juvenile rheumatoid arthritis; LHI: large hemispheric infarction; MCA: middle cerebral artery; MOA: mechanism of action; MS: multiple sclerosis; OA: osteoarthritis; RA: rheumatoid arthritis; S1P: sphingosine-1-phosphate; SUR1: sulfonylurea receptor 1; TRPM4: transient receptor potential cation channel subfamily M member 4. 1. Jauch EC et al. Stroke. 2013;44:870-947. 2. Demchuk AM et al. Stroke. 2005;36:2110-2115. 3. Powers WJ et al. Stroke. 2015;46:3020-3035. 4. Campbell BC et al. N Engl J Med. 2015;372:1009-1018.5. Saver JL et al. N Engl J Med. 2015;372:2285-2295. 6. Jovin TG et al. N Engl J Med. 2015;372:2296-2306. 7. Nogueira RG et al. N Engl J Med. 2018;378:11-21. 8. Goyal M et al. N Engl J Med. 2015;372:1019-1030. 9. Albers GW et al. N Engl J Med. 2018;378:708-718. 10. Torbey MT et al. Neurocrit Care. 2015;22:146-164. 11. Stokum JA et al. Annu Rev Pharmacol Toxicol. 2020;60:291-309. 12. Vaprisol (conivaptan hydrochloride). Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/021697s005lbl.pdf. 13. Gilenya (fingolimod). Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/ label/2019/022527s031lbl.pdf. 14. Celebrex (celecoxib). Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/020998s054lbl.pdf. 15. https://www.accessdata.fda.gov/scripts/opdlisting/oopd/detailedIndex.cfm?cfgridkey=20165393. PRACTICE AID Access the activity, “Large Hemispheric Infarction: Exploring the Latest Clinical Advances in the Diagnosis and Treatment,” at PeerView.com/NDJ40 Managing Cerebral Edema: Potential Targets, Emerging Therapies, and Mechanisms of Action11 • Emerging therapy: conivaptan – Currently indicated for hyponatremia12 • MOA: absorbs free water in kidneys • Emerging therapy: fingolimod – Currently indicated for relapsing MS13 • MOA: reduces vascular permeability • Emerging therapy: celecoxib – Currently indicated for OA, RA, JRA, AS, acute pain, and primary dysmenorrhea14 • MOA: reduces inflammation • Emerging therapy: glyburide – Orphan desgination for severe edema in patients who had an AIS15 • MOA: conducts monovalent cations Target: aquaporin receptor Target: S1P Target: COX-2 Target: SUR1/TRPM4

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