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≤4.5 hours from last known well.
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BP must be <185/110 before giving tPA.
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MCA is a direct continuation of the ICA.
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To reduce risk of hemorrhagic transformation.
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Post-tPA goal is <180/105.
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Hypertension - Basal ganglia most common site.
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Up to 24 hours for large vessel occlusion.
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Think ICA or proximal MCA occlusion.
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Medullary compression:
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To maintain perfusion to ischemic penumbra.
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Lowering BP too fast worsens infarct.
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Minimal drug interactions, no hepatic metabolism.
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Safe in polypharmacy.
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Carbamazepine.
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Avoid narrow-spectrum drugs in generalized epilepsy.
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Cellular swelling → neuronal excitability.
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Check sodium in new-onset seizure.
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GABA downregulation + glutamate upregulation.
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Treat with benzo’s/
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Parasympathetic fibers are superficial → compressed first.
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Dilated pupil = compressive aneurysm.
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To minimize vertical diplopia from superior oblique weakness.
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Head tilt away from lesion.
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Early hippocampal degeneration.
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Medial Temporal lobe first.
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Periventricular white matter compression affecting frontal gait pathways.
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Gait is earliest symptom.
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Severe neuroleptic sensitivity.
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Can worsen rigidity dramatically.
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CO₂ vasoconstriction decreases cerebral blood flow.
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Bridge only — not long-term solution.
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Increases cerebral metabolic demand.
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Aggressive normothermia.
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CPP = MAP − ICP.
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Goal CPP ≥ 60–70 mmHg.
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Apnea test.
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Must normalize temperature and BP first.
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Sacral segments are located centrally at the conus.
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Early symmetric deficits = conus.
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Lesion at cervical cord damages anterior horn cells at that level and corticospinal tracts below.