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<< Cervical Artery Dissection: Early Recognition and Stroke Prevention (Stroke CME, Trauma CME and Pharmacology CME)

Treatment

Stroke

When patients present to the ED with neurological deficits, it may not be readily apparent that dissection is the culprit, and the stroke symptoms should be evaluated and treated according to standard acute ischemic stroke protocols. Treatment of acute stroke with thrombolytics in patients in whom there is suspicion for carotid or vertebral artery dissections remains a concern of many emergency clinicians, due to the possible risk of hemorrhage or intramural hematoma expansion. Although there are no randomized controlled trials to assess the safety and efficacy of rtPA in these patients, they were not excluded in the original National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke (NINDS) Intravenous (IV) rtPA trial.63 Since then, other authors have reviewed their data on the use of rtPA in patients presenting with stroke due to dissections, and they support its safety and efficacy.64-68

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