Neurocritical Care

Preventive Therapies

Abortive Therapies

Baclofen IT (titrated according to patient response)

Bromocriptine 1.25 mg enterally BID (up to 40 mg/day)

Clonidine 0.1–0.3 mg enterally three times daily

Gabapentin 100–300 mg three times daily (up to 4800

mg/day)

Propranolol 20–60 mg enterally every 4–6 hr

Baclofen IT (titrated according to patient response)

Dantrolene 0.25–2 mg/kg IV every 6–12 hr

Dexmedetomidine 0.2–1.5 mcg/kg/hr IVa

Diazepam 5–10 mg IV PRN

Fentanyl 25–100 mcg IV PRN

Morphine 2–8 mg IV PRNa

Propranolol 1–3 mg IV every 4 hra

aMost common treatments.

IT = intrathecal; PRN = as needed.

Rabinstein AA, Benarroch EE. Treatment of paroxysmal sympathetic hyperactivity. Curr Treat Options Neurol 2008;10:151-7; Thomas A, Greenwald BD. Paroxysmal

Fifth leading cause of death and number 1 cause of disability in the United States, with around 800,000

strokes in the United States annually

Diagnostic tests

Neurologic examination

Vital signs

NIH Stroke Scale (greater than 25 is severe, range 1–42)

Noncontrast CT scan or magnetic resonance imaging (MRI) of the brain (to rule out bleeding)

ii.

CT angiography (for patients with evidence of large vessel occlusion)

iii.

CT or MRI perfusion and diffusion imaging may be considered for patients outside the

thrombolysis window.

iv.

Chest radiography (if lung disease is suspected)

Lumbar puncture (if SAH is suspected and CT scan is negative for blood)

vi.

EEG (if seizures are suspected)

Blood glucose

INR, activated partial prothrombin time (consider thrombin time, anti–factor Xa [anti-Xa] activity

for direct oral anticoagulants)

Complete blood cell count (CBC)

Cardioembolic (29.1%)

Lacunar infarcts (15.9%)