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Reperfusion Therapy, Cerebral

Reperfusion Therapy, Cerebral is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

An ischemic cerebrovascular accident (CVA), or stroke, is an acute, sudden or gradual, interruption of regional cerebral blood supply
Cerebral reperfusion therapy involves:
- Administration of an IV thrombolytic agent to rapidly dissolve a thromboembolic occlusion
- Site-specific endovascular intra-arterial thrombolysis
- Mechanical clot removal

Etiology

Thrombotic CVA is from an in situ thrombosis:
- At an ulcerated atherosclerotic plaque or other prothrombotic endothelial abnormality
- From hypercoagulable states:
  - Antithrombin III, protein C or S deficiency
- From sludging:
  - Sickle cell disease
  - Polycythemia vera
Embolic CVA is caused by acute obstruction by an embolus from:
- Cardiac mural thrombus formed in:
  - Atrial fibrillation
  - Hypokinetic ventricle (MI, cardiomyopathy)
  - Ventricular aneurysm
- An abnormal or prosthetic cardiac valve
- Aortic, carotid, or cerebrovascular atherosclerotic plaques
Other occlusive events include:
- Vascular dissection in aorta, cerebral, vertebral, carotid, or innominate arteries
- Cerebral vasospasm induced by:
  - Subarachnoid hemorrhage (SAH)
  - Vasoconstrictive agents (e.g., cocaine)

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Citation

Barkin, Adam Z., et al., editors. "Reperfusion Therapy, Cerebral." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307259/all/Reperfusion_Therapy__Cerebral.

Reperfusion Therapy, Cerebral. In: Barkin AZ, Barkin RM, Hayden SR, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307259/all/Reperfusion_Therapy__Cerebral. Accessed February 23, 2019.

Reperfusion Therapy, Cerebral. (2016). In Barkin, A. Z., Barkin, R. M., Hayden, S. R., Rosen, P., Schaider, J. J., Shayne, P., & Wolfe, R. E. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307259/all/Reperfusion_Therapy__Cerebral

Reperfusion Therapy, Cerebral [Internet]. In: Barkin AZ, Barkin RM, Hayden SR, Rosen P, Schaider JJ, Shayne P, Wolfe RE, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 February 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307259/all/Reperfusion_Therapy__Cerebral

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case

TY - ELEC T1 - Reperfusion Therapy, Cerebral ID - 307259 ED - Barkin,Adam Z, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Shayne,Philip, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307259/all/Reperfusion_Therapy__Cerebral PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -