Low NIHSS stroke with M1 occlusion

3 october 2016 – 9:50

Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, United States
Team led by Raul G. Nogueira


How would you treat a patient – a 56-year-old practicing radiologist – who presents with an acute stroke, a low NIHSS score of 2 and the remnant of a large vessel, M1, occlusion?

Follow the step-by-step discussion and debate as the audience questions, challenges and offers their support to R. Nogueira (Atlanta, GA, USA, catchment area of around 10 million) as he presents this recent, pre-recorded and challenging case. Every detail is available to the audience and viewer concerning the management of this patient from the very beginning with the patient’s history, vital functions and interesting ideas about workflow, including early examination by directly integrating the angio-suite into the Atlanta center’s arrival area with no pass by the emergency room – the so-called “fast” protocol.

Watch as the management unfolds: When was a CT scan performed? Did they do an MRI? What were the reasons for or against either of these protocols? Discover the 4 point exam used by R. Nogueira in evaluating this patient: Was there a higher NIHSS score at the first hospital? Blood pressure? What happens when you perform a simple stress test by having the patient sit up? What does the CT scan indicate? Concerning the intervention itself: What tools were used? What is the concept of “mismatch”? What complications can occur? Perforations? Pre- or post-operative bleeding? How would you treat these complications and why would they occur?

Finally, learn how this patient was treated along with the outcome as you and the audience react and come to grips with how and why you would treat such a complex situation…

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