Time is brain

Introduction: Acute ischaemic stroke is a neurological emergency that can be treated with time sensitive interventions including IV TPA and endovascular approaches. Chief criteria to select patients for vascular reperfusion treatment is duration of stroke symptoms. These patients are usually agitated. General anaesthesia keeps them comfortable and motionless during endovascular reperfusion treatment. However retrospective studies show poorer outcomes with general anaesthesia due to haemodynamic instability, delay in treatment and prolonged intubation. We present two cases of stroke in young patients with timely intervention under general anaesthesia. Case Summary: Case 1: 34 year old male patient, with no comorbidities, brought to casualty within 2 hours 10 minutes of onset of right sided hemiparesis and inability to talk. Code GOLD activated. CT normal. MRI showed left basal ganglia infarct with totally occluded left ICA. IV TPA started. Patient taken for DSA within 3 hours of onset of symptoms where left MCA recanalization and thrombus aspiration with near total recanalization of cervical ICA done under general anaesthesia. Patient shifted to ICU on mechanical ventilation. Extubated after 24 hours. Post operatively no neurological deficit. Case 2: 19 year old female patient, known case of epilepsy brought to casualty within one hour 15 minutes of onset of left sided weakness and slurred speech. Code GOLD activated. CT normal. MRI revealed right internal capsule posterior limb acute infarct with right ICA not visualized. Patient taken for DSA within 2 hours of onset of symptoms under general anaesthesia which revealed complete stenosis of supraclinoid ICA. Patient underwent thrombolysis. Good collaterals achieved. Patient shifted to ICU onmechanical ventilation. No neurological deficit postoperatively. Conclusion: Anaesthesiologists not only play an integral part of the stroke team but also in maintaining optimum haemodynamics during intervention.