Stroke, GBS, MND & raised ICP drugs
also: alteplase thrombolysis · aspirin stroke · riluzole · IVIG Guillain-Barre · mannitol
Overview
The acute-neurology drug decisions — ischaemic stroke (thrombolysis/antiplatelets), Guillain-Barré, motor neurone disease, and raised intracranial pressure.
Mechanism
Alteplase (tPA) activates plasminogen → fibrinolysis (thrombolysis within 4.5 h, after haemorrhage excluded). Aspirin/clopidogrel are antiplatelets (secondary prevention). Riluzole inhibits glutamate release (modest survival benefit in MND). IVIG/plasma exchange remove pathogenic antibody (GBS). Dexamethasone reduces tumour-associated oedema; mannitol/hypertonic saline osmotically reduce ICP.
Indications
- Acute ischaemic stroke / TIA
- Guillain-Barré syndrome
- Motor neurone disease
- Raised ICP / cerebral oedema
The agents
Aspirin 300 mg for 2 weeks after stroke (exclude bleed first), then clopidogrel long-term; AF → anticoagulate.
within 4.5 h
After CT excludes haemorrhage + no contraindications; ± thrombectomy.
Steroids do NOT help GBS; monitor FVC (respiratory failure).
Modest survival benefit; + NIV/nutrition.
Dexamethasone for tumour oedema; mannitol/hypertonic saline for acute ICP.
Adverse effects
Cautions & contraindications
Catastrophic bleeding.
Ineffective — use IVIG/PLEX.
Interactions
- Thrombolysis + anticoagulants/antiplatelets ↑bleeding
Monitoring & kinetics
Stroke: CT before/after; GBS/MND: FVC; riluzole: LFTs
Time-critical (thrombolysis <4.5 h). See Antiplatelets/Anticoagulants cards (CV) for secondary prevention detail.
Source: NICE NG128 — Stroke/TIA · BNF — Stroke