Key Points The ideal cytoprotective agent should be low in cost and complexity to allow access in emergency settings of variable sophistication. Cerebral ischemia provides the potential to modify the process both during and after the event to affect outcome.…
Key Points Mechanical ventilation and sedation. Brain edema and increased intracranial pressure. Blood pressure and blood glucose management. Neuromonitoring. Targeted temperature management. Large middle cerebral artery stroke. Basilar artery occlusion. Large cerebellar infarction. Intracerebral hemorrhage. Cerebral venous thrombosis. We are…
Key Points All stroke patients should be admitted to hospitals that offer 24/7 specialized stroke care with access to stroke unit care. Multiprofessional stroke unit care reduces significantly mortality, dependency, and need for long-term institutional care, independent of patients’ age…
Key Points Aspirin therapy (initial dose of 325 mg and subsequently 81 mg a day) should be initiated to patients within 24–48 hours after acute ischemic stroke. Patients receiving thrombolytic therapy should delay treatment until after 24 hours. Antiplatelet agents…
Key Points Intravenous (IV) recombinant tissue plasminogen activator (t-PA), commercially known as alteplase, remains the most commonly used therapy that is effective and safe for acute ischemic stroke. Pivotal trials in the 1990s demonstrated the beneficial effect of t-PA; subsequent…
Key Points Prehospital and emergency department care of the stroke patient must be focused on identification of potential stroke victims, rapid assessment, and prompt initiation of treatment for eligible individuals. Time from initiation of symptoms to first medical contact represents…
Key Points Rates of thrombolysis and thrombectomy remain low relative to the clinical burden of stroke worldwide and remain challenging for rural, limited resource communities. Use of thrombolytic therapy and triage for thrombectomy has expanded in the pre-hospital setting through…
Key Points OMICs-based technologies are identifying novel molecules and pathways associated with stroke. Markers identified through an OMICs-based approach may have utility as biomarkers to aid in the diagnosis of stroke, prediction of stroke risk, and assessment of stroke complications…
Key Points The technique of cerebral angiography emanates from before the advent of noninvasive imaging, yet this approach serves a unique role in the management of patients with cerebrovascular disorders. The risks and benefits of cerebral angiography include morbidity due…
Key Points The magnetic resonance imaging (MRI) acute stroke protocol includes T2-weighted imaging, fluid attenuated inversion recovery, gradient recalled echo, MR angiography, diffusion-weighted imaging, and perfusion-weighted imaging and can be acquired in 15–20 minutes. Diffusion-weighted MRI is an excellent tool…