Acute stroke evaluation and management

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Stroke is the fourth leading cause of death and the leading cause of disability in the United States. Several new therapeutic strategies such as institution of recanalization therapies in the first few hours after ischemic stroke are now available to reduce death and stroke-related disability. Understanding the stroke epidemiology and pathophysiology, and knowledge of evidencebased guidelines are the cornerstones of high-quality emergent acute stroke management. Stroke is typically characterized by sudden onset of focal neurological deficits. Advanced neuroimaging (CT and MRI) can help confirm the clinical diagnosis and guide treatment. Ischemic stroke is by far the most common form of stroke resulting from sudden arterial occlusion in a vascular territory. Common etiologies include cardiogenic embolism, extracranial and intracranial large artery atherosclerosis, lacunar stroke, and cryptogenic stroke. In acute ischemic stroke, intravenous tPA should be given with 4.5 h after symptom onset in patients without contraindications. Endovascular therapy shows benefit in selected patients within certain time window. Most strokes after transient ischemic attack occur within 90 days, and majority within 48 h. Urgent evaluation and treatment of patient with TIA especially in high-risk patients are important. Intracerebral hemorrhage and subarachnoid hemorrhage are devastating diseases. Hypertension and smoking are common risk factors. The clinical symptoms are characterized by focal neurological deficits associated with headache and other signs of high intracranial pressure. Blood pressure management is critical in managing intracerebral hemorrhage. Recently clinical trials suggested that aggressive blood pressure reduction does not worse the outcome. In subarachnoid hemorrhage, emergent aneurysm occlusion with coiling or clipping to prevent rebleed is crucial in acute phase. Delayed cerebral vasospasm should be monitored closely. Cerebral venous thrombosis (CVT) is uncommon. Headache and seizures are the common symptoms. Anticoagulation is the primary therapy for CVT.

Original languageEnglish (US)
Title of host publicationEmergency Neurology
PublisherSpringer US
Pages143-160
Number of pages18
ISBN (Print)9780387885858, 9780387885841
DOIs
StatePublished - Jan 1 2012

Fingerprint

Stroke
Intracranial Thrombosis
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Venous Thrombosis
Headache
Therapeutics
Blood Pressure
Lacunar Stroke
Intracranial Embolism
Intracranial Vasospasm
Transient Ischemic Attack
Intracranial Pressure
Neuroimaging
Aneurysm
Blood Vessels
Cause of Death
Atherosclerosis
Epidemiology
Seizures

Keywords

  • Acute ischemic stroke
  • Intracerebral hemorrhage
  • Stroke
  • Subarachnoid hemorrhage
  • tPA

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Acute stroke evaluation and management. / Shang, Ty Tiesong; Yavagal, Dileep R; Romano, Jose G; Sacco, Ralph L.

Emergency Neurology. Springer US, 2012. p. 143-160.

Research output: Chapter in Book/Report/Conference proceedingChapter

Shang, Ty Tiesong ; Yavagal, Dileep R ; Romano, Jose G ; Sacco, Ralph L. / Acute stroke evaluation and management. Emergency Neurology. Springer US, 2012. pp. 143-160
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