Management of acute ischemic stroke.
The treatment of acute ischemic stroke has evolved from observation and the passage of time dictating outcome to an approach that emphasizes time from ictus, rapid response, and a dedicated treatment team. We review the treatment of acute ischemic stroke from the prehospital setting, to the emergency department, to the inpatient hospital setting. We discuss the importance of prehospital assessment and treatment, including the use of elements of the neurologic examination, recognition of symptoms that can mimic those of acute ischemic stroke, and rapid transport of patients who are potential candidates for thrombolytic therapy to hospitals with that capability. Coordinated management of acute ischemic stroke in the emergency department is critical as well, beginning with non-contrast-enhanced computed tomography of the brain. The advantages of a multidisciplinary dedicated stroke team are discussed, as are thrombolytic therapy and other inpatient treatment options. Finally, we cover evolving management strategies, treatments, and tools that could improve patient outcomes.
Fulgham
Jimmy R
JR
Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Ingall
Timothy J
TJ
Stead
Latha G
LG
Cloft
Harry J
HJ
Wijdicks
Eelco F M
EF
Flemming
Kelly D
KD
D000208:Acute Disease; D002545:Brain Ischemia / Q000175:diagnosis / Q000628:therapy*; D003937:Diagnosis, Differential; D004638:Emergency Treatment; D006801:Humans; D017410:Practice Guidelines as Topic; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014187:Transportation of Patients