title: Neuroprotection in acute ischemic stroke.
abstract: Neuroprotection of patients with acute ischemic stroke should start at the scene and continue in the ambulance with the assessment and treatment of the airway, breathing, circulation, body temperature, and blood glucose. The key goal in eligible patients should be fast vessel recanalization with intravenous recombinant tissue-type plasminogen activator Results from a meta-analysis suggest that systemic thrombolysis is effective when given within 4.5 hours after stroke onset. The time window extends to 6 hours for patients undergoing intravascular thrombolysis. Acute stroke patients should be admitted to stroke care units. A crucial component of neuroprotection is the prevention of secondary brain damage, which can be caused by hypoxemia, hypotension, hyperthermia and hyperglycemia. This can be achieved by avoiding complications, e.g. aspiration, and intensive control of oxygenation, hydration and blood pressure, body temperature, blood glucose, and cardiac monitoring. Neuroprotective agents are designed to try to salvage brain tissue within the penumbra. Thus far, despite promising preclinical studies, clinical trials with neuroprotective drugs in acute ischemic stroke have been disappointing. However, we have been able to identify many of the factors that were responsible for these failures, and better-designed clinical trials with neuroprotective drugs should look more promising. Mild induced hypothermia is another form of neuroprotective treatment that is currently being investigated in acute stroke.
authors.affiliation: Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands. j.h.a.de.keyser@neuro.azg.nl
authors.forename: Jacques
authors.initials: J
authors.lastname: De Keyser
authors.forename: Maarten
authors.initials: M
authors.lastname: Uyttenboogaart
authors.forename: Marcus W
authors.initials: MW
authors.lastname: Koch
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Elting
authors.forename: Geert
authors.initials: G
authors.lastname: Sulter
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Vroomen
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: Luijckx
mesh_terms: D000818:Animals; D001930:Brain Injuries / Q000209:etiology / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D006801:Humans; D007036:Hypothermia, Induced; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D020521:Stroke / Q000150:complications / Q000628:therapy*; D015912:Thrombolytic Therapy
chemical_list: D018696:Neuroprotective Agents