title: Critical care in acute ischemic stroke.
abstract: Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics. In this chapter, we discuss aspects of acute ischemic stroke care that are of particular relevance to a neurointensivist, covering neuropathology, neurodiagnostics and imaging, blood pressure management, glycemic control, temperature management, and the selection and timing of antithrombotics. We also focus on the care of patients who have received intravenous thrombolysis or mechanical thrombectomy. Complex clinical decision making in decompressive hemicraniectomy for hemispheric infarction and urgent management of basilar artery thrombosis are specifically addressed.
authors.affiliation: Stroke Program, University of Michigan, Ann Arbor, MI, USA. Electronic address: mcdermom@med.umich.edu.
authors.forename: M
authors.initials: M
authors.lastname: McDermott
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: T
authors.initials: T
authors.lastname: Jacobs
authors.affiliation: Stroke Program, University of Michigan, Ann Arbor, MI, USA.
authors.forename: L
authors.initials: L
authors.lastname: Morgenstern
mesh_terms: D002545:Brain Ischemia / Q000150:complications / Q000628:therapy; D003422:Critical Care / Q000379:methods*; D006801:Humans; D020521:Stroke / Q000209:etiology / Q000628:therapy*
keywords: ICU; acute ischemic stroke; basilar thrombosis; blood pressure; decompressive hemicraniectomy; hyperglycemia; mechanical thrombectomy; temperature; thrombolysis