Management of acute stroke

Abstract

Management of acute stroke has considerably changed over the past 20 years. It has evolved from extreme nihilism to an exciting science where patients can improve to near normal with reperfusion therapies. We have reviewed the recent advances in the management of acute stroke, especially acute ischemic type (AIS). A search was done in pub med with keywords- “Acute Stroke,” “Treatment,” and “Recent advances.” Relevant articles were downloaded, cross-references were reviewed and this article was written. Stroke care requires the organization of the available facilities at the hospital to provide basic to advanced services, with coordination between different centers through the Hub and Spoke model. Recognition of time of onset of stroke, knowledge about options available for AIS patients at 4.5, 6, and 24 h and planning appropriate imaging studies helps in management. Intravenous thrombolysis and endovascular therapies play a key role in the reperfusion in patients with AIS. Patients with transient ischemic attack/minor stroke should be treated with dual anti-platelets, for at least three weeks followed by a single agent. Investigating a stroke patient for modifiable risk factors and classifying them to various subtypes will help in the prevention of recurrence. Management of intracerebral hemorrhage requires evaluation for etiology and supportive care. Cerebral venous thrombosis is a rare but unique type of stroke, which requires knowledge about signs on imaging, risk factor evaluation, and treatment with anticoagulants. Health education plays an important role in prevention and compliance with medications.

Keywords

• endovascular therapy
• intravenous thrombolysis
• ischemic stroke