Skip to main navigation menu Skip to main content Skip to site footer

An Approach To:

Vol. 20 No. 1 (2022)

Approach to Ischemic Stroke

DOI
https://doi.org/10.26443/mjm.v20i1.855
Submitted
February 10, 2021
Published
2021-09-04

Abstract

An approach to managing acute ischemic stroke includes recognition, investigations, treatment, and secondary prevention.  Firstly, facial drooping, limb weakness and slurred speech are some common signs that should raise the suspicion for stroke.  Upon presentation, investigations, including the national institute of health stroke scale and a CT head, should be done to rule out intracranial hemorrhage and diagnose an ischemic stroke. The treatment principles for an acute ischemic stroke focus on removing or dissolving the occlusion to maintain or reinstate perfusion of the brain.  Finally, patients suffering ischemic stroke should be admitted to the acute stroke unit and monitored for complications. Basic medical management of comorbidities should also be considered to prevent subsequent ischemic episodes. This article will explain each of these processes in more detail to help develop a basic approach to the management of an acute ischemic stroke.

References

  1. Powers William J., Rabinstein Alejandro A., Ackerson Teri, Adeoye Opeolu M., Bambakidis Nicholas C., Becker Kyra, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec 1;50(12):e344–418. https://doi.org/10.1161/STR.0000000000000211
  2. FAST Signs of Stroke...are there other signs? [Internet]. Heart and Stroke Foundation of Canada. [cited 2021 Feb 9]. Available from: https://www.heartandstroke.ca/en/stroke/signs-of-stroke/existe-t-il-d-autres-signes-de-l-avc-que-vite/
  3. Flynn D, Ford GA, Rodgers H, Price C, Steen N, Thomson RG. A time series evaluation of the FAST National Stroke Awareness Campaign in England. PloS one. 2014;9(8):e104289–e104289. https://doi.org/10.1371/journal.pone.0104289
  4. Boulanger JM, Lindsay MP, Gubitz G, Smith EE, Stotts G, Foley N, et al. Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018. International journal of stroke. 2018;13(9):949–84. https://doi.org/10.1177/1747493018786616
  5. Powers WJ. Acute Ischemic Stroke. The New England Journal of Medicine. 2020;383(3):252–60. https://doi.org/10.1056/NEJMcp1917030
  6. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, van den Berg R, van den Berg JS, et al. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke. The New England Journal of Medicine. 2015;372(1):11–20. https://doi.org/10.1056/NEJMoa1411587
  7. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. The New England Journal of Medicine. 2015;372(11):1019–30. https://doi.org/10.1056/NEJMoa1414905
  8. Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, et al. Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA. New England Journal of Medicine. 2018 Jul 19;379(3):215–25. https://doi.org/10.1056/NEJMoa1800410
  9. Nogles TE, Galuska MA. Middle Cerebral Artery Stroke. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2021 Feb 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK556132/
  10. Konan LM, Reddy V, Mesfin FB. Neuroanatomy, Cerebral Blood Supply. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2021 Feb 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532297/
  11. Kumral E, Bayulkem G, Evyapan D, Yunten N. Spectrum of anterior cerebral artery territory infarction: clinical and MRI findings. European Journal of Neurology. 2002;9(6):615–24. https://doi.org/10.1046/j.1468-1331.2002.00452.x
  12. Cereda C, Carrera E. Posterior Cerebral Artery Territory Infarctions. Manifestations of Stroke. 2012;30:128–31. https://doi.org/10.1159/000333610
  13. Kuybu O, Tadi P, Dossani RH. Posterior Cerebral Artery Stroke. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2021 Feb 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK532296/
  14. Kumral E, Bayulkem G, Ataç C, Alper Y. Spectrum of superficial posterior cerebral artery territory infarcts. European Journal of Neurology. 2004;11(4):237–46. https://doi.org/10.1046/j.1468-1331.2003.00750.x
  15. Buchman SL, Merkler AE. Basilar Artery Occlusion: Diagnosis and Acute Treatment. Curr Treat Options Neurol. 2019 Sep 26;21(10):45. https://doi.org/10.1007/s11940-019-0591-0

Metrics

Metrics Loading ...