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Stroke patients, what to do and what to avoid
F Della Corte1, G L Vignazia, M Cavaglià
1Università degli Studi del Piemonte Orientale Amedeo Avogadro, Cattedra di Anestesia e Rianimazione, Ospedale Maggiore della Carità, Novara, Italy. fdcorte@tin.it
Insights
Acute ischemic stroke is a leading cause of death in Italy. Prompt evaluation and emergency treatment, including intravenous recombinant tissue plasminogen activator (r-TPA) within 3 hours, are crucial for improving outcomes.
Area of Science:
- Neurology
- Emergency Medicine
- Cardiovascular Research
Background:
- Ischemic stroke is a significant cause of mortality and morbidity in Italy, with 130,000 new cases annually and a 6.5% prevalence.
- Effective management of acute ischemic stroke requires a multidisciplinary approach involving prompt physician evaluation and intervention.
Purpose of the Study:
- To outline the essential components of emergent evaluation and treatment for acute ischemic stroke.
- To emphasize the critical time window for thrombolytic therapy in ischemic stroke management.
Main Methods:
- Initial assessment focusing on airway, breathing, cardiocirculatory status, and neurological examination within 5-10 minutes.
- Prioritization of a plain CT scan of the brain for diagnosis, especially to rule out intracranial hemorrhage.
- Emergency management strategies including correction of hypovolemia, hypoxia, and treatment of severe hypertension, hypoglycemia, intracranial hypertension, and seizures.
Main Results:
- The primary goal of emergency therapy is to maintain adequate cerebral perfusion by managing intracranial pressure and mean arterial pressure.
- Intravenous thrombolytic therapy with recombinant tissue plasminogen activator (r-TPA) is recommended within 3 hours of ischemic stroke onset when no contraindications exist.
- Evidence supporting the efficacy of intravenous r-TPA beyond 3 hours from stroke onset is lacking.
Conclusions:
- Rapid and accurate assessment is vital for acute ischemic stroke patients.
- Timely administration of intravenous r-TPA within the established 3-hour window is critical for potential patient benefit.
- Further research may be needed to explore treatment options for ischemic stroke beyond the 3-hour time frame.
Abstract:
In Italy (130,000 new strokes in the general population per year) ischemic stroke is the third cause of death, after cardiovascular disease and neoplastic disease with a prevalence of 6.5%. Different physicians are involved in the emergent evaluation and treatment of the acute ischemic stroke. As other acute events, the initial evaluation must be addressed to assess the patient's airway and breath-ing and cardiocirculatory conditions. The neurological examination must not be exhaustive and it should be completed in 5-10 minutes and a particular attention should be given to clinical findings leading to the suspect of an intracranial hemorrhages. A plain CT scan of the brain is the most important initial diagnostic study. Emergency therapy must be mainly directed to the correction of hypovolemia, hypoxia and the treatment of severe hypertension, hypoglycemia, intracranial hypertension and seizures. The goal is to achieve and to maintain an adequate cerebral perfusion by lowering the intracranial pressure (treating the cerebral oedema) and by increasing the mean arterial pressure, with an appropriate volemic expansion and/or with inotropic or vasopressor drugs. The thrombolytic therapy with intravenous recombinant tessutal plasminogen activator (r-TPA) when not specifically contraindicated, is recommended within 3 hours of onset of ischemic stroke. The benefit of intravenous r-TPA for acute ischemic stroke beyond 3 hours from the onset has never been proved.