Treatment of progressing stroke

Adequate management of a patient with progressing stroke should include the following. (1) Understanding of the pathophysiologic mechanisms causing cerebral infarction. (2) prompt diagnosis. When the possibility of progressing stroke is considered by the physician, it automatically becomes the priority diagnosis. (3) Prompt clinical and laboratory evaluation should be initiated. (4) Prompt institution of anticoagulant treatment unless contraindicated is appropriate. Heparin followed by coumadin is used most commonly. (5) If there is not prompt cessation of progression over the next 1--3 hr (following adequate anticoagulation), the patient should have a repeat CAT scan, and in many instances, a carotid angiogram to investigate the possibility of misdiagnosis or that an ulcerated atherosclerotic plaque is present releasing emboli not affected by anticoagulation. (6) If any progression occurs, the question of antiedema treatment should be raised.