Management of patients with acute ischaemic stroke

The management of patients with acute ischaemic stroke, which was once accompanied by a sense of futility, has shifted to emergency intervention, as a result of clinical trials demonstrating the efficacy of acutely administered therapies in reducing mortality and morbidity. The current approach to stroke thus emphasises early recognition, rapid transport to hospital, speedy evaluation and urgent treatment. In the emergency room, treatment decisions are largely influenced by the neurological status of patients, although their respiratory, cardiovascular and metabolic status are also considered. Initially, efforts are aimed at reducing hypoxia and hypercarbia, controlling symptoms such as pain or vomiting, and reducing the morbidity and mortality associated with stroke. Most patients with stroke require hospitalisation; in-hospital care continues to focus on preventing and controlling subacute and chronic complications, but also includes planning for rehabilitation and care after discharge, and treatment to prevent recurrent stroke. Administration of newer treatment interventions, such as thrombolytic therapy, requires the availability of teams of stroke specialists; furthermore, the management of stroke patients in a dedicated unit has been shown to reduce death and disability and to shorten the hospital stay. While therapies aimed at reducing the neurological consequences of stroke are the keystone of current and future care, the control of acute, subacute, or chronic medical and neurological complications, prevention of recurrent stroke, and rehabilitation to maximise recovery from stroke remain crucial components of patient management.