[Acute therapy of ischemic stroke]

Ischemic stroke is a neurological emergency as transition form reversible to irreversible lesions of the brain may be prevented by starting the therapy within six hours after the onset of the neurological deficits. Intravenous thrombolysis may be administered within the first three hours and intraarterial thrombolysis within the first six hours after considering inclusion and exclusion criteria. Neuroprotective drugs are under investigation and may enlarge the spectrum of acute therapy in the near future. Ischemic strokes that do not qualify for thrombolysis may be treated with unfractionated heparin, aspirin or low-molecular weight heparin. Indications for the administration of antithrombotic drugs are discussed. Blood pressure is frequently elevated in acute ischemic stroke, but rarely needs therapy or careful lowering. Fever, hypo- und hyperglycemia, epileptic seizures and intracranial hypertension should be treated.