Diagnosis and management of acute ischaemic stroke

Abstract

Acute ischaemic stroke is a major public health priority and will become increasingly relevant to neurologists of the future. The cornerstone of effective stroke care continues to be timely reperfusion treatment. This requires early recognition of symptoms by the public and first responders, triage to an appropriate stroke centre and efficient assessment and investigation by the attending stroke team. The aim of treatment is to achieve recanalisation and reperfusion of the ischaemic penumbra with intravenous thrombolysis and/or endovascular thrombectomy in appropriately selected patients. All patients should be admitted directly to an acute stroke unit for close monitoring for early neurological deterioration and prevention of secondary complications. Prompt investigation of the mechanism of stroke allows patients to start appropriate secondary preventative treatment. Future objectives include improving accessibility to endovascular thrombectomy, using advanced imaging to extend therapeutic windows and developing neuroprotective agents to prevent secondary neuronal damage.

Acute intracerebral haemorrhage: diagnosis and management

“…The approach to an efficient and focused history and physical examination in suspected acute stroke has been outlined in the first article in this series. 10 It is important to obtain a history of any recent trauma, including from a witness if available, and to assess for any circumstantial evidence, making sure to determine clinically whether the trauma preceded the haemorrhage or vice versa. Acute ischaemic stroke and ICH cannot be reliably distinguished at the bedside but the diagnosis is made rapidly and easily on imaging, so every effort should be made to minimise delays to the initial CT brain scan.…”

“… 45 The general principles of acute care are the same as those for acute ischaemic stroke, as outlined in the first article in this series. 10 Secondary prevention measures, cerebral small vessel disease and decisions regarding restarting antithrombotic therapy will be addressed in subsequent articles.…”

Systematic review protocol to assess artificial intelligence diagnostic accuracy performance in detecting acute ischaemic stroke and large-vessel occlusions on CT and MR medical imaging

“…Imaging modalities, such as advanced MRI and CT medical imaging, have been shown to be critical in improving clinical stroke care in clinical practice. For example, Hurford et al 14 reported on AIS management using a CT imaging workflow. Currently used imaging techniques include non-contrast CT (NCCT), CTA, CT perfusion (CTP) and MRI.…”

Where in the Brain do Strokes Occur? A Pilot Study and Call for Data

“…4 The etiology of a stroke correlates with its neuroanatomical location in the brain, clinical presentation, and appropriate treatment. 5 Appropriate treatment of stroke is a matter of extreme urgency because neurons die rapidly, within minutes of losing their blood supply. New treatments such as endovascular thrombectomy have significantly improved the outcomes of some types of stroke.…”

“…New treatments such as endovascular thrombectomy have significantly improved the outcomes of some types of stroke. 5 Research into new stroke etiologies and treatments would benefit from precise data on the neuroanatomical location of strokes in the brain. Textbooks and review articles about stroke have abundant information on the epidemiology, risk factors, pathophysiology, and many clinical features, but lack specific numerical quantitation on the neuroanatomical distribution of strokes.…”