This chapter discusses the four main components of acute ischemic stroke care. The sections on prevention of complications and recovery and rehabilitation are applicable to both ischemic and hemorrhagic stroke patients.
An ischemic stroke is death of brain tissue due to interruption of blood flow to a region of the brain, caused by occlusion of a cerebral or cervical artery or, less likely, a cerebral vein.
The etiology of the ischemic stroke is important to help determine the best treatment to prevent another stroke. However, regardless of etiology, initial therapy is for the most part the same, and so initially, the most important thing is to implement the acute measures described in this chapter.
The first important task is to differentiate between ischemic and hemorrhagic stroke, which can be done with a head CT. Detailed brain and vascular imaging are critically important but should not delay assessment for TPA candidacy. There are things that can mimic stroke (see Chapter 1). A focused history should quickly exclude stroke mimics. Unless the presentation is atypical or a stroke mimic is suggested, one should assume it is a stroke and proceed with the determination of whether or not the patient is a candidate for acute therapy. A detailed diagnostic evaluation should be deferred.
The four components of ischemic stroke care
There are four components to caring for people with acute ischemic stroke. At every point, you should be thinking about the four issues:
Acute therapy and optimization of neurological status.
Etiological work-up for secondary prevention.