From the Guidelines
Acute stroke presents with sudden onset neurological deficits and requires immediate medical attention with a rapid neurological assessment, brain imaging, and timely treatment to minimize morbidity, mortality, and improve quality of life. The presentation of acute stroke includes facial drooping, arm weakness, speech difficulties, vision changes, severe headache, or balance problems. Diagnosis requires a rapid neurological assessment using the NIH Stroke Scale, brain imaging (CT or MRI) to distinguish between ischemic and hemorrhagic stroke, and additional tests like blood work, ECG, and carotid ultrasound 1.
Key Diagnostic Steps
- Rapid neurological assessment using the NIH Stroke Scale
- Brain imaging (CT or MRI) to distinguish between ischemic and hemorrhagic stroke
- Additional tests like blood work, ECG, and carotid ultrasound
Treatment
For ischemic stroke treatment, intravenous alteplase (tPA) at 0.9 mg/kg (maximum 90 mg) should be administered within 4.5 hours of symptom onset, with 10% given as a bolus and the remainder over 60 minutes. Mechanical thrombectomy may be performed within 24 hours for large vessel occlusions 1. Hemorrhagic stroke management focuses on controlling blood pressure, reversing anticoagulation if applicable, and possible surgical intervention. All stroke patients require blood pressure management, with targets below 185/110 mmHg for those receiving thrombolytics.
Secondary Prevention
Secondary prevention includes antiplatelet therapy (aspirin 325 mg initially, then 81 mg daily), statins, and addressing risk factors. Stroke unit care with early rehabilitation improves outcomes by providing specialized monitoring, swallowing assessments, and preventing complications like deep vein thrombosis through early mobilization and prophylactic measures 1.
Importance of Timely Intervention
Timely intervention is crucial in acute stroke management, as every minute delay in recanalization decreases the chance of a good functional outcome by 8% to 14% 1. Therefore, rapid patient transfer, diagnosis, and treatment are essential to improve outcomes in acute stroke patients.
From the Research
Presentation of Acute Stroke
- Acute stroke is a leading cause of morbidity and mortality, and a major cause of long-term disability 2, 3, 4
- Stroke can be either ischemic or hemorrhagic, with ischemic stroke being the most common type 3
- Patients with acute stroke often present with sudden onset of symptoms such as weakness, numbness, or paralysis of the face, arm, or leg, difficulty with speech or understanding, and sudden blurred vision or loss of vision 2
Diagnosis of Acute Stroke
- Diagnosis of acute stroke is critical and requires a thorough history, physical examination, and imaging studies such as CT or MRI scans 2, 3
- The use of multimodal CT and MRI can help identify the location and extent of the stroke, as well as the presence of any potential complications 3
- The diagnosis of acute stroke is often made using the ABCD2 score, which assesses the severity of the stroke and the risk of recurrence 4
Treatment of Acute Stroke
- Treatment of acute stroke depends on the type and severity of the stroke, as well as the time from onset of symptoms to presentation 2, 3, 4
- Intravenous thrombolysis with tissue plasminogen activator (tPA) is a common treatment for acute ischemic stroke, and is most effective when given within 4.5 hours of symptom onset 2, 3, 4
- Mechanical thrombectomy is another treatment option for acute ischemic stroke, and involves the use of a device to remove the blood clot from the affected artery 3, 4
- Antiplatelet therapy, such as aspirin or dual antiplatelet therapy, may also be used to prevent recurrent stroke 5, 6
- The use of early anti-platelet therapy after intravenous thrombolysis is still a topic of debate, with some studies suggesting that it may not be beneficial 6