Diagnostic and treatment of acute ischemic stroke
Universitätsklinik für Neurologie und Schlaganfallzentrum, Universitätsklinikum Essen.DMW - Deutsche Medizinische Wochenschrift (Impact Factor: 0.54). 03/2013; 138(9):423-36. DOI: 10.1055/s-0032-1327391
The incidence of first stroke in Germany is about 200.000, most of which are ischemic. The benefit of stroke unit treatment and systemic thrombolysis has been shown in large randomized trials. Diagnostic work-up besides neurologic examination includes cerebral imaging by CT or MR imaging including angiography, ultrasound of brain supplying arteries, ECG and Holter ECG and - if indicated - transesophageal echocardiography. Aspirin is the cornerstone of early secondary prevention in the acute phase, thereafter secondary prevention is determined by stroke etiology. Carotid endarterectomy or stent-assisted angioplasty are indicated in patients with hemodynamic or arterio-arterial stroke etiologies due to high-grade carotid stenosis. For cardioembolism due to atrial fibrillation, oral anticoagulation with vitamin K-antagonists or new oral anticoagulants should be started after the acute phase. In patients with non-cardioembolic stroke etiologies, platelet inhibitors are used for secondary prevention.
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ABSTRACT: Targets of acute ischemic stroke management include verification of clinical diagnosis, start of basic care and decision-making about specific treatments.Effectiveness of most therapeutic options is time dependent. Time delays within the rescue chain are associated with worse outcome. Trained and multidisciplinary teams on Stroke Unit form the backbone of acute management. Moreover, technical infrastructure influences therapeutic options. Cerebral imaging is pivotal.The following five therapies are evidence-based: treatment on a stroke unit, thrombolysis within 4.5hrs after symptom onset, mechanical recanalization in patients with occlusion of proximal, intracranial arteries, early administration of Aspirin, and hemicraniectomy in patients with so-called malignant infarction.This article describes the necessary diagnostic steps and specific as well as non-specific therapeutic options that compose acute management within the first 72 hours.DMW - Deutsche Medizinische Wochenschrift 10/2015; 140(21):1583-1586. DOI:10.1055/s-0041-106309 · 0.54 Impact Factor
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