Stroke: supportive care

Murray Flaster MD PhD (Dr. Flaster of the Stritch School of Medicine at Loyola University of Chicago has no relevant financial relationships to disclose.)
Sarkis Morales-Vidal MD (Dr. Morales-Vidal of the Stritch School of Medicine at Loyola University of Chicago has no relevant financial relationships to disclose.)
Michael J Schneck MD (Dr. Schneck of Loyola University of Chicago has no relevant financial relationships to disclose.)
Jose Biller MD (Dr. Biller of the Stritch School of Medicine at Loyola University of Chicago has no relevant financial relationships to disclose.)
Steven R Levine MD, editor. (Dr. Levine of the SUNY Health Science Center at Brooklyn has received honorariums from Genentech for service on a scientific advisory committee and a research grant from Genentech as a principal investigator.)
Originally released December 30, 2003; last updated September 9, 2014; expires September 9, 2017

Overview

Acute ischemic stroke accounts for more than half of the hospitalizations for neurologic disease. Meticulous, aggressive supportive care for the acute stroke patient is imperative in order to achieve the best possible outcome and to avoid the many medical complications that frequently follow stroke. The authors provide an overview of the current literature, including the most recent guidelines from the American Stroke Association.

Key points

 

• Lowering blood pressure at acute ischemic stroke onset below general guidelines values of 220/120 should be avoided; lowering pressures acutely to just below 185/110 is recommended when thrombolytic therapy is intended.

 

• Volume repletion and circulatory volume maintenance is crucial; hypotonic saline and intravenous dextrose should be avoided.

 

• The head of the bed should be lowered if perfusion limitation during acute ischemic stroke is suspected, but raised when mounting cerebral edema or elevated ICPs are suspected.

 

• Meticulous medical care, including good glycemic control, prompt treatment of fever and infection, early and effective measures to prevent deep vein thrombosis, and the continuation or early addition of statin therapy improves outcome.

 

• Early mobilization reduces the frequency of medical complications and improves outcome.

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.