Stroke: supportive care

Jasvinder Chawla MD MBA (Dr. Chawla of Loyola University Medical Center and Chief of Neurology at Hines VA Hospital 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 January 9, 2018; expires January 9, 2021

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 author provides 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.

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