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  • Updated 03.11.2020
  • Released 12.30.2003
  • Expires For CME 03.11.2023

Stroke: supportive care

Introduction

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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