Acute Ischemic Stroke

Acute Ischemic Stroke - Early Management

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Treatment ÎÎTreat concomitant medical diseases (I-C). ÎÎInstitute early interventions to prevent recurrent stroke (I-C). ÎÎThe use of aspirin is reasonable for treatment of patients who cannot receive anticoagulants for prophylaxis of deep vein thrombosis (IIa-A). ÎÎIn selecting between nasogastric and percutaneous endoscopic gastrostomy tube routes of feeding in patients who cannot take solid food or liquids orally, it is reasonable to prefer nasogastric tube feeding until 2-3 weeks after stroke onset (IIa-B). ÎÎThe use of intermittent external compression devices is reasonable for treatment of patients who cannot receive anticoagulants (IIa-B). ÎÎRoutine use of nutritional supplements has NOT been shown to be beneficial (III-B). ÎÎRoutine use of prophylactic antibiotics has NOT been shown to be beneficial (III-B). ÎÎRoutine placement of indwelling bladder catheters is NOT recommended because of the associated risk of catheter-associated urinary tract infections (III-C). Treatment of Acute Neurological Complications ÎÎPatients with major infarctions are at high risk for complicating brain edema and increased intracranial pressure. Take measures to lessen the risk of edema and closely monitor patients for signs of neurological worsening during the first days after stroke (I-A). Note: Consider early transfer of patients at risk for malignant brain edema to an institution with neurosurgical expertise. ÎÎDecompressive surgical evacuation of a space-occupying cerebellar infarction is effective in preventing and treating herniation and brain stem compression (I-B). ÎÎDecompressive surgery for malignant edema of the cerebral hemisphere is effective and potentially lifesaving (I-B). Note: Advanced patient age and patient/family valuations of achievable outcome states may affect decisions regarding surgery. ÎÎRecurrent seizures after stroke should be treated in a manner similar to other acute neurological conditions. Antiepileptic agents should be selected by specific patient characteristics (I-B). ÎÎPlacement of a ventricular drain is useful in patients with acute hydrocephalus secondary to ischemic stroke (I-C). 20

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