23
Treatment of Acute Neurological Complications
Î Patients 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.
Î Decompressive surgical evacuation of a space-occupying cerebellar
infarction is effective in preventing and treating herniation and brain
stem compression (I-B).
Î Decompressive 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.
Î Recurrent 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).
Î Placement of a ventricular drain is useful in patients with acute
hydrocephalus secondary to ischemic stroke (I-C).
Î Although aggressive medical measures have been recommended for
treatment of deteriorating patients with malignant brain edema after
large cerebral infarction, the usefulness of these measures is not well
established (IIb-C).
Î Because of lack of evidence of efficacy and the potential to increase the
risk of infectious complications, corticosteroids (in conventional or large
doses) are NOT recommended for treatment of cerebral edema and
increased intracranial pressure complicating ischemic stroke (III-A).
Î Prophylactic use of anticonvulsants is NOT recommended (III-C).
