Vaskulárna medicína 2/2010

Diagnostics and treatment of acute stroke

Stroke is the third leading cause of death and the most common cause of permanent disability in adult patients. Timely recognition and appropriate treatment is imperative to reduce stroke-related morbidity and mortality. Patients with acute ischemic stroke should be evaluated for early reperfusion therapy. The window for administration of intravenous rtPA is narrow, within 3 hours of symptom onset. Management of intracerebral hemorrhage includes limitation of hematoma growth by means of early lowering of the increased blood pressure, ultraearly hemostatic treatment using recombinant factor VIIa, treatment of coagulopathies and consideration of early surgery. Treatment of subarachnoid hemorrhage focuses on stopping the rebleeding from ruptured aneurysm by endovascular coiling or surgical clipping and maintaining normal cerebral blood flow by preventing vasospasms. In all stroke patients, other neurologic and medical complications should be treated aggressively.

Keywords: acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, CT, MR, TCD, thrombolysis, recanalization therapy, recombinant factor VIIa (rFVIIa), surgical hematoma treatment, vasospasms, aneurysm clipping, coiling, complex intensive care.