The intensive care management of acute ischemic stroke

BACKGROUND- Therapy for acute ischemic stroke is rapidly evolving. The introduction of the use of thrombolytics along with an increased physician and community awareness of stroke has created a demand for earlier and more aggressive interventions. As a result, there is increased interest in meeting the unique cardiovascular, pulmonary, and neurologic needs of these patients in specialized intensive care and stroke units. REVIEW SUMMARY- This article will review indications for admission of ischemic stroke patients to an intensive care or stroke unit; airway, respiratory, and cardiovascular management; thrombolytic therapy; and general medical issues such as nutrition, temperature management, deep venous thrombosis prophylaxis, and control of blood glucose. In addition, specific management issues for patients with large hemispheric stroke, cerebellar stroke, and basilar artery thrombosis will be reviewed. CONCLUSIONS- Stroke units and intensive care units with specially trained neurologic intensivists are becoming increasingly involved in the initial management of patients with acute ischemic stroke. The main non-neurologic indications for admission to these units are airway management and cardiovascular monitoring. In addition, new therapies such as the use of intravenous and intra-arterial thrombolytics and decompressive craniectomy have increased the need for close neurologic and hemodynamic monitoring in specialized units.