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Review
. 2020 Aug;20(4):304-316.
doi: 10.1136/practneurol-2020-002557. Epub 2020 Jun 7.

Diagnosis and management of acute ischaemic stroke

Robert Hurford  1 , Alakendu Sekhar  2 , Tom A T Hughes  3 , Keith W Muir  4
Affiliations
Review

Diagnosis and management of acute ischaemic stroke

Robert Hurford et al. Pract Neurol. 2020 Aug.

Abstract

Acute ischaemic stroke is a major public health priority and will become increasingly relevant to neurologists of the future. The cornerstone of effective stroke care continues to be timely reperfusion treatment. This requires early recognition of symptoms by the public and first responders, triage to an appropriate stroke centre and efficient assessment and investigation by the attending stroke team. The aim of treatment is to achieve recanalisation and reperfusion of the ischaemic penumbra with intravenous thrombolysis and/or endovascular thrombectomy in appropriately selected patients. All patients should be admitted directly to an acute stroke unit for close monitoring for early neurological deterioration and prevention of secondary complications. Prompt investigation of the mechanism of stroke allows patients to start appropriate secondary preventative treatment. Future objectives include improving accessibility to endovascular thrombectomy, using advanced imaging to extend therapeutic windows and developing neuroprotective agents to prevent secondary neuronal damage.

Keywords: CEREBROVASCULAR DISEASE; DYSPHAGIA; NEUROANATOMY; NEUROEPIDEMIOLOGY; NEURORADIOLOGY; REHABILITATION; STROKE.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Eligibility, investigations, diagnosis and treatment in a rapid-access TIA clinic. DVLA, Driver and Vehicle Licensing Agency; TIA, transient ischaemic attack.
Figure 2
Figure 2
Process of acute ischaemic stroke reperfusion therapy: an overview of ‘best practice’.
Figure 3
Figure 3
Suggested treatment algorithm for rtPA-associated angioedema. rtPA, recombinant tissue-type plasminogen activator.
See this image and copyright information in PMC

References

Further Reading

    1. Fernandes PM, Whiteley WN, Hart SR. et al. Strokes: mimics and chameleons. Pract Neurol. 2013;13:21–8. - PubMed
    1. Nadarajan V, Perry RJ, Johnson J. et al. Transient ischemic attacks: mimics and chameleons. Pract Neurol. 2014;14:23–31. - PMC - PubMed
    1. Evans MRB, White P, Cowley P. et al. Revolution in acute ischaemic stroke care: a practical guide to mechanical thrombectomy. Pract Neurol. 2017;17:252–65. - PMC - PubMed

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