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Review
. 2025 Jan 7;18(1):7.
doi: 10.1186/s12245-024-00780-5.

Management of acute ischemic stroke in the emergency department: optimizing the brain

Latha Ganti  1   2
Affiliations
Review

Management of acute ischemic stroke in the emergency department: optimizing the brain

Latha Ganti. Int J Emerg Med. .

Abstract

Acute ischemic stroke is a devastating condition that afflicts more than 12 million people every year. Globally, stroke is the 2nd leading cause of death and 3rd leading cause of disability worldwide. While not all patients can avail themselves of existing acute therapies, all patients can benefit from brain optimization measures. This paper details the 12 steps in the management of acute ischemic stroke in the emergency department.

Keywords: Acute ischemic stroke; Blood pressure management; Thrombolysis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Competing interests: Dr. Ganti has an editorial role at Springer.

Figures

Fig. 1
Fig. 1
Acute stroke care map. Graphic designed by Latha Ganti on Canva.com. CT= computed tomography; NIHSS= National Institutes of Health Stroke Scale; D50= dextrose 50%; ICH= intracerebral hemorrhage; MAP= mean arterial pressure; ECG= electrocardiogram
Fig. 2
Fig. 2
Time is Brain Quantified. Data from [9]. Graphic designed by Latha Ganti on Canva.com
Fig. 3
Fig. 3
A summary of the National Institutes of Health Stroke Scale [10]
Fig. 4
Fig. 4
The “sweet spot” for blood pressure in acute ischemic stroke follows a U-shaped curve [32]
Fig. 5
Fig. 5
Elements of a non-disabling stroke. Infographic designed by Latha Ganti on Canva.com based on data from [34]
Fig. 6
Fig. 6
algorithm for treatment of mild acute ischemic strokes with NIHSS < 6
Fig. 7
Fig. 7
Management of symptomatic intracranial hemorrhage in the first 24 h after alteplase administration. Infographic designed by Latha Ganti on Canva.com based on data from [11]
See this image and copyright information in PMC

References

    1. Fan J, et al. Global burden, risk factors analysis, and prediction study of ischemic stroke, 1990–2030. Neurology. 2023;101(2):17. 10.1212/wnl.0000000000207387. - PMC - PubMed
    1. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581–7. 10.1056/NEJM199512143332401. PMID: 7477192. - PubMed
    1. Potla N, Ganti L. Tenecteplase vs. alteplase for acute ischemic stroke: a systematic review. Int J Emerg Med. 2022;15(1):1. 10.1186/s12245-021-00399-w. PMID: 34983359; PMCID: PMC8903524. - PMC - PubMed
    1. Bambauer KZ, et al. Reasons why few patients with acute stroke receive tissue plasminogen activator. Arch Neurol. 2006;63(5):661–4. 10.1001/archneur.63.5.661. - PubMed
    1. Desai SM, Starr M, Molyneaux BJ, Rocha M, Jovin TG, Jadhav AP. Acute ischemic stroke with vessel occlusion-prevalence and thrombectomy eligibility at a comprehensive stroke center. J Stroke Cerebrovasc Dis. 2019;28(11): 104315. 10.1016/j.jstrokecerebrovasdis.2019.104315. Epub 2019 Aug 10. PMID: 31409537. - PubMed

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