PURPOSE Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. METHODS Members of the panel were appo...

Elevated blood pressure (BP) is the leading modifiable risk factor for stroke and the benefit of BP lowering therapy on the stroke risk reduction is well established. The optimal BP target for preventing stroke and other vascular events have been controversial, but the evidences from epidemiological studies and randomized controlled trials (RCTs) support intensive BP lowering for greater vascul...

Acute brain injury, in the form of trauma, stroke, or spontaneous hemorrhage, occurs commonly and in all age groups. Although the management of these conditions differs considerably, certain physiologic principles are shared by all and are useful in guiding the management of the most severely injured patients. This article reviews basic cerebral physiology and describes the links between physio...

Long standing, evidence based approved therapies for acute ischemic stroke include intravenous thrombolysis therapy (IVT) with alteplase (recombinant tissue plasminogen activator, rtPA) given within 4.5 h; aspirin therapy within 48 h; management in an acute stroke unit and hemicraniectomy in cases of malignant infarction. Multiple recent positive randomized controlled trials (RCTs) have now als...

Blood pressure elevation in the setting of acute ischemic stroke and intracerebral hemorrhage is common. Controversy exists as to the optimal management of elevated blood pressure in this patient population. This article reviews the available clinical data that guides acute blood pressure management and how this may affect clinical outcomes. Furthermore, it examines how these data have led to c...

Neuroimaging is fundamental to stroke diagnosis and management. Non-contrast computed tomography (NCCT) has been the primary imaging modality utilized for this purpose for almost four decades. Although NCCT does permit identification of intracranial hemorrhage and parenchymal ischemic changes, insights into blood vessel patency and cerebral perfusion are limited. Advances in reperfusion strateg...

Intracranial pressure (ICP) is a dynamic and fluctuating within the cranial vault influenced by cerebrospinal fluid (CSF), brain tissue, blood. Any increase in volume of its contents will vault. As response to ICP, compensation begins movement CSF from ventricle cerebral subarachnoid space increases absorption. Increased ICP state neurological emergency caused various injuries. It associated wi...

Acute ischaemic stroke due to large vessel occlusion leads to grave neurological morbidity and mortality. Conventional intravenous thrombolysis is ineffective in achieving timely reperfusion in this group of patients. The publication of five positive randomised controlled trials of emergency thrombectomy for acute ischaemic stroke in 2015 provided strong evidence to support endovascular reperfu...

BACKGROUND AND PURPOSE Sleep-disordered breathing (SDB) negatively impacts stroke outcome. Near-infrared spectroscopy showed the acute cerebral hemodynamic effects of SDB. METHODS Eleven patients (7 men, age 61±13 years) with acute/subacute middle cerebral artery stroke (National Institutes of Health Stroke Scale score 10±7) and SDB (apnea-hypopnea index 32±28/hour) were assessed with nocturn...

OBJECTIVE To review the management and some of the recent advances in acute haemorrhagic stroke. DATA SOURCES Articles and published reviews on acute haemorrhagic stroke. SUMMARY OF REVIEW Hypertensive intracerebral haemorrhage or subarachnoid haemorrhage (SAH) from a ruptured intracranial saccular aneurysm are the commonest causes for an acute haemorrhagic stroke. Both lesions are often cl...