TREATMENT for stroke
• Goals of Treatment: The goals are to (1) reduce ongoing neurologic injury and
decrease mortality and long-term disability, (2) prevent complications secondary to
immobility and neurologic dysfunction, and (3) prevent stroke recurrence.
GENERAL APPROACH
• Ensure adequate respiratory and cardiac support and determine quickly from CT
scan whether the lesion is ischemic or hemorrhagic.
• Evaluate ischemic stroke patients presenting within hours of symptom onset for
reperfusion therapy.
• Elevated blood pressure (BP) should remain untreated in the acute period (first 7 days)
after ischemic stroke to avoid decreasing cerebral blood flow and worsening symp-
toms. BP should be lowered if it exceeds 220/120 mm Hg or there is evidence of aortic
dissection, acute myocardial infarction (MI), pulmonary edema, or hypertensive
encephalopathy. If BP is treated in the acute phase, short-acting parenteral agents (eg,
labetalol, nicardipine, nitroprusside) are preferred.
• Assess patients with hemorrhagic stroke to determine whether they are candidates
for surgical intervention.
• After the hyperacute phase, focus on preventing progressive deficits, minimizing
complications, and instituting secondary prevention strategies.
NONPHARMACOLOGIC THERAPY
• Acute ischemic stroke: Surgical decompression is sometimes necessary to reduce
intracranial pressure. An interprofessional team approach that includes early reha-
bilitation can reduce long-term disability. In secondary prevention, carotid endarter-
ectomy and stenting may be effective in reducing stroke incidence and recurrence in
• Goals of Treatment: The goals are to (1) reduce ongoing neurologic injury and
decrease mortality and long-term disability, (2) prevent complications secondary to
immobility and neurologic dysfunction, and (3) prevent stroke recurrence.
GENERAL APPROACH
• Ensure adequate respiratory and cardiac support and determine quickly from CT
scan whether the lesion is ischemic or hemorrhagic.
• Evaluate ischemic stroke patients presenting within hours of symptom onset for
reperfusion therapy.
• Elevated blood pressure (BP) should remain untreated in the acute period (first 7 days)
after ischemic stroke to avoid decreasing cerebral blood flow and worsening symp-
toms. BP should be lowered if it exceeds 220/120 mm Hg or there is evidence of aortic
dissection, acute myocardial infarction (MI), pulmonary edema, or hypertensive
encephalopathy. If BP is treated in the acute phase, short-acting parenteral agents (eg,
labetalol, nicardipine, nitroprusside) are preferred.
• Assess patients with hemorrhagic stroke to determine whether they are candidates
for surgical intervention.
• After the hyperacute phase, focus on preventing progressive deficits, minimizing
complications, and instituting secondary prevention strategies.
NONPHARMACOLOGIC THERAPY
• Acute ischemic stroke: Surgical decompression is sometimes necessary to reduce
intracranial pressure. An interprofessional team approach that includes early reha-
bilitation can reduce long-term disability. In secondary prevention, carotid endarter-
ectomy and stenting may be effective in reducing stroke incidence and recurrence in
