Management of the acute ischemic stroke patient beyond 24 hours

Introduction Acute stroke treatment has changed tremendously in recent years as it continues to evolve from the nihilistic approach of yesterday to the active approach of today. After the hyperacute stage of stroke ends, the astute clinician needs to maintain continued vigilance to protect the patient from further ischemic injury. Specific neuroprotective measures must be instituted. The acute stroke patient faces a potential myriad of medical complications that must be managed efficiently. Thus, acute stroke management requires the clinician to take an interactive approach to enhance the patient’s chances for a good long-term outcome. In this chapter, we review the management of acute ischemic stroke from the time after the hyperacute phase (<24 hours) to hospital discharge. We address important factors that may significantly impact upon the patient’s clinical outcome. The role of a stroke unit or neuroscience critical care unit (neuro-ICU). Neuroprotective measures, including management of blood pressure (BP), temperature and hyperglycemia, airway management, and treatment of cerebral edema and elevated intracranial pressure (ICP). The role of pharmacological management of stroke patients, including the use of antithrombotics and statins in the acute hospital setting. Institution of early nutrition and rehabilitation. Prevention of pneumonia, deep venous thrombosis (DVT), urinary tract infection (UTI), and decubitus ulcers. The utility of various surgical modalities in the treatment of the acute stroke patient.