Key Concepts

© Strokes can either be ischemic (88%) or hemorrhagic (12%).

Ischemic stroke is the abrupt development of a focal neurologic deficit that occurs due to inadequate blood supply to an area of the brain. Most often, this is due to a thrombotic or embolic arterial occlusion leading to cerebral infarction.

Hemorrhagic stroke is a result of bleeding into the brain and other spaces within the CNS and includes subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and subdural hematomas.

O1 There are two main classifications of cerebral ischemic events: transient ischemic attacks and cerebral infarction.

A major goal in the long-term treatment of ischemic stroke involves the prevention of a recurrent stroke through the reduction and modification of risk factors.

All patients should have a brain CT scan or MRT scan to differentiate an ischemic stroke from a hemorrhagic stroke, as the treatment will differ accordingly and thrombolytic (fibrinolytic) therapy must be avoided until a hemorrhagic stroke is ruled out.

01 In carefully selected patients, alteplase is effective in limiting the infarct size and protecting brain tissue from ischemia and cell death by restoring blood flow. Treatment should preferably be given within 3 hours and not more than 4.5 hours after symptom onset. Earlier treatment is preferred due to improved outcomes.

Early aspirin (ASA) therapy with an initial dose of 50 to 325 mg is recommended in most patients with acute ischemic stroke within 48 hours after stroke onset.

© Selection of the initial antiplatelet agent for secondary prevention of ischemic stroke should be individualized. Clopidogrel and the combination of extended-release dipyridamole and immediate-release ASA are preferred over ASA mono-therapy.

© There is no proven treatment for ICH. Management is based on neurointensive care treatment and prevention of complications. Oral nimodipine is recommended in SAH to prevent delayed cerebral ischemia.

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