Document Detail

Treatment of acute ischemic stroke: beyond thrombolysis and supportive care.
MedLine Citation:
PMID:  21556680     Owner:  NLM     Status:  MEDLINE    
The initial therapeutic approach to acute ischemic stroke consists of thrombolytic therapy and early initiation of supportive care, usually commenced prior to the determination of the underlying stroke etiology. Varying stroke mechanisms may call for specific, etiology-based treatment. The majority of strokes result from cardioembolism, large-vessel atherothromboembolism, and small-vessel occlusive disease. There are scant data to support the use of acute anticoagulation therapy over anti-platelet therapy in cardioembolic stroke and large-vessel atherosclerosis, although it may be reasonable in a certain subset of patients. However, augmentation of blood flow with early surgery, stenting, or induced hypertension, may play a role in patients with large artery stenosis. The less commonly identified stroke mechanisms may warrant special consideration in treatment. Controversy remains regarding the optimal anti-thrombotic treatment of arterial dissection. Reversible cerebral vasoconstriction syndrome may benefit from therapy with calcium channel blockers, high-dose steroids, or magnesium, although spontaneous recovery may occur. Inflammatory vasculopathies, such as isolated angiitis of the central nervous system and temporal arteritis, require prompt diagnosis as the mainstay of therapy is immunosuppression. Cerebral venous thrombosis is a rare cause of stroke, but one that needs early identification and treatment with anticoagulation. Rapid determination of stroke mechanism is essential for making these critical early treatment decisions.
Neelofer Shafi; Scott E Kasner
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics     Volume:  8     ISSN:  1878-7479     ISO Abbreviation:  Neurotherapeutics     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-27     Completed Date:  2011-11-29     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  101290381     Medline TA:  Neurotherapeutics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  425-33     Citation Subset:  IM    
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MeSH Terms
Anemia, Sickle Cell / etiology
Central Nervous System / pathology
Embolism / complications
Fibrinolytic Agents / therapeutic use*
Giant Cell Arteritis / etiology
Ischemia / complications*
Stroke* / diagnosis,  etiology,  therapy
Thrombolytic Therapy / methods*
Vasculitis / etiology
Venous Thrombosis / etiology
Grant Support
Reg. No./Substance:
0/Fibrinolytic Agents

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