Abstract
Patients with acute ischemic stroke may have different prognosis based on the ischemic lesion burden, the reperfusion status after thrombolytic therapy or endovascular thrombectomy. In addition, the quality of neurocritical care has a different effect on clinical outcome, according to the appropriateness of diagnosis and treatment of neurologic worsening. Here, we will mainly focus on general medical care, such as intravenous fluid therapy, glucose control, and hemodynamic optimization. In the latter part, we will briefly discuss the specific issues on neurocritical care in treating patients with large ischemic burden, especially on managing brain edema and elevated intracranial pressure.
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References
Visvanathan A, Dennis M, Whiteley W. Parenteral fluid regimens for improving functional outcome in people with acute stroke. Cochrane Database Syst Rev. 2015:CD011138.
Ko SB. Multimodality monitoring in the neurointensive care unit: a special perspective for patients with stroke. J Stroke. 2013;15:99–108.
Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2013;44:870–947.
Huang Y, Sharma VK, Robinson T, et al. Rationale, design, and progress of the enhanced control of hypertension and thrombolysis stroke study (enchanted) trial: an international multicenter 2 × 2 quasi-factorial randomized controlled trial of low- vs. standard-dose rt-pa and early intensive vs. guideline-recommended blood pressure lowering in patients with acute ischaemic stroke eligible for thrombolysis treatment. Int J Stroke. 2015;10:778–88.
Meier K, Lee K. Neurogenic fever: review of pathophysiology, evaluation, and management. J Intensive Care Med. 2016;32(2):124–9. [Epub ahead of print]
Saric M, Armour AC, Arnaout MS, et al. Guidelines for the use of echocardiography in the evaluation of a cardiac source of embolism. J Am Soc Echocardiogr. 2016;29:1–42.
Ko SB, Choi SI, Chun EJ, et al. Role of cardiac multidetector computed tomography in acute ischemic stroke: a preliminary report. Cerebrovasc Dis. 2010;29:313–20.
Zha AM, Sari M, Torbey MT. Recommendations for management of large hemispheric infarction. Curr Opin Crit Care. 2015;21:91–8.
Marko NF. Hypertonic saline, not mannitol, should be considered gold-standard medical therapy for intracranial hypertension. Crit Care. 2012;16:113.
Kamel H, Navi BB, Nakagawa K, et al. Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: a meta-analysis of randomized clinical trials. Crit Care Med. 2011;39:554–9.
Ko SB, Choi HA, Parikh G, et al. Real time estimation of brain water content in comatose patients. Ann Neurol. 2012;72:344–50.
Sheth KN, Elm JJ, Molyneaux BJ, et al. Safety and efficacy of intravenous glyburide on brain swelling after large hemispheric infarction (games-rp): a randomised, double-blind, placebo-controlled phase 2 trial. Lancet Neurol. 2016;15:1160–9.
Su Y, Fan L, Zhang Y, et al. Improved neurological outcome with mild hypothermia in surviving patients with massive cerebral hemispheric infarction. Stroke. 2016;47:457–63.
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Ko, SB. (2017). Critical and Medical Management in Acute Stage of Ischemic Stroke. In: Lee, SH. (eds) Stroke Revisited: Diagnosis and Treatment of Ischemic Stroke. Stroke Revisited. Springer, Singapore. https://doi.org/10.1007/978-981-10-1424-6_14
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DOI: https://doi.org/10.1007/978-981-10-1424-6_14
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