Management of Stroke in the Neurocritical Care Unit

Chethan P. Venkatasubba Rao, MD, FNCS; Jose I. Suarez, MD, FNCS, FANA p. 1658-1682 December 2018, Vol.24, No.6 doi: 10.1212/CON.0000000000000670
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PURPOSE OF REVIEW: This article provides updated information regarding the diagnosis and treatment (specifically critical care management) of acute ischemic stroke. This article also discusses the increased use of thrombolysis and thrombectomy in clinical practice.

RECENT FINDINGS: Stroke is the leading cause of disability in the United States. A significant proportion of patients with acute ischemic stroke require critical care management. Much has changed in the early evaluation and treatment of patients presenting with acute ischemic stroke. The introduction of embolectomy in large vessel occlusions for up to 24 hours post–symptom onset has resulted in one in every three eligible patients with acute ischemic stroke with the potential to lead an independent lifestyle. These patients increasingly require recognition of complications and initiation of appropriate interventions as well as earlier admission to dedicated neurocritical care units to ensure better outcomes.

SUMMARY: This article emphasizes issues related to the management of patients with acute ischemic stroke undergoing mechanical thrombectomy and thrombolysis and addresses the complex physiologic changes affecting neurologic and other organ systems.

Address correspondence to Dr Chethan P. Venkatasubba Rao, Baylor College of Medicine, MS NB 124, One Baylor Plaza, Houston, TX 77030, cprao@bcm.edu.

RELATIONSHIP DISCLOSURE: Dr Venkatasubba Rao has received personal compensation as an editorial board member of Brain Disorders & Therapy. Dr Suarez has received research/grant support from the National Institute of Neurological Disorders and Stroke and as co-investigator in the SETPOINT2 (Stroke-related Early Tracheostomy Versus Prolonged Orotracheal Intubation in Neurocritical Care Trial) study from the Patient-Centered Outcomes Research Institute. Dr Suarez is the current president and a member of the board of directors of the Neurocritical Care Society.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Venkatasubba Rao and Suarez report no disclosures.

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SUPPLEMENTAL DIGITAL CONTENT (SDC) AVAILABLE ONLINE

© 2018 American Academy of Neurology