Skip to main content

Advertisement

SpringerLink
Log in

Intensive care management of ischemic stroke

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

The practice of neurointensive care was initially developed to manage postoperative neurosurgical patients and expanded thereafter to the management of patients with primary head trauma, intracranial hemorrhage, vasospasm after subarachnoid hemorrhage, elevated intracranial pressure, and unstable pulmonary or cardiovascular medical conditions in neurologic patients. Can neurointensive care with its advanced medical and neurologic resources improve the outcome of the ischemic stroke patient? This review discusses selection of patients appropriate for admission to the neurologic intensive care unit (NICU) and current options for the intensive care management of severe ischemic stroke and its attendant complications. We propose that the NICU team is well suited to acute stroke management if they apply their advanced skills and technologic resources to manage the severe stroke patient from the time of presentation to the emergency ward. Study is needed to determine the effect that a critical care level of service has on functional outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Fleming PR: A Short History of Cardiology. Atlanta: Rodopi; 1997.

    Google Scholar 

  2. Fisher CM, Picard EH, Polak A, Dalal P, Ojemann RG: Acute hypertensive cerebellar hemorrahge: diagnosis and surgical treatment. J Nerv Ment Disord 1965, 140:38–57.

    Article  CAS  Google Scholar 

  3. Lehrich JR, Winkler GF, Ojemann RG: Cerebellar infarction with brain stem compression. Arch Neurol 1970, 22:490–498.

    PubMed  CAS  Google Scholar 

  4. Jauss M, Krieger D, Hornig C, Schramm J, Busse O: Surgical and medical management of patients with massive cerebellar infarctions: results of the German-Austrian Cerebellar Infarction Study. J Neurol 1999, 246:257–264.

    Article  PubMed  CAS  Google Scholar 

  5. Kase CS, Wolf PA: Cerebellar infarction: upward transtentorial herniation after ventriculostomy [letter]. Stroke 1993, 24:1096–1098.

    PubMed  CAS  Google Scholar 

  6. Hornig CR, Rust DS, Busse O, Jauss M, Laun A: Space-occupying cerebellar infarction. Clinical course and prognosis. Stroke 1994, 25:372–374.

    PubMed  CAS  Google Scholar 

  7. Chaves CJ, Pessin MS, Caplan LR, et al.: Cerebellar hemorrhagic infarction. Neurology 1996, 46:346–349.

    PubMed  CAS  Google Scholar 

  8. Kubik CS, Adams RD: Occlusion of the basilar artery—a clinical and pathological study. Brain 1946, 69:73–121.

    Article  CAS  PubMed  Google Scholar 

  9. Hacke W, Zeumer H, Ferbert A, et al.: Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 1988, 19:1216–1222.

    PubMed  CAS  Google Scholar 

  10. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995, 333:1581–1587.

    Article  Google Scholar 

  11. Furlan A, Higashida R, Wechsler L, et al.: Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999, 282:2003–2011.

    Article  PubMed  CAS  Google Scholar 

  12. Hirsch DR, Goldhaber SZ: Contemporary use of laboratory tests to monitor safety and efficacy of thrombolytic therapy. Chest1992, 101(suppl 4):98S-105S.

    PubMed  CAS  Google Scholar 

  13. The NINDS rt-PA Stroke Study Group: Intracerebral hemorrhage after intravenous r-PA therapy for ischemic stroke. Stroke 1997, 2109–2118.

  14. Molina CA, Alvarez-Sabin J, Montaner J, et al.: Thrombolysisrelated hemorrhagic infarction. A marker of early reperfusion, reduced infarct size, and improved outcome in patients with proximal middle cerebral artery occlusion. Stroke 2002, 33:1551–1556.

    Article  PubMed  Google Scholar 

  15. Hill MD, Barber PA, Takahashi J, et al.: Anaphylactoid reactions and angioedema during alteplase treatment of acute ischemic stroke. Can Med Assoc J 2000, 162:1281–1284.

    CAS  Google Scholar 

  16. Pancioli A, Brott T, Donaldson V, Miller R: Asymmetric angioneurotic edema associated with thrombolysis for acute stroke. Ann Emerg Med 1997, 30:227–229.

    Article  PubMed  CAS  Google Scholar 

  17. Hacke W, Schwab S, Horn M, et al.: Malignant middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 1996, 53:309–315.

    PubMed  CAS  Google Scholar 

  18. Ropper AH, Shafran B: Brain edema after stroke: clinical syndrome and intracranial pressure. Arch Neurol 1984, 41:26–29.

    PubMed  CAS  Google Scholar 

  19. Schwarz S, Georgiadis D, Aschoff A, Schwab S: Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke 2002, 33:136–140. s study shows that hypertonic saline is effective at lowering intracranial pressure in ischemic stroke patients when mannitol is not effective. The duration of the effect is about 4 hours.

    Article  PubMed  CAS  Google Scholar 

  20. Belayev L, Liu Y, Zhao W, Busto RU, Ginsberg MD: Human albumin therapy of acute ischemic stroke: marked neuroprotective efficacy at moderate doses and with a broad therapeutic window. Stroke 2001, 32:553–560.

    PubMed  CAS  Google Scholar 

  21. Schwab S, Schwarz S, Spranger M, et al.: Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 1998, 29:2461–2466.

    PubMed  CAS  Google Scholar 

  22. Schwab S, Spranger M, Schwarz S, et al.: Barbituate coma in severe hemispheric stroke: useful or obsolete? Neurology 1997, 48:1608.

    PubMed  CAS  Google Scholar 

  23. Carter BS, Ogilvy CS, Candia GJ, Rosas HD, Buonanno F: One-year outcome after decompressive surgery for massive nondominant hemispheric infarction. Neurosurgery 1997, 40:1168–1175.

    Article  PubMed  CAS  Google Scholar 

  24. Schwab S, Steiner T, Aschoff A, et al.: Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 1998, 29:1888–1893.

    PubMed  CAS  Google Scholar 

  25. Koh MS, Goh KY, Tung MY, Chan C: Is decompressive craniectomy for acute cerebral infarction of any benefit? Surg Neurol 2000, 53:225–230.

    Article  PubMed  CAS  Google Scholar 

  26. Rordorf G, Cramer SC, Efird JT, et al.: Pharmacological elevation of blood pressure in acute stroke. Clinical effects and safety. Stroke 1997, 28:818–821.

    Google Scholar 

  27. Aichner FT, Fazekas F, Brainin M, et al.: Hypervolemic hemodilution in acute ischemic stroke: the Multicenter Austrian Hemodilution Stroke Trial (MAHST). Stroke 1998, 29:743–749.

    PubMed  CAS  Google Scholar 

  28. Widjicks EF: Monitoring devices. In The Clinical Practice of Critical Care Neurology. Philadelphia: Lippincott Raven; 1997.

    Google Scholar 

  29. Singhal AB, Dijkhuizen R, Rosen BR: Normobaric hyperoxia reduces MRI diffusion abnormalities and infarct size in experimental stroke. Neurology 2002, 58:945–952.

    PubMed  Google Scholar 

  30. Randomised trial of a perindopril-based blood-pressurelowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet 2001, 358:1033–1041.

  31. Reith J, Jorgensen HS, Pedersen PM, et al.: Body temperature in acute stroke: relation to stroke severity, infarct size, mortality, and outcome. Lancet 1996, 347:422–425.

    Article  PubMed  CAS  Google Scholar 

  32. Krieger DW, De Georgia MA, Abou-Chebl A, et al.: Cooling for acute ischemic brain damage (cool aid): an open pilot study of induced hypothermia in acute ischemic stroke. Stroke 2001, 32:1847–1854.

    PubMed  CAS  Google Scholar 

  33. Nicholson FB, Korman MG, Richardson MA: Percutaneous endoscopic gastrostomy: a review of indications, complications, and outcome. J Gastroenterol Hepatol 2000, 15:21–25.

    Article  PubMed  CAS  Google Scholar 

  34. James A, Kapur K, Hawthorne AB: Long term outcome of percutaneous endoscopic gastrostomy feeding in patients with dysphagic stroke. Age Ageing 1998, 27:671–676.

    Article  PubMed  CAS  Google Scholar 

  35. Berger C, Hakim AM: The association of hyperglycemia with cerebral edema in stroke. Stroke 1986, 17:865.

    PubMed  CAS  Google Scholar 

  36. Demchuk AM, Morgenstern LB, Krieger DW, et al.: Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke. Stroke 1999, 30:34.

    PubMed  CAS  Google Scholar 

  37. Van den Berghe G, Wouters P, Weekers F, et al.: Intensive insulin therapy in critically ill patients. N Engl J Med 2001, 345:1359–1367. authors demonstrate that tight control of blood sugar below 110 mg/dL is feasible in patients with critical illness, and that this leads to improved outcome. The incorporation of this protocol for glucose control into the stroke patient management in the neurointensive care unit may also lessen the harm caused by elevated glucose on worsening stroke size and infarct edema.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Stroke and Neurointensive Care Service, Massachusetts General Hospital, 55 Fruit Street, VBK 915, 02114, Boston, MA, USA

    Thanh Nguyen MD & Walter J. Koroshetz MD

Authors
  1. Thanh Nguyen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Walter J. Koroshetz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nguyen, T., Koroshetz, W.J. Intensive care management of ischemic stroke. Curr Neurol Neurosci Rep 3, 32–39 (2003). https://doi.org/10.1007/s11910-003-0034-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-003-0034-9

Keywords

Search

Navigation