Acute Ischaemic Stroke

  • Dheeraj Khurana
  • Biplab Das
  • Rohit Bhatia


Stroke is a generic term for a clinical syndrome that includes focal cerebral infarction (ischaemic stroke), focal haemorrhage in the brain and subarachnoid haemorrhage [1]. Effective treatment of the patient who has sustained an acute stroke requires rapid assessment and early intervention. Acute stroke represents a true emergency for which time is crucial and, therefore, evaluation and treatment often proceed simultaneously. Advanced imaging techniques can provide information about the state of brain perfusion, metabolism and the cerebrovascular anatomy to help identify patients with viable brain tissue who may derive the greatest benefit from available therapies. Currently, several agents are available for rapid restoration of perfusion to the ischaemic brain. Development of stroke centres and systems of care have revolutionized the medical management of patients with acute stroke.


  1. 1.
    Whisnant JP, Basford JR, Bernstein EF. Classification of cerebrovascular diseases III. Stroke. 1990;21:637–76.CrossRefGoogle Scholar
  2. 2.
    Goldstein LB, Bertels C, Davis JN. Inter-rater reliability of the NIH stroke scale. Arch Neurol. 1989;46:660–2.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Adams HP Jr, Davis PH, Leira EC, et al. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: a report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999;53:126–31.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Kwiatkowski TG, Libman RB, Frankel M, et al. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group. Effects of tissue plasminogen activator for acute ischemic stroke at one year. N Engl J Med. 1999;340:1781–7.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    The NINDS t-PA Stroke Study Group. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke. 1997;28:2109–18.CrossRefGoogle Scholar
  6. 6.
    Kidwell C, Villablanca JP, Saver JL. Advances in neuroimaging of acute stroke. Curr Atheroscler Rep. 2000;2:126–35.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Powers WJ. Testing a test: a report card for DWI in acute stroke. Neurology. 2000;54:1549–51.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Moulin T, Cattin F, Crepin-Leblond T, et al. Early CT signs in acute middle cerebral artery infarction: predictive value for subsequent infarct locations and outcome. Neurology. 1996;47:366–75.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    von Kummer R, Nolte PN, Schnittger H, et al. Detectability of cerebral hemisphere ischaemic infarcts by CT within 6 hours of stroke. Neuroradiology. 1996;38:31–3.CrossRefGoogle Scholar
  10. 10.
    Tomsick TA, Brott TG, Chambers AA, et al. Hyperdense middle cerebral artery sign on CT: efficacy in detecting middle cerebral artery thrombosis. AJNR Am J Neuroradiol. 1990;11:473–7.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Demaerschalk BM, Yip TR. Economic benefit of increasing utilization of intravenous tissue plasminogen activator for acute ischemic stroke in the United States. Stroke. 2005;36:2500–3.PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Hacke W, Kaste M, Bluhmki E, et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–29.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    The National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.Google Scholar
  14. 14.
    Clark WM, Albers GW, Madden KP, et al. The rtPA (alteplase) 0- to 6-hour acute stroke trial, part a (a0276g): results of a double-blind, placebo-controlled, multicenter study. Thrombolytic therapy in acute ischemic stroke study investigators. Stroke. 2000;31:811–6.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Clark WM, Wissman S, Albers GW, et al. Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3–5 hours after symptom onset. The ATLANTIS study: a randomized controlled trial. Alteplase thrombolysis for acute noninterventional therapy in ischemic stroke. JAMA. 1999;282:2019–26.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA. 1995;274:1017–25.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3–4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–29.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Donnan GA, Davis SM, Chambers BR, et al. Streptokinase for acute ischemic stroke with relationship to time of administration: Australian Streptokinase (ASK) trial study group. JAMA. 1996;276:961–6.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Thrombolytic therapy with streptokinase in acute ischemic stroke. The Multicenter Acute Stroke Trial–Europe study group. N Engl J Med. 1996;335:145–50.Google Scholar
  20. 20.
    Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Multicentre Acute Stroke Trial–Italy (MAST-I) group. Lancet. 1995;346:1509–14.Google Scholar
  21. 21.
    Sherman DG, Atkinson RP, Chippendale T, et al. Intravenous ancrod for treatment of acute ischemic stroke: The STAT study: A randomized controlled trial. Stroke Treatment with Ancrod Trial. JAMA. 2000;283:2395–403.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Hacke W, Furlan AJ, Al-Rawi Y, et al. Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion-diffusion weighted imaging of perfusion CT (DIAS-2): a prospective randomised double-blind, placebo-controlled study. Lancet Neurol. 2009;8:141–50.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Haley EC, Lyden PD, Johnston KC, et al. A pilot doseescalation safety study of tenecteplase in acute ischemic stroke. Stroke. 2005;36:607–12.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Haley C, Thompson J, Grotta J, et al. Phase IIB/III trial of tenecteplase in acute ischemic stroke: results of a prematurely terminated randomized clinical trial. Stroke. 2010;41:707–11.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Huang X, Cheripelli BK, Lloyd SM, et al. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint study. Lancet Neurol. 2015;14:368–76.PubMedCrossRefGoogle Scholar
  26. 26.
    Parsons M, Spratt N, Bivard A, et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med. 2012;366:1099–107.CrossRefGoogle Scholar
  27. 27.
    Logallo N, Novotny V, Assmus J, et al. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol. 2017;16(10):781–8. Scholar
  28. 28.
    Thelengana A, Radhakrishnan DM, Prasad M, et al. Tenecteplase versus alteplase in acute ischemic stroke: systematic review and meta-analysis. Acta Neurol Belg. 2018;
  29. 29.
    Singh V. Critical care assessment and management of acute ischemic stroke. J Vasc Interv Radiol. 2004;15:S21–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Furlan A, Higashida R, Wechsler L, et al. PROACT II: recombinant prourokinase (r-ProUK) in acute cerebral thromboembolism, initial trial results. Stroke. 1999;30:234.Google Scholar
  31. 31.
    Brandt T, von Kummer R, Muller-Kuppers M, et al. Thrombolytic therapy of acute basilar artery occlusion. Variables affecting recanalization and outcome. Stroke. 1996;27:875–81.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Hacke W, Zeumer H, Ferbert A, et al. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke. 1998;29:1216–22.CrossRefGoogle Scholar
  33. 33.
    Lisboa RC, Jovanovic BD, Alberts MJ. Analysis of the safety and efficacy of intra-arterial thrombolytic therapy in ischemic stroke. Stroke. 2002;33:2866–71.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Lewandowski CA, Frankel M, Tomsick TA, et al. Combined intravenous and intra-arterial r-TPA versus intra-arterial therapy of acute ischemic stroke: Emergency Management of Stroke (EMS) Bridging Trial. Stroke. 1999;30:2598–605.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    IMS III. Interventional Management of Stroke (IMS) III trial web page. http://clinicaltrials.Gov/ct2/show/nct00359424. Term interventional stroke trial & rank1. Accessed 12 Aug 2010.
  36. 36.
    Bhatia R, Hill MD, Shobha NM, et al. Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke. 2010;41:2254–8.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Meyers PM, Schumacher HC, Higashida RT. Indications for the performance of intracranial endovascular neurointerventional procedures. A scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation. 2009;119:2235–49.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Powers WJ, Rabinstein AA, Ackerson T, et al. on behalf of the American Heart Association Stroke Council. 2018 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. 2018;49:e46–99. Scholar
  39. 39.
    Smith WS, Sung G, Starkman S, et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke. 2005;36:1432–8.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Menon BK, Hill MD, Eesa M, et al. Initial experience with the Penumbra Stroke System for recanalization of large vessel occlusions in acute ischemic stroke. Neuroradiology. 2011;53:261–6.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    The Penumbra Pivotal Stroke Trial Investigators. The penumbra pivotal stroke trial. Stroke. 2009;40:2761–8.CrossRefGoogle Scholar
  42. 42.
    Touma L, Filion KB, Sterling LH, Atallah R, Windle SB, Eisenberg MJ. Stent retrievers for the treatment of acute ischemic stroke: A systematic review and meta-analysis of randomized clinical trials. JAMA Neurol. 2016;73:275–81.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Koh JS, Lee SJ, Ryu CW, Kim HS. Safety and efficacy of mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke: a systematic review. Neurointervention. 2012;7:1–9.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Badhiwala JH, Nassiri F, Alhazzani W, Selim MH, Farrokhyar F, Spears J, et al. Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA. 2015;314(17):183.CrossRefGoogle Scholar
  45. 45.
    Husain S, Srijithesh P. Homogeneity and the outcome of clinical trials: an appraisal of the outcome of recent clinical trials on endovascular intervention in acute ischemic stroke. Ann Indian Acad Neurol. 2016;19:21–4.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372:2285–95.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296–306.PubMedCrossRefGoogle Scholar
  51. 51.
    Mocco J, Zaidat O, Von Kummer R, Yoo A, Gupta R, Lopes D, Frei DO, Sit S, Bose A, Khatri P. Results of the therapy trial: a prospective, randomized trial to define the role of mechanical thrombectomy as adjunctive treatment to IV rtPA in acute ischemic stroke [abstract ESOC-1614]. Int J Stroke. 2015;10(Suppl. 2):10.Google Scholar
  52. 52.
    Bracard S, Ducrocq X, Mas JL, Soudant M, Oppenheim C, Moulin T, et al. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol. 2016;15(11):1138–47.PubMedCrossRefGoogle Scholar
  53. 53.
    Campbell BC, Mitchell PJ, Churilov L, et al. EXTEND-IATNK Investigators. Tenecteplase versus alteplase before endovascular thrombectomy (EXTEND-IA TNK): A multicenter, randomized, controlled study. Int J Stroke. 2018;13(3):328–34. Scholar
  54. 54.
    Nogueira RG, Jadhav AP, Haussen DC, Bonafe A et al, DAWN Trial Investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21. doi: Scholar
  55. 55.
    Albers GW, Marks MP, Kemp S, Christensen S, et al. DEFUSE 3 Investigators. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018;378(8):708–18. Scholar
  56. 56.
    Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379:2364–72.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384:1929–35.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010;375:1695–703.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, 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(3):870–947.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    de Los Rios la Rosa F, Khoury J, Kissela BM, Flaherty ML, Alwell K, Moomaw CJ, et al. Eligibility for intravenous recombinant tissue-type plasminogen activator within a population: the effect of the European cooperative acute stroke study (ECASS) III trial. Stroke. 2012;43:1591–5.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Ribo M, Alvarez-Sabin J, Montaner J, Romero F, Delgado P, Rubiera M, et al. Temporal profile of recanalization after intravenous tissue plasminogen activator: selecting patients for rescue reperfusion techniques. Stroke. 2006;37:1000–4.PubMedCrossRefPubMedCentralGoogle Scholar
  62. 62.
    Saqqur M, Uchino K, Demchuk AM, Molina CA, Garami Z, Calleja S, et al. Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke. 2007;38:948–54.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke. 2009;40:2761–8.Google Scholar
  64. 64.
    Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46:3020–35.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Bhatia R, Shobha N, Menon BK, Bal SP, Kochar P, Palumbo V, et al. Combined full-dose IV and endovascular thrombolysis in acute ischaemic stroke. Int J Stroke. 2014;9:974–9.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Mazighi M, Meseguer E, Labreuche J, Amarenco P. Bridging therapy in acute ischemic stroke: a systematic review and meta-analysis. Stroke. 2012;43(5):1302–8.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Arnold M, Steinlin M, Baumann A, et al. Thrombolysis in childhood stroke: report of 2 cases and review of the literature. Stroke. 2009;40:801–7.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    De Keyser J, Gdovinová Z, Uyttenboogaart M, et al. Intravenous alteplase for stroke: beyond the guidelines and in particular clinical situations. Stroke. 2007;38:2612–8.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Baumann CR, Baumgartner RW, Gandjour J, et al. Good outcomes in ischemic stroke patients treated with intravenous thrombolysis despite regressing neurological symptoms. Stroke. 2006;37:1332–3.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Sandercock PA, Counsell C, Gubitz GJ, et al. Antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev. 2008;3:CD000029.Google Scholar
  72. 72.
    Albers GW, Amarenco P, Easton JD, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(Suppl):483S–512S.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Qureshi AI, Luft AR, Sharma M, et al. Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures, part I: pathophysiological and pharmacological features. Neurosurgery. 2000;46:1344–59.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Gurbel PA, Cummings CC, Bell CR, et al. Onset and extent of platelet inhibition by clopidogrel loading in patients undergoing elective coronary stenting: The Plavix Reduction Of New Thrombus Occurrence (PRONTO) trial. Am Heart J. 2003;145:239–47.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    International Stroke Trials Collaborative Group. The International Stroke Trial (IST): a randomized trial of aspirin, subcutaneous heparin, a both or neither among 19435 patients with acute ischaemic stroke. Lancet. 1997;349:986–990, 1569–81.Google Scholar
  76. 76.
    Sandercock PAG, van den Belt ABM, Lindley RI, et al. Antithrombotic therapy in acute ischemic stroke: an overview of completed randomized trials. J Neurol Neurosurg Psychiatry. 1993;56:17–25.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Sherman DG, Albers GW, Bladin C, et al. The efficacy and safety of enoxaparin versus unfractionated heparin for the prevention of venous thromboembolism after acute ischaemic stroke (PREVAIL study): An open-label randomised comparison. Lancet. 2007;369:1347–55.PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Cohen JE, Leker RR, Gotkine M, et al. Emergent stenting to treat patients with carotid artery dissection: clinically and radiologically directed therapeutic decision making. Stroke. 2003;34:e254–7.PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Nedeltchev K, Brekenfeld C, Remonda L, et al. Internal carotid artery stent implantation in 25 patients with acute stroke: preliminary results. Radiology. 2005;237:1029–37.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Jovin TG, Gupta R, Uchino K, et al. Emergent stenting of extracranial internal carotid artery occlusion in acute stroke has a high revascularization rate. Stroke. 2005;36:2426–30.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Brekenfeld C, Remonda L, Nedeltchev K, et al. Endovascular neuroradiological treatment of acute ischemic stroke: techniques and results in 350 patients. Neurol Res. 2005;27(Suppl 1):S29–35.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Kirton A, Wong JH, Mah J, et al. Successful endovascular therapy for acute basilar thrombosis in an adolescent. Pediatrics. 2003;112:e248–51.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Lin DD, Gailloud P, Beauchamp NJ, et al. Combined stent placement and thrombolysis in acute vertebrobasilar ischemic stroke. AJNR Am J Neuroradiol. 2003;24:1827–33.PubMedPubMedCentralGoogle Scholar
  84. 84.
    Ronning OM, Guldvog B. Should stroke victims routinely receive supplemental oxygen? A quasi-randomized controlled trial. Stroke. 1999;30:2033–7.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Grotta J, Pasteur W, Khwaja G, et al. Elective intubation for neurologic deterioration after stroke. Neurology. 1995;45:640–4.PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    Read SJ, Jackson GD, Abbott DF, et al. Experience with diffusion-weighted imaging in an acute stroke unit. Cerebrovasc Dis. 1998;8:135–43.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Steiner T, Mendoza G, De Georgia M, et al. Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke. 1997;28:711–5.PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Hajat C, Hajat S, Sharma P. Effects of post-stroke pyrexia on stroke outcome: a meta-analysis of studies in patients. Stroke. 2000;31:410–4.PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Azzimondi G, Bassein L, Nonino F, et al. Fever in acute stroke worsens prognosis: a prospective study. Stroke. 1995;26:2040–3.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Kammersgaard LP, Jorgensen HS, Rungby JA, et al. Admission body temperature predicts long-term mortality after acute stroke: The Copenhagen Stroke Study. Stroke. 2002;33:1759–62.PubMedCrossRefGoogle Scholar
  91. 91.
    Bruno A, Biller J, Adams HP Jr, et al. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Acute blood glucose level and outcome from ischemic stroke. Neurology. 1999;52:280–4.PubMedCrossRefGoogle Scholar
  92. 92.
    Bruno A, Levine SR, Frankel MR, et al. NINDS rt-PA Stroke Study Group. Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology. 2002;59:669–74.PubMedCrossRefGoogle Scholar
  93. 93.
    Parsons MW, Barber PA, Desmond PM, et al. Acute hyperglycemia adversely affects stroke outcome: a magnetic resonance imaging and spectroscopy study. Ann Neurol. 2002;52:20–8.PubMedCrossRefGoogle Scholar
  94. 94.
    Leonardi-Bee J, Bath PM, Phillips SJ, Sandercock PA, IST Collaborative Group. Blood pressure and clinical outcomes in the International Stroke Trial. Stroke. 2002;33:1315–20.PubMedCrossRefGoogle Scholar
  95. 95.
    Hacke W, Schwab S, Horn M, et al. Malignant middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996;53:309–15.PubMedCrossRefGoogle Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  • Dheeraj Khurana
    • 1
  • Biplab Das
    • 1
  • Rohit Bhatia
    • 2
  1. 1.Department of NeurologyPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations