Neuro-Intensive Care Units and Management of Acute Stroke Patients: Benefits and Limitations
Reduction of mortality and improvement of outcome are the major goals of new therapeutic strategies in acute ischemic stroke. Some subtypes of acute ischemic stroke such as intracranial internal carotid artery (ICA) occlusion, proximal middle cerebral artery (MCA) occlusion, basilar thrombosis, and space-occupying infarcts carry a high mortality of more than 80% in selected cohorts [1,2]. Aggressive approaches to acute ischemic stroke such as thrombolytic therapy, hypervolemic-hypertensive therapy, or decompressive surgery require management in specialized neurological critical care units: computed tomographic (CT) scans, magnetic resonance imaging (MRI), Doppler ultrasound, and electrophysiological and intracranial pressure monitoring device are essential and should be readily available. A 24-h-shift service by neurologists and close collaboration with neurosurgery and neuroradiology are necessary. Another challenge of critical care in acute ischemic stroke is reduction of mortality from cardiovascular complications and nosocomial infections. Mortality within the first 4 weeks after an ischemic stroke is greatly influenced by coexistent cardiovascular disease [3,4]. In total, about 8%–10% of acute stroke victims may require critical care treatment.
KeywordsMean Arterial Pressure Acute Stroke Acute Ischemic Stroke Thrombolytic Therapy Cerebral Perfusion Pressure
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