Cerebrovascular accident, or stroke, represents acute disruption of cerebral perfusion. There are two categories of stroke, ischemic and hemorrhagic. Ischemic stroke (70% of all stroke) is when there is disruption of the vascular supply of the brain, be it by vascular occlusion or obliteration, with downstream ischemia. Hemorrhagic stroke (30% of all stroke) represents bleeding into the skull, which is further subdivided depending on the location of the bleeding. Below is a summary of guidelines that detail pre-hospital care, urgent and emergency evaluation, treatment with intravenous and intra-arterial therapies. Generally speaking, time is brain, and so emergent evaluation is highly recommended in the hyperacute/acute setting.In-hospital management is also covered, including secondary prevention measures that are appropriately instituted within the first 2 weeks.
Transient Ischemic Attack (TIA)
Modifiable Risk Factors
Nonmodifiable Risk Factors
Note: Aspirin plus clopidogrel is more effective than aspirin but less effective than anticoagulation for preventing stroke from atrial fibrillation
Blood Pressure Control
Treat Other Comorbidities
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
Use of Dual Antiplatelet Therapy Following Ischemic Stroke (Dong et al, Stroke 2020)
Optimal Blood Pressure After Intracerebral Hemorrhage: Still a Moving Target (Rabinstein, Stroke 2018)
Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA (Johnston et al, NEJM 2018)
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