Abstract
The key points of acute stroke therapy are summarized as follows: 1) 24 hours' operation of CT and MRI, 2) prompt intravenous rt-PA therapy, 3) specific therapies according to stroke subtype, 4) immediate secondary prevention, 5) acute rehabilitation, 6) infection control and nutrition support, 7) surgical therapy, 8) endovascular therapy.
Within 3 hours of stroke onset, administration of rt-PA to appropriate patient is the top priority. Evaluation of early ischemic changes on CT or DWI, and blood test's result (platelet counts, glucose, PT-INR, and APTT) are required.
Beyond 3 hours, identification of ischemic penumbra and site of vessel occlusion need to be evaluated. Endovascular therapy is considered as effective up to 6 hours. New generation plasminogen activator may further expand the therapeutic time window. The concept of diffusion-perfusion mismatch will help the selection of proper candidate.
After 3 hours, accurate diagnosis of stroke subtype is essential. Special drugs approved in Japan are all restricted to selected subtype. Brain imaging, ultrasound examination, blood tests, cerebral blood flow evaluation and cerebral angiography are used to determine the subtype. To monitor stroke severity and efficacy of therapy, neurological examination is important. NIHSS is most commonly used in clinical practice.
