GENERAL-PRINCIPLES IN THE TREATMENT OF ACUTE ISCHEMIC STROKE

Currently, therapy of acute ischemic stroke includes general treatment, such as pulmonary function and airway protection, cardiac care and blood pressure management, fluid and electrolyte balance, treatment of elevated intracranial pressure due to brain edema and specific treatment, such as restitution of perfusion, maintenance of perfusion and increase of diminished blood flow, as well as prevention of ischemic cellular damage. In this article, the rationale for these therapeutic strategies is discussed and appropriate approaches to different subgroups of strokes are proposed. These include dissection of the carotid and vertebral arteries, basilar occlusion, middle cerebral artery occlusion, multiple transient ischemic attacks or slowly progressive stroke due to high-grade internal carotid artery stenosis and space-occupying cerebellar infarction. Despite the lack of generally accepted and scientifically proven therapies, many approaches seem promising. Individual concepts for defined stroke subgroups need to be verified in controlled prospective multicenter trials.