9 Critical Care Management of Acute Ischemic Stroke

Bhavesh Patel, Sneha Jacob, and Benzion Blech

Abstract

The first 24 to 48 hours of monitoring in the critical care unit is often crucial in patients who suffer from an acute ischemic stroke, especially if they have undergone emergent therapies such as intravenous alteplase (IV tPA) or mechanical thrombectomy. Monitoring and treatment of progressive infarction and complications associated with brain reperfusion such as cerebral edema and hemorrhagic transformation are the primary goals. Although the neurological examination still remains the key tool to assess deterioration, there are times when this is insufficient to detect or predict deterioration such as in intubated, sedated, or delirious patients. Despite having advanced monitoring techniques, robust studies of multimodal neurocritical care monitoring tools are lacking in acute ischemic stroke care. In this chapter, we review the critical care monitoring and management of the acute ischemic stroke patient that are necessary to effectively detect and prevent secondary brain injury and complications of critical illness.

Key words

ischemic stroke - critical care - cerebral edema - multimodal neuromonitoring - complications of critical illness - stroke-associated pneumonia

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