Treatment of acute clinical stroke

Stroke is an emergency. Treatment must begin as soon as possible because si gnificant sustained neurological improvement has been demonstrated when thr ombolytic treatment, mainly with recombined tissue plasminogen activator (r tPA) is initiated within the first hours of stroke onset. On the other hand in the acute phase of stroke it is critical that patients get adequate man agement for the prevention of early complications. Management of the acute phase of stroke is the target of this article. Preclinically started treatm ent must be continued in the neurological emergency unit. Clinical examinat ion is followed by technical investigations: cerebral computertomography (C CT) is the most useful radiological investigation in the acute phase. It al lows to distinguish between ischemia and hemorrhagic lesions and also to ru le out nonstroke brain conditions. Multimodal magnetic resonance imaging (m MRI) may provide data on viable versus irreversibly damaged tissue. Suffici ent stroke treatment is based on well managed in-hospital infrastructure. T hrombolysis is the only causative treatment of stroke in selected patients. Complications of acute stroke comprise changes of blood pressure with hemo dynamically relevant effects on cerebral perfusion pressure,acute postische mic brain edema,and intracerebral bleedings.