Management Of Ischaemic Stroke – Recent Advances
AbstractThere is a better understanding of the natural course of stroke as well as its pathogenesis. This has led to the philosophy of “watch and intervene from ischaemie damage. Thrombolytic therapy given within 3 hours of ictus has been effective but this is not feasible in Africa because of time delay and lack of neuro-imaging facilities in most centers. Contemporary management of stroke is divided into 4 phases; acute, early subacute, late subacute and long term.
Acute phase involves early assessment and supportive care from the onset of stroke to the 7th day. These include adequate fluid therapy (not haemodilution) of isotonic or hypertonic infusion to improve cerebral blood flow and reduce cerebral oedema;
insulin therapy for hyperglycaemia as well as use of free radical scavengers. Hypertension is the commonest predisposing factor for stroke, but the weight of available evidence does not support its treatment in the first 10 days of stroke onset.
However, for extra cerebral complications with blood pressure above 220/120, oral antihypertensive agents could be beneficial. Combination of thrombolytics, agents to protect against the effects of ischaemia and ant-oedema measures are likely to be required. Possible agents that might halt the ischaemic process before infarction becomes inevitable include NMDA receptor blockers, ion channel blockers, free radical scavengers, caspace and xanthine oxidase inhibitors.
During the early subacute phase, from the 2nd to the 4th week, prevention of pulmonary embolism with subcutaneous heparin, treatment of pneumonia with antibiotics and early physiotherapy are important. During the late phase, physical and psychological rehabilitation and prevention of stroke recurrence by modifying the risk factors are essential.
For effective management of stroke (“brain attack”), stroke units are now in vogue in developed nations. Stroke management in our nation should be reprioritized as a time dependent urgent medical emergency just as is currently stressed for major trauma and acute myocardial infarction (heart attack). Efforts should equally be made to set up stroke units and strengthen primary prevention.
KEY WORDS: stroke, management.
Nigerian Journal of Clinical Practice Vol.5(2) 2002: 130-138