Chapter 17 - Prevention, Diagnosis, and Management of Stroke

Summary

Stroke is an episode of sudden neurological dysfunction caused by focal ischemia of the central nervous system leading to cell death. Transient ischemic attack (TIA) is a transient episode of neurological dysfunction, without acute infarction. Stroke is a leading cause of long-term disability and the fifth leading cause of death in the United States. Advancing age remains a leading nonmodifiable risk factor for stroke. Targeting modifiable risk factors is critical to preventing recurrent strokes. This includes screening for diabetes, initiating statin therapy, and identifying and treating atrial fibrillation and hypertension. Aspirin remains the preferred antiplatelet drug for secondary prevention of ischemic stroke (in the absence of an indication for anticoagulation); however, patients with minor stroke or TIA should be treated for at least 21–30 days with both aspirin and clopidogrel. The management of acute ischemic stroke centers around thrombolytic treatment and mechanical thrombectomy, to maximize cerebral perfusion to the ischemic brain tissue. This must be balanced against the risks for hemorrhagic complications. Common poststroke complications include venous thromboembolic disease, dysphagia, and depression. All members of the health-care team and physicians should communicate openly and frequently with patients, their families, and/or their caregivers to ensure that their goals of care are met.