Management of acute stroke

Lancet Neurol. 2002 May;1(1):41-50. doi: 10.1016/s1474-4422(02)00005-4.


Acute stroke is a medical emergency. The outcome is influenced by the rapidity and quality of initial care, which is best delivered by specialists with appropriate facilities, including 24 h access to computed tomography. Stroke management requires attention to simple details and has been summarised in clinical guidelines. General measures include control of blood glucose concentration, temperature, fluid balance, and oxygenation. Blood-pressure management is a matter for continuing research. Aspirin should be started early in ischaemic stroke, but heparin has doubtful value; antiembolism stockings may be preferable. Thrombolysis has a substantial benefit in selected circumstances, and trials continue to examine a wider role. Neuroprotection remains experimental, though magnesium is potentially of interest. Early neurosurgery has a role limited to decompression of lesions in the posterior fossa but is under trial for large hemispheric infarcts and moderate intracerebral bleeds.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Clinical Trials as Topic / statistics & numerical data
  • Disease Management*
  • Humans
  • Stroke / drug therapy
  • Stroke / mortality
  • Stroke / therapy*
  • Thrombolytic Therapy / methods
  • Thrombolytic Therapy / statistics & numerical data