Overview of Acute Ischemic Stroke Evaluation and Management

Abstract

Stroke is a major contributor to death and disability worldwide. Prior to modern therapy, post-stroke mortality was approximately 10% in the acute period, with nearly one-half of the patients developing moderate-to-severe disability. The most fundamental aspect of acute stroke management is “time is brain”. In acute ischemic stroke, the primary therapeutic goal of reperfusion therapy, including intravenous recombinant tissue plasminogen activator (IV TPA) and/or endovascular thrombectomy, is the rapid restoration of cerebral blood flow to the salvageable ischemic brain tissue at risk for cerebral infarction. Several landmark endovascular thrombectomy trials were found to be of benefit in select patients with acute stroke caused by occlusion of the proximal anterior circulation, which has led to a paradigm shift in the management of acute ischemic strokes. In this modern era of acute stroke care, more patients will survive with varying degrees of disability post-stroke. A comprehensive stroke rehabilitation program is critical to optimize post-stroke outcomes. Understanding the natural history of stroke recovery, and adapting a multidisciplinary approach, will lead to improved chances for successful rehabilitation. In this article, we provide an overview on the evaluation and the current advances in the management of acute ischemic stroke, starting in the prehospital setting and in the emergency department, followed by post-acute stroke hospital management and rehabilitation.

Sex Differences in Functional Outcomes Following Endovascular Treatment for Acute Ischemic Stroke

“…21,22 It is worth noting that subjects with posterior circulation occlusions were excluded from most of the early EVT trials, and that our study found that posterior circulation occlusions were significantly more common in males, a finding that has previously been reported. 39 This poses the question of whether sex differences in post-EVT outcomes should be compared for studies carried out before and after completion of the landmark EVT trials, either in studies using pooled data traversing this period, such as meta-analyses.…”

Effect of ginkgolide K on calcium channel activity in Alzheimer's disease

“…Alzheimer's disease (AD) is one of the most common neurodegenerative diseases, with an estimated global prevalence of 6.2 million ( 1 ). AD has multiple clinical symptoms, including memory loss, confusion regarding time or place, decline in the ability to make decisions and judgments, aphasia, apraxia and agnosia, in addition to other symptoms, including fatigue, sleep disturbance, anxiety, depression and gastrointestinal dysfunction.…”

Clinical role of serum histone deacetylase 4 measurement in acute ischemic stroke: Relation to disease risk, severity, and prognosis

“…Acute ischemic stroke (AIS) is viewed as one of main causes of neurologic death worldwide. 1 , 2 In China, stroke is the third highest cause of death with mortality of approximately 1.5 million in 2018, 3 which AIS may result in permanent disability, both functionally and cognitively; meanwhile, the morbidity of AIS is continuous increasing, which causes a huge economical and humanistic burden. 4 , 5 Over the decades, great advances have made in the strategies for AIS management such as neuroprotective treatment, intravenous thrombolysis, and anticoagulation treatment, while AIS patients still suffer from elevating recurrence and increasing mortality.…”

“…Acute ischemic stroke (AIS) is viewed as one of main causes of neurologic death worldwide 1,2 . In China, stroke is the third highest cause of death with mortality of approximately 1.5 million in 2018, 3 which AIS may result in permanent disability, both functionally and cognitively; meanwhile, the morbidity of AIS is continuous increasing, which causes a huge economical and humanistic burden 4,5 .…”

“…(1) elevated HDAC4 could inhibit the disease severity and progression of AIS through suppressing inflammation and restraining the development of atherosclerosis (above-mentioned), which led to better RFS;(2) the events of mortality was relatively low in the current study, thus it might be difficult to observe statistical significance in the correlation between HDAC4 and OS.There were several limitations in the current study: (1) we did not have a tailed protocol for current study to conduct a regular and stable follow-up, and the follow-up in our study was based on routine schedule and the intention of patients, which might result in high number of patients who lost follow-up; hence, the patients who lost follow-up were treated as censored data (2) the role of HDAC4 in regulatory mechanism of AIS could be explored; (3) the enrolled patients were first-episode AIS patients, hence the clinical role of HDAC4 in recurrent AIS could be further explored; (4) HDAC4 participated in stroke-induced angiogenesis, which was a protective process after stroke14 ; thus, the correlation of HDAC4 with markers of angiogenesis, such as VEGF, HIF-1 alpha could be explored in the further study; (5) a huge number of patients lost follow-up in the current study; (6) lacking of transcriptive level of HDAC4 detection in the present study.…”