What is the approach to acute management of stroke?

Updated: Sep 08, 2017
  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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Serial monitoring and interventions when necessary early in the clinical course and eventual stroke rehabilitation and physical and occupational therapy are the ideals of management. (See Table 2, below.)

In patients with transient ischemic attacks (TIAs), failure to recognize the potential for near- term stroke, failure to perform a timely assessment for stroke risk factors, and failure to initiate primary and secondary stroke prevention exposes the patient to undue risk of stroke and exposes clinicians to potential litigation. TIAs confer a 10% risk of stroke within 30 days, and one half of the strokes occurring after a TIA, occurred within 48 hours. [3]

Table 2. General Management of Patients With Acute Stroke [1, 4] (Open Table in a new window)

Blood glucose

Treat hypoglycemia with D50

Treat hyperglycemia with insulin if serum glucose >200 mg/dL

Blood pressure

See recommendations for thrombolysis candidates and noncandidates (Table 3)

Cardiac monitor

Continuous monitoring for ischemic changes or atrial fibrillation

Intravenous fluids

Avoid D5W and excessive fluid administration

IV isotonic sodium chloride solution at 50 mL/h unless otherwise indicated

Oral intake

NPO initially; aspiration risk is great, avoid oral intake until swallowing assessed


Supplement if indicated (Sa02< 94%)


Avoid hyperthermia; use oral or rectal acetaminophen and cooling blankets as needed

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