New Approaches to Bedside Monitoring in Stroke

Alma Cyrous; Brandon O'Neal; W David Freeman


Expert Rev Neurother. 2012;12(8):915-928. 

In This Article

Abstract and Introduction


Stroke is a common, potentially devastating disease with potential high morbidity and mortality. Recognition at the onset of acute ischemic stroke is pivotal to changing outcomes such as intravenous thrombolysis. Stroke monitoring is a burgeoning field with various methods described and newer devices that aid in detecting acute or worsening ischemia that can lead to improved bedside and intensive care unit management. This article describes various methods of bedside stroke monitoring including newer techniques of intracranial pressure monitoring using the pressure reactivity index and compensatory reserve index to detect changes in autoregulatory states, noninvasive intracranial pressure monitoring, quantitative EEG with alpha–delta ratio, transcranial Doppler, methods of arteriovenous brain oxygen monitoring such as jugular venous oxygen and near-infrared spectroscopy, invasive brain oxygen probes such as LicoxTM (brain tissue O2), cerebral blood flow probe (CBF HemedexTM) and cerebral microdialysis.


Stroke is a major cause of death and disability worldwide, and the third or fourth most common cause of death in the USA.[1] Therefore, stroke is an extremely common and potentially devastating disease. Acute recognition is critical to timely therapeutic intervention, which has evolved over time due to research including intravenous recombinant tissue plasminogen activator for ischemic stroke.[2] However, the management of the stroke patient after the initial few hours and over the next few days – including blood pressure management, development of raised intracranial pressure (ICP) and management of seizures, fever and medical complications – are critical to patient outcomes.[3] The evolution of bedside intensive care unit (ICU) techniques to monitor unstable brain tissue has developed in parallel to the ongoing research in acute stroke therapeutics.[4] For example, the avoidance of hypoglycemia or hypotension after acute ischemic stroke might improve patient outcomes.[5] However, after acute stroke, long-term hypertension control is important to preventing secondary stroke.[6,7] Prevention and treatment of fever after stroke can also potentially improve outcome.[5] This article briefly describes standard ICU bedside stroke monitoring techniques and expands upon them with newer ICU stroke monitoring techniques.