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Updates of the diagnosis and treatment of ischemic stroke are given. The diagnosis of ischemic stroke is stated to be based on the risk factors of its development, the rapid progression of focal neurological deficits (neurovascular syndrome) and brain computed or magnetic resonance imaging. Arterial studies of the brain (ultrasound studies, angiography) and heart (EchoCG, and others), and blood analyses are performed to establish the causes of stroke. Treatment for ischemic stroke is noted to be most effective in a specialized unit, which substantially reduces mortality and disability. The intravenous injection of tissue plasminogen activator is stated to be the method of choice in treating ischemic stroke in the first 3-4,5 hours after its development. The value of anticoagulants, antithrombocytic, neuroprotective, and other drugs and the monitoring of blood glucose, blood pressure, and other vital functions are also of importance. The important role of early activation of a patient and his/her rehabilitation is noted.

About the Author

V. A. Parfenov
I.M. Sechenov Moscow Medical Academy
Russian Federation


1. <div><p>Гусев Е.И., Скворцова В.И. Ишемия головного мозга. М., 2001; 328 с.</p><p>Дамулин И.В., Парфенов В.А., Скоромец А.А. и др. Нарушения кровообращения в головном и спинном мозге. В кн.: Болезни нервной системы. Руководство для врачей. Под ред. Н.Н. Яхно. М.: Медицина, 2005;(1):232-303.</p><p>Инсульт: диагностика, лечение и профилактика. Под ред. З.А. Суслиной, М.А. Пирадова. М.: МЕДпресс-информ, 2008; 288 с.</p><p>Фейгин В., Виберс Д., Браун Р. Инсульт: Клиническое руководство. М.: Бином; СПб.: Диалект, 2005; 608 с.</p><p>Шевченко О.П., Праскурничий Е.А., Яхно Н.Н. и др. Артериальная гипертония и церебральный инсульт. М., 2001; 192 с.</p><p>Adams H. P. , del Zoppo G. Alberts M. J. Guidelines for the Early Management of Adults With Ischemic Stroke. Stroke 2007;38:1655-711.</p><p>European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 2008;25:457-507.</p><p>Chalela J., Kidwell C., Nentwich L. et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 2007;369:293-8.</p><p>Wardlaw J., West T. , Sandercock P. et al. The International Stroke Trials Collaborative Group: Visible infarction on computed tomography is an independent predictor of poor functional outcome after stroke, and not of haemorrhagic transformation. JNNP 2003;74:452-8.</p><p>Hand P. , Kwan J., Lindley R. et al. Distinguishing between stroke and mimic at the bedside: The Brain Attack Study. Stroke 2006;37:769-75.</p><p>Hacke W., Kaste M., Bluhmki E. et al. Trombolysis with alteplase 3 to 4,5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317-29.</p><p>The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581-7.</p><p>The Multicenter Acute Stroke TrialРEurope Study Group. Thrombolytic therapy with streptokinase in acute ischemic stroke. N Engl J Med 1996;335:145-50.</p><p>Hennerici M.G., Kay R., Bogousslavsky J. et al. Intravenous ancrod for acute ischaemic stroke in the European Stroke Treatment with Ancrod Trial: a randomised controlled trial. Lancet 2006;368:1871-8.</p><p>Haley E.C.Jr, Lyden P.D., Johnston K.C. et al. TNK in Stroke Investigators. A pilot dose-escalation safety study of tenecteplase in acute ischemic stroke. Stroke. 2005;36:607-12.</p><p>Furlan A., Higashida R., Wechsler L. et al. Intra-arterial prourokinase for acute ischemic stroke: the PROACT II study: a randomized controlled trial: Prolyse in Acute Cerebral Thromboembolism. JAMA 1999;282:2003-11.</p><p>Macleod M.R., Davis S.M., Mitchell P.J. et al. Results of a multicentre, randomised controlled trial of intra-arterial urokinase in the treatment of acute posterior circulation ischaemic stroke. Cerebrovasc Dis 2005;20:12-7.</p><p>Alexandrov A.V., Molina C.A., Grotta J.C. et al. CLOTBUST Investigators. Ultrasoundenhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med 2004;351:2170-8.</p><p>Qureshi A.I., Kirmani J.F., Sayed M.A. et al. Buffalo Metropolitan Area and Erie County Stroke Study Group. Time to hospital arrival, use of thrombolytics, and in-hospital outcomes in ischemic stroke. Neurology 2005;64:2115-20.</p><p>International Stroke Trial Collaborative Group. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet 1997;349:1569-81.</p><p>Roden-Jullig A., Britton M. Effectiveness of heparin treatment for progressing ischaemic stroke: before and after study. J Intern Med 2000;248:287-91.</p><p>Camerlingo M., Salvi P. , Belloni G. et al. Intravenous heparin started within the first 3 hours after onset of symptoms as a treatment for acute nonlacunar hemispheric cerebral infarctions. Stroke 2005;36:2415-20.</p><p>CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet 1997;349:1641-9.</p><p>Robertson S.C., Lennarson P. , Hasan D.M. et al. Clinical course and surgical management of massive cerebral infarction. Neurosurgery 2004;55:55-61.</p><p>Aichner F.T., Fazekas F. , Brainin M. et al. Hypervolemic hemodilution in acute ischemic stroke: the Multicenter Austrian Hemodilution Stroke Trial (MAHST). Stroke 1998;29:743-9.</p><p>Horn J., Limburg M. Calcium antagonists for acute ischemic stroke. Cochrane Database Syst Rev 2000;(2):CD001928.</p><p>Wahlgren N.G., MacMahon D.G., DeKeyser J. et al. Intravenous Nimodipine West European Stroke Trial (INWEST) of nimodipine in the treatment of acute ischaemic stroke. Cerebrovasc Dis 1994;4:204-10.</p><p>De Deyn P.P., Reuck J.D., Deberdt W. et al. Members of the Piracetam in Acute Stroke Study (PASS) Group. Treatment of acute ischemic stroke with piracetam. Stroke 1997;28:2347-52.</p><p>Muir K.W., Lees K.R. Excitatory amino acid antagonists for acute stroke. Cochrane Database Syst Rev 2003;(3):CD001244.</p><p>Lees K.R., Zivin J.A., Ashwood T. et al. Stroke-Acute Ischemic NXY Treatment (SAINT I) Trial Investigators. NXY-059 for acute ischemic stroke. N Engl J Med 2006;354:588-600.</p><p>Shuaib A., Lees K.R., Lyden P. et al. NXY-059 for the treatment of acute ischemic stroke. N Engl J Med. 2007;357:562-71.</p><p>Lampl Y., Gilad R., Geva D. et al. Intravenous administration of magnesium sulfate in acute stroke: a randomized double-blind study. Clin Neuropharmacol 2001;24:11-5.</p><p>Muir K.W., Lees K.R., Ford I. et al. Intravenous Magnesium Efficacy in Stroke (IMAGES) Study Investigators. Magnesium for acute stroke (Intravenous Magnesium Efficacy in Stroke trial): randomised controlled trial. Lancet 2004;363:439-45.</p><p>Aslanyan S., Weir C. J., Muir K. W. et al. Magnesium for Treatment of Acute Lacunar Stroke Syndromes. Stroke 2007;38:1269-73.</p><p>Tazaki Y., Sakai F. , Otomo E. et al. Treatment of acute cerebral infarction with a choline precursor in a multicenter double-blind placebo-controlled study. Stroke 1988;19:211-6.</p><p>Clark W.M., Warach S.J, Pettigrew L.C. et al. A randomized dose-response trial of citicoline in acute ischemic stroke patients. Citicoline Stroke Study Group. Neurology 1997;49:671-8.</p><p>Clark W.M., Williams B.J., Selzer K.A. et al. A randomized efficacy trial of citicoline in patients with acute ischemic stroke. Stroke 1999;30:2592-7.</p><p>Clark W.M., Wechsler L.R., Sabounjian L.A. et al. Citicoline Stroke Study Group. A phase III randomized efficacy trial of 2000 mg citicoline in acute ischemic stroke patients. Neurology 2001;57:1595-602.</p><p>Warach S., Pettigrew L.C., Dashe J.F. et al. Effect of citicoline on ischemic lesions as measured by diffusion-weighted magnetic resonance imaging. Ann Neurol 2000,48:713-22.</p><p>Davalos A., Castillo J., Alvarez-Sabin J. et al. Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials. Stroke 2002;33:2850-7.</p><p>Saver J.L., Kidwell C., Eckstein M. et al. FAST-MAG Pilot Trial Investigators. Prehospital neuroprotective therapy for acute stroke: results of the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) pilot trial. Stroke 2004;35:106-8.</p><p>Gray C.S., Hildreth A.J., Alberti G.K. et al. GIST Collaboration. Poststroke hyperglycemia: natural history and immediate management. Stroke 2004;35:122-6.</p><p>Sandercock P.A., van den Belt A.G., Lindley R.I. et al. Antithrombotic therapy in acute ischaemic stroke: an overview of the completed randomised trials. J Neurol Neurosurg Psychiatry 1993;56:17-25.</p><p>Diserens K., Michel P. , Bogousslavsky J. Early mobilisation after stroke: review of the literature. Cerebrovasc Dis 2006;22:183-90.</p><p>Rudd A.G., Hoffman A., Irwin P. et al. Stroke unit care and outcome: results from the 2001 National Sentinel Audit of Stroke (England, Wales, and Northern Ireland). Stroke 2005;36:103-6.</p><p>Gilligan A.K., Thrift A.G., Sturm J.W. et al. Stroke units, tissue plasminogen activator, aspirin and neuroprotection: which stroke intervention could provide the greatest community benefit? Cerebrovasc Dis 2005;20:239-44.</p></div><br />


For citations:

Parfenov V.A. THE ACUTE PERIOD OF ISCHEMIC STROKE: DIAGNOSIS AND TREATMENT. Neurology, Neuropsychiatry, Psychosomatics. 2009;1(1):5-12.

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