Part of the book: Acute Ischemic Stroke
Stroke, a disease of millions, and a financial burden for many more is still challenging health sciences, as we greatly increase our efforts to better understand stroke pathogenesis, early diagnose, prevent and treat high risk and major risk factors we still need to update our clinical and surgical skills in treating stroke event and its aftermath. Use of applied anatomical and physiological knowledge should apply the same everywhere, and based on these standard principles we should be able to predict the early course of stroke neuropathology and its potential consequences. Updated new guidelines of recombinant tissue plasminogen activator (r-tPA) indications should help in early intervention when correct diagnosis is promptly made, but as the list of contraindications as well has changed staff neuroscientists should consider all possible medical and or surgical options for treatment. With prompt actions to try to reinstate perfusion we should always try to do so within the first 4 h, and having a maximal additional 2 h in reserve to consider surgical therapeutic options (should the clinic/unit’s infrastructure allow it). Treatment modalities, therapeutic/endovascular and or surgical (embolectomy, bypass, decompression) are the alternatives among which we should wisely chose to treat our patients based on the best medical practice not in the skills of the individuals performing each or either procedure. It is of critical importance to know when surgery should be performed, how to calculate craniotomy size, what are the intra-, extra-cranial surgical landmarks and when should we put the bone back in cases of decompression. We should be able to correctly predict at what extent volume and intracranial pressure values will change by the size of decompressive craniectomy and its effect on the patient’s prognosis. Clinic is the best indicator for timing of surgical decompression as it is the sole determinant of any other treatment option, and what high risk and major risk factors are present (if any) at the time of diagnosis will predict the clinical outcome of the patient, but not the age (which should not be the limit).
Part of the book: Ischemic Stroke