Acute management of stroke

In this article the diagnosis, investigation and early management of stroke are discussed. Confirmation of the diagnosis of stroke can be difficult. The neurological deficit should be recorded in detail at admission. Head CT or brain MRI should be obtained in all patients within 24-48 hours of admission. Blood pressure reduction is of benefit in the secondary prevention of stroke. Monitoring and correction of physiological parameters may be partially responsible for the improved outcomes observed with acute stroke units. Ischaemic tissue is salvageable in the hyperacute phase of stroke by thrombolysis. Pneumonia is one of the most important early complications. Early rehabilitation aims include early mobilisation and appropriate management of dysphagia and communication problems. For a more detailed overview of current recommendations the European Stroke Initiative recommendations for stroke management may be consulted.