Acute Ischemic Stroke

The primary focus for the initial treatment of acute ischemic stroke is determining whether a patient who presents with acute neurological deficits is a candidate for intravenous (IV) thrombolytic therapy. Within the last two decades, the use of IV alteplase (tPA) for acute ischemic stroke together with the establishment of stroke systems of care has changed the treatment “landscape” for both acute and recovery stroke care. Certified stroke centers are organizations recognized for the implementation of protocols that address the triaging and assessment of potential stroke patients quickly and that deliver selected treatments in a timely manner. At the forefront is the acute stroke team. Neurologists and non-neurologists including emergency department physicians, internists, and advanced practice clinicians comprise the modern-day providers (or LIPs – licensed independent practitioners) on the stroke team. All members of the team must understand the variable spectrum of acute stroke presentations, the critical elements of the neurological examination, the basis for imaging, the indications for treatment, and the need for specific order sets that outline subsequent inpatient care including post-lytic assessments. This chapter focuses on a review of the pathophysiology of acute ischemic stroke, the critical thinking algorithms that direct acute stroke care during the “golden hour” after presentation, and the role of the advanced practice clinician during the hyperacute, acute, and posttreatment recovery care process.